ENDOCRINOLOGY - DM

Question 1

Differentiate T1DM and T2DM in term of :
-osmotic symptoms
-family history
-body weight
-chronic complication
-weight loss

Answer 1

T1DM
-short duration osmotic symptoms
-no family history
-normal or under
-no chronic complication
-yes weight loss

T2DM
-long duration osmotic symptoms
-involved family history
-over / obese body weight
- yes weight loss

Question 2

How you want to diagnose DM

Answer 2

-HbA1C > 6.2 %
-Fasting Blood Sugar > 7.0 mmol /L
-2 hours Glucose of OGTT > 11.11mmol/L
-Random Blood Glucose > 11.11 mmol/L

:need 2 readings if no symptoms
:need 1 reading if has symptoms

Question 3

What is the lifestyle modification in DM ?

Answer 3

• Diabetic diet : no simple sugars , moderate carbohydrate intake 130g/day
• at least 150mins /week of moderate intensity exercises , with no 2 consecutive days without physical activity

Question 4

In assessing control glucometer , what is your target ?

Answer 4

acceptable range :
pre meals 4-6mmol/L
2 hours post meals 6-8 mmol/L

Question 5

what is your HbA1C target ?

Answer 5

majority <7%

Question 6

How to calculate BMI ?

Answer 6

weight (kg) / height (m2)

Question 7

What is the range for overweight and obese ?

Answer 7

> 23 overweight
27 obese

Question 8

What is the need to do investigation for DM ?

Answer 8

Control : HBA1C
Complications :
-ECG
-Urine albumin creatinine ratio
-Renal profile
Co-morbidities
-Lipid profile ,Uric acid

Question 9

Treatment : Oral and Injectable

Answer 9

Oral
-Biguanide
Injectable
-GLP I analogue
-Insulin

Question 10

Acute DM Complications (DHH)

Answer 10

Diabetic ketoacidosis
Hyperglycemic Hyperosmolar syndrome
Hypoglycemia

Question 11

What is the main pathophysiology of DKA ?

Answer 11

Insulin deficiency - reduced peripheral glucose uptake - increased glucogenolysis and gluconeogenesis

Hyperglycemia - increased counter-regulatory hormones

Hyperglycemia - osmotic diuresis and intravascular volume depletion

Alternative fuel by proteolysis ,lipolysis –> increased Free Fatty Acid –> ketones

Question 12

What is the presentation of DKA (VAN 2P)

Answer 12

Vomiting , Abdominal pain , Nausea , Polydipsia ,Polyuria

Question 13

What you do to confirm the diagnosis of DKA

Answer 13

Diabetic - Blood sugar >11mmol/L
Ketones - blood ketone > 3mmol/L
ABG - Bicarbonate < 15mmol/L or pH <7.3

Question 14

How you want to manage DKA ?

Answer 14

ABC (airway , breathing, circulation)

Fluid replacement is the most important

Question 15

How you want to confirm the diagnosis Hyperglycemic Hyperosmolar Syndrome ?

Answer 15

Blood glucose > 30mmol/L
No ketonemia
No acidosis
Serum osmolarity > 320m osm/kg

Question 16

How you want to manage HHS ?

Answer 16

-ABC (Airway , Breathing , Circulation)

-Fluid replacement is the most important

Prophylactic anticoagulation - DVT