Endocrine

Question 1

How to diagnose T2DM?

Answer 1

• FPG >7.0 mmol/L or
• A1C>6.5% (adults)
  *if either in 6 range it = pre diabetes

Others:
- 2hPG in a 75g OGTT >11.1mmol/L or
- Random PG >11.1 mmol/L

*if 2 tests are in diabetic range = diabetes confirmed
*if asymptomatic, repeat test on another day
*if only one test is in diabetic range, rpt only that test
*if symptoms present, diabetes can be confirmed with one test (typically fasting BG, but A1C is a better picture)

Question 2

Who to screen for T2DM?

Answer 2

• Screen everyone >40 years old every 3 years
• if found to be pre-diabetic, screen more often than q3years
• If <40 years assess for risk factors annually
• If risk factors present screen every 6-12m

Question 3

What are some risk factors for T2DM?

Answer 3

• Fam hx of T2DM (1st degree relative)
• Non-white, low socioeconomic status
• Hx GDM, pre-diabetes
• Hx delivery of microbic infant
• CV risk factors
• Presence of end organ damage typically associated with diabetes

Question 4

What are the microvascular complications of diabetes?

Answer 4

• Retinopathy: microaneurysms, cotton wool spots, angiogenesis
• Nephropathy: Albumin Creatinine Ratio (ACR) > 2.0mg/mmol &/or eGFR <60mL/min
• Neuropathy: Monofilament or tuning fork test

Question 5

What are the macrovascular complications of diabetes?

Answer 5

• Cardiovascular (MI, CVD): Lipids – Framingham risk score
• Cerebrovascular (CVA, TIA)
• Peripheral Vascular (PAD)

Question 6

What is the monofilament test?
What score is considered positive?

Answer 6

Rapid screening for neuropathy using the 10g monofilament

3/8 = neuropathy likely
3.5/8 = not yet but likely to develop in next 4 yrs
5.5/8 = not yet and low risk of developing in next 4 yrs

Question 7

When to Refer to specialty services for diabetics?

Answer 7

• Ophthalmology/Optometry: at diagnosis
• Podiatry: at diagnosis
• Neurology: atypical presentation/uncontrolled pain
• Nephrology: sustained ACR <60 &/or eGFR <30, chronic progressive loss of kidney function, difficult to control BP
• Cardiology: abnormal ECG, intermittent chest pain

Question 8

What are you screening at EVERY Primary Care visit for a diabetic?

Answer 8

• BP (should be <130/80)
• Assess self-care, hypoglycaemia, smoking and nutrition
• Foot check (ask them if they are checking their feet)

Question 9

What is the annual screening for diabetics?

Answer 9

• Random urine ACR and serum creatinine for eGFR
• Optometrist/Ophthalmologist
• Full foot exam (60 sec foot screen)
• Lipids (with ECG q2years)
• Flu shot/vaccination review
• Home glucometer calibration (they bring in their home glucometer and you check it with the office glucometer)

Question 10

How often is the A1C checked?

Answer 10

Every 3-6 months

Question 11

Side effects of hyperthyroidism

Answer 11

Everything is slowed down:
- cold
- dec weight
- amenorrhea
- exopthalmos
-

Question 12

What are the Rotterdam diagnostic criteria for PCOS?

Answer 12

Must have at least 2 of 3 present:
- Hyperandrogenism (hirsutism, acne)
- Anovulation (no periods or unpredictable periods)
- Polycystic ovaries on U/S

Question 13

What labs would you order is suspecting PCOS?

Answer 13

testosterone, prolactin, FSH, LH, FBG, lipids, beta-hcg