DM Clinical Presentations W1

Question 1

Common symptoms for both type one and type two diabetes

Answer 1

Polyuria
Polydipsia
Weight loss
Fatigue
Blood vision

Question 2

Polyuria

Answer 2

Characterised by excessive urine production typically exceeding 3 L a day in adults

Question 3

Polydipsia

Answer 3

Often categorise by excessive thirst and increased fluid intake and commonly linked to polyuria

Question 4

Weight loss

Answer 4

Due to fluid depletion and an increased breakdown of fat and muscle

Question 5

Fatigue

Answer 5

Due to the bodies inability to get glucose from blood into cells to me energy needs

Question 6

Blurred vision

Answer 6

Due to glucose induced changes in refraction

Question 7

Clinical manifestations of type one diabetes - diabetic ketoacidosis

Answer 7

DKA

Can be the first presentation if diagnosis is not made from common symptoms such as polyuria

Or can be from an interruption of insulin supply in a diagnosed type one diabetic

Or can be from intercurrent illnesses in a diagnosed type one diabetic ie infection or diarrhoea

Question 8

Symptoms of DKA

Answer 8

Hyperventilation, nausea and vomiting, dehydration, weakness, ketone breath, reduced consciousness

• Increase blood glucose (20 to 45mmol/l) leading to osmotic diocese and dehydration leading to lower blood pressure
• Increased ketone bodies which produce metabolism acidosis which is a hunger and keto breath which is hyperventilating and a sweet smell
• Hyperosmolarity, which is a measure of fluid status
• Potassium loss
• Muscle catabolism and generalised weakness

Question 9

Clinical manifestations of type two diabetes

Answer 9

Often have an insidious onset with a few or none of the classical symptoms of diabetes and is typical an obese

May only be detected as part of routine investigation

Can include chronic skin infections and UTI as well as pruritis and candida infection of vagina and undiagnosed women

Can often present first as the complications, i.e. Retinopathy, neuropathy, foot ulcer, nephropathy

Question 10

Can you manifestations of type two diabetes - hyperglycaemic hyperosmolar nonketotic syndrome

Answer 10

HHNS

Similar to DKA in type one diabetics but no significant ketosis and no acidosis due to endogenous insulin levels being sufficient to inhibit hepatic ketogenesis but HHNS still occurs

Has the same symptoms as DKA except no ketone breath/air hunger

Question 11

Normal blood glucose without diabetes

Answer 11

3.4-5.8mmol/l

This is not the target level when treating diabetes

Question 12

WHO diagnostic criteria with symptoms - random Venus plasma glucose?

Answer 12

More than or equal to 11.1mmol/L

Question 13

WHO diagnostic criteria with symptoms - fasting Venus plasma glucose?

Answer 13

More than or equal to 7.0mmol/L

Question 14

WHO diagnostic criteria with symptoms - plasma glucose two hours after 75 g of anhydrous glucose in a oral glucose tolerance test?

Answer 14

More than or equal to 11.1mmol/L

Question 15

WHO diagnostic criteria without symptoms

Answer 15

Two separate measurements of either random (11.1mmol/L) or fasting (>7.0mmol/L)from two hours post GTT

These don’t rely on a single test must take the test twice

Question 16

Glycated/glycosylated haemoglobin (HbA1c)

Answer 16

Used as part of diagnosis of diabetes in type two as well as monitoring for both types

> 48mmol/L (6.5%) with symptoms = diagnosis of type two

If no symptoms, then repeat the HbA1c after two weeks to confirm

Question 17

Other diagnosis and investigations

Answer 17

Blood pressure
Urine analysis
Renal function
Liver function
Lipids