Endocrinology

Question 1

Diabetes treatment - after metformin

if HbA1C > 58 or 7.5 mmol/L add second drug

Answer 1

SGPT
S - sulphonylurea (gliclazide)
G - Gliptin/ DPP 4 inhibitor (Sitagliptin)
P - Pioglitazone (thiazolidinediones)
T - SGLT 2 inhibitor (Empagliflozin)

prediabetes- check HbA1c every year

diabetes- check HbA1c every 6 months

unstable-6 months

stable-3 months

S- sulphonylurea e.g gliclazide- weight gain, hypoglycaemia (CI in drivers) SIADH, cholestasis
G- DPP4 inhibitor e.g gliptins
P- Thiazolidinediones e.g pioglitazone- weight gain, fracture, fluid retention, impaired liver function, bladder cancer
T- SGLT 2 inhibitor e.g dapagliflozin- weight loss, UTI, foot check
GLP1 mimetic e.g exenatide- weight loss, BMI>35

Question 2

DM diagnosis

Answer 2

HbA1C >48 - DM
HbA1C 42-47
fasting glucose 6.1 -7 Prediabetes (impaired)
OGTT 7.8 -11.1 Impaired 
Pregnancy - fasting glucose >5.6 DM
OGTT >7.8 DM

Question 3

assessing proteinuria in a patient with type 2 diabetes and CKD

Answer 3

ACR

Question 4

most common cause of urinary stones

Answer 4

Calcium oxalate

Question 5

target uric acid level after treatment

Answer 5

0.3

Question 6

Sick day rule for patients’ with Addison’s diesease

Answer 6

Double the normal dose of hydrocortisone for a fever of more than 37.5º C or for infection/sepsis requiring antibiotics
For severe nausea (often with headache), take 20 mg hydrocortisone and sip rehydration/electrolyte fluids
On vomiting, use the emergency injection (100 mg hydrocortisone) immediately. Then call a doctor, saying ‘steroid-dependent patient’, ‘adrenal crisis’ or ‘Addison’s emergency’
Take 20 mg hydrocortisone orally immediately for serious injury to avoid shock