Endocrinology

Question 1

Diabetes -> how will you improve their glycaemic control?

Answer 1

Confirm current status / diagnosis -> look at HbA1c + BSL diary

Identify RFs:

• Obesity + decreased insulin resistance
• Absorption issues / injection sites
• Medications (steroid / CNIs)
• Manage ‘diabetes distress’, acknowledge difficulty of diabetes self-care. Link with Psychology / support group

To improve glycaemic control: **acknowledge good that is already in place)

• Diet -> low calorie, consumption of low GI foods (dietician), cutting out particular problem foods
• Aerobic and resistance exercise to lose weight
• Weight loss will increase insulin sensitivity

Pharm:

• Metformin for everyone who can tolerate
• Obese -> think about GLP1 agonists (Semaglutide / dulaglutide weekly, liraglutide but non-PBS) or SGLT2 inhibitors (dapa / empag)
• CV risk -> GLP-1 / SGLT2
• Renal failure -> linagliptin, insulin, low dose sulf

Monitoring:
- close follow up to monitor progress and uptitrate medications as able

Question 2

How will you monitor Diabetes over time?

Answer 2

Regular HbA1c + MDT review

Screen for complications:

• Micro: Urine ACR annually, ophthal annually, podiatry 3 monthly
• Macro: BP checks, lipid profile

Aggressive management of CVRFs
Introduce RAAS inhibition if proteinuric

Question 3

What is your approach to managing their erectile dysfunction?

Answer 3

Often multifactorial

Identify contributing factors:

• physical => vascular, neuropathy, endocrine
• psychosocial stressors
• drugs / ETOH

Management:

• Non-pharm -> counselling, healthy lifestyle
• Manage CVRFs
• Pharm -> sildenafil, Test

Question 4

What are some useful bone turnover markers?

Answer 4

P1NP

Bone specific ALP