DM

Question 1

What fasting glucose definition of DM?

Answer 1

Fasting glucose >7

Question 2

What are presenting features of DM?

Answer 2

• Thirst
• Polyuria
• Weight loss & fatigue
• Hunger
• Pruritus and balantis (candidiasis)
• Blurred vision (altered acuity due to uptake of glucose/water into lens)

Question 3

Which HLA is T1DM associated with>

Answer 3

HLA DR 3 and 4

Question 4

What causes T1DM/

Answer 4

Autoimmune destruction of B pancreatic cells

Question 5

What do urinary ketones indicate?

Answer 5

Insulin at any age

T1

Question 6

What causes T2DM?

Answer 6

Decreased secretion of and increased resistance to insuline

Question 7

How can you tell prognosis in T2DM?

Answer 7

Impaired FG

Impaired GTT

Question 8

What are other causes of Diabetes?

Answer 8

Steroids
Thiazides
Pancreatitis
Trauma
Cushings
CF
Acromegaly
Hyperthyroidism
Pregnancy

Question 9

Explain the disease process behind DKA

Answer 9

Hyperglycaemia causing ketones which escape into urine and osmotic diuresis= fall in blood volume.
Ketones also cause anorexia and vomit
Therefore dehydration and vomit and hyperglycaemia leading to acidosis > CV collapse > death

Question 10

What are the 3 main things in DKA?

Answer 10

Hyperglycaemia
Ketones
Acidosis

Question 11

What causes DKA?

Answer 11

Illness
Medication errors
New diagnosis

Question 12

What are clinical features of DKA?

Answer 12

Polyuria and polydipsia
Nausea and vomit
Weight loss
Weakness
Abdominal pain
Drowsiness/confusion
Hyperventilation
Dehydration
Hypotension
Tachycardia
Coma
Kussmaul's Resps

Question 13

What happens to K+ in DKA?

Answer 13

Initially high then falls fast with vomiting

Question 14

How is DKA managed?

Answer 14

Rehydrate (3L in 3 hours)
Insulin
Replace K+
Treat cause

Question 15

What are complications of DKA?

Answer 15

Cerebral oedema
ARDS
Thromboembolism
Aspiration
Pneumonia
Death

Question 16

What is management of T1DM?

Answer 16

Insulin

Usually BD short/med acting and a basal bolus after meals

Question 17

What are symptoms of diabetic retinopathy?

Answer 17

Ischemia and occlusion . proliferation- laser therapy only treatment- risk of tunnel vision, loss of night vision

Question 18

How do you manage stroke risk in diabetes?

Answer 18

Aspirin

Question 19

How is peripheral neuropathy in diabetes managed?

Answer 19

Tricyclics
SSRIs
Gabapentin
Opioids
Lignocaine

Question 20

What are symptoms of autonomic neuropathy in DM?

Answer 20

Postural hypotension
Arrhythmia (silent MI)
Urine retention
Erectile dysfunction
Gastroparesis- constipation, diarrhoea

Question 21

What are symptoms of diabetic nephropathy?

Answer 21

Proteinuria (hallmark sign)

Main cause of ESRF

Question 22

How is DM nephropathy managed?

Answer 22

BP control- ACEi/ARB and spironolactone
Glycaemic control
Cholesterol control (statin)

Question 23

How is T2DM managed without medication?

Answer 23

Lifestyle advice- diet, weight loss

excercise, BP target 140/90

Question 24

What are HbA1C treatment thresholds?

Answer 24

42-48- lifestyle advice
48+ metformin
58+ metformin plus another
Resistant at 58+ add third

Question 25

How often should you check HbA1c?

Answer 25

3-6 montly until stable then 6 monthly

Question 26

What are risks of T2DM drugs?

Answer 26

Weight gain

Hypos risk

Question 27

What is main side effect of metformin>

Answer 27

GI upset

Question 28

Name a sulfonurea?

Answer 28

Glicazide

Question 29

Name a Gliptin

Answer 29

Vildagliptin

Question 30

What are 4 classes of T2DM drugs>

Answer 30

Sulfonureas
Gliptins
Pioglitazone
SGLT2 inhibitors