Diabetic Foot

Question 0

Metabolic syndrome - risk factors

Answer 0

1. FHx of T2DM
2. Prior gestational DM or fetal macrosomia
3. Obesity - BMI>30, increased waist to hip ratio, increased waist circumference (men > 40, female > 35)

Question 1

Hyperinsulinaemia

Answer 1

Diminished insulin response
1. Fewer insulin receptors on cells
2. Less glucose transporters in cell
Predisposes to CVD

Question 2

Metabolic syndrome - diagnosis

Answer 2

3 or more of:

1. Low HDL
2. HTN > 130/85
3. Hyperlipidaemia
4. Abdominal obesity
5. Raised fasting glucose

Question 3

Metabolic syndrome - investigations

Answer 3

1. Fasting glucose, HbA1c

2. Lipid profile - serum triglycerides, cholesterol

Question 4

Metabolic syndrome - management

Answer 4

1. Exercise, change diet, reduce weight
2. Cardiac risk assessment - aspirin, statins, HTN management
3. Glucose control - metformin

Question 5

T1DM - presentation

Answer 5

1. Polyuria/nocturia
2. Polydipsia
3. Unexplained Weight loss

Question 6

T1DM - dx

Answer 6

1. HbA1c
2. Serum glucose
   ABPI not useful in DM because stiff vessels
   Angiogram also not good because contrast damages kidneys

Question 7

T1DM - management (positive urine ketones)

Answer 7

1. Evaluate for DKA

Question 8

T1DM - management (urine ketones negative)

Answer 8

1. Hydration
2. Insulin
3. Metformin if normal renal function
4. Lantus
5. Teach glucose testing
   Manage comorbidities
6. Aspirin/clopidogrel
7. ACEi (diabetic nephropathy)

Question 9

DM - complications

Answer 9

1. Diabetic retinopathy - microaneurysm, macular oedema, haemorrhages
2. Diabetic nephropathy - CKD, microalbuminuria, renal USS, ACEi/CCB and thiazide diuretic
3. Diabetic neuropathy - amitriptyline (antidepressant), gabapentin/carbamazepine (anticonvulsant), SSRI, analgesia (NOT NSAID)