Endocrine

Question 1

What are the types of Diabetes Insipidus

Answer 1

1. Pituitary (cranial)
   caused by insufficient levels of ADH
2. Nephrogenic
   caused by kidney defects

Question 2

What is Diabetes Mellitus?

Answer 2

a group of metabolic disorders in which persistent hyperglycaemia is caused by deficient insulin secretion or by resistance to the action of insulin

Question 3

What are the types of Diabetes Mellitus

Answer 3

Type 1 diabetes and Type 2 diabetes. Other common types of diabetes are gestational diabetes (develops during pregnancy and resolves after delivery) and secondary diabetes (may be caused by pancreatic damage, hepatic cirrhosis, or endocrine disease)

Question 4

What do diabetics have to notify DVLA of?

Answer 4

• Their condition depending on their treatment
• the type of licence they hold.
• Whether they have diabetic complications (including episodes of hypoglycaemia)
• All drivers who are treated with insulin must inform the DVLA, with some exceptions for temporary treatment.

Question 5

What have diabetic drivers been advised by DVLA (1)

Answer 5

1. Be particularly careful to avoid hypoglycaemia.
2. Should be informed of the warning signs and actions to take.
   3.Drivers treated with insulin should always carry a capillary blood-glucose meter and test strips when driving, even if they use a continuous glucose monitoring (CGM) system

Question 6

What have diabetic drivers been advised by DVLA (2)

Answer 6

1.Blood-glucose concentration should be checked no more than 2 hours before driving and every 2 hours while driving.
2.Blood-glucose concentration should be at least 5 mmol/litre while driving. If blood-glucose is 5 mmol/litre or below, a snack should be taken

Question 7

What have diabetic drivers been advised by DVLA (3)

Answer 7

1. Drivers treated with insulin should ensure that a supply of fast-acting carbohydrate is always available in the vehicle.

Question 8

What blood glucose levels is not safe for driving.

Answer 8

If blood-glucose is less than 4 mmol/litre, or warning signs of hypoglycaemia develop, the driver should not drive.

Question 9

What should diabetics do if driving and they experience hypoglycaemia.

Answer 9

1. Stop the vehicle in a safe place as soon as possible,
2. Turn off the engine, remove the keys from the ignition,
3. Move from the driver’s seat;
4. Drivers should wait until 45 minutes after their blood-glucose has returned to normal (at least 5 mmol/litre), before continuing their journey.

Question 10

What other medications may need notification to the DVLA.

Answer 10

Sulfonylureas and Meglitinides (Oral antidiabetics that carry risk of hypoglycaemia.)

Question 11

How can alcohol influence hypoglycaemia?

Answer 11

Alcohol can make the signs of hypoglycaemia less clear, and can cause delayed hypoglycaemia

Question 12

What are oral glucose tolerance tests.

Answer 12

• The oral glucose tolerance test is used mainly for diagnosis of impaired glucose tolerance
• it is not recommended or necessary for routine diagnostic use when severe symptoms of hyperglycaemia are present

Question 13

What do oral glucose tolerance test involve

Answer 13

Measuring the blood-glucose concentration after fasting, and then 2 hours after drinking a standard anhydrous glucose drink. E.g. Polycal®

Question 14

What is the Hba1c measurement.

Answer 14

Glycated haemoglobin (HbA1c) forms when red blood cells are exposed to glucose in the plasma

Question 15

Why is HbA1c useful?

Answer 15

The HbA1c test reflects average plasma glucose over the previous 2 to 3 months and provides a good indicator of glycaemic control.

Question 16

What are the considerations for HbA1c?

Answer 16

Unlike the oral glucose tolerance test, an HbA1c test can be performed at any time of the day and does not require any special preparation such as fasting.

Question 17

When should HbA1c be used?

Answer 17

Monitoring glycaemic control in both Type 1 diabetes and Type 2 diabetes and is now also used for diagnosis of type 2 diabetes

Question 18

When should HbA1c not be used?

Answer 18

1. suspected type 1 diabetes
2. children,
3. during pregnancy
4. in women who are up to two months postpartum.

It should also not be used for patients who have:

1. had symptoms of diabetes for less than 2 months;
2. a high diabetes risk and are acutely ill;
3. treatment with medication that may cause hyperglycaemia;
4. acute pancreatic damage;
5. end-stage chronic kidney disease;
6. HIV infection.

Question 19

When does HbA1c monitoring take place in T1DM?

Answer 19

HbA1c should usually be measured in patients with type 1 diabetes every 3 to 6 months, and more frequently if blood-glucose control is thought to be changing rapidly.

Question 20

When does HbA1c monitoring take place in T2DM?

Answer 20

Patients with type 2 diabetes should be monitored every 3 to 6 months until HbA1c and medication are stable when monitoring can be reduced to every 6 months.

Question 21

What does HbA1c predict?

Answer 21

• HbA1c is also a reliable predictor of microvascular and macrovascular complications and mortality.
• Lower HbA1c is associated with a lower risk of long term vascular complications and patients should be supported to aim for an individualised HbA1c target

Question 22

Symptoms of Diabetes Insipidus?

Answer 22

Polyuria (Excessive Urination) and Polydipsia (Extreme thirst)