Management of diabetes and its complications (1)

Question 1

In an asymptomatic patient if the hba1c is >48 what do u do

Answer 1

repeat test

If second sample <48 then treat as high diabetes risk and repeat test in 6 months or sooner if symptoms develop

Question 2

When should you not use hba1c to diagnose diabetes

Answer 2

ALL children and young people
Suspected Type 1 diabetes
Symptoms less than 2 months
Acutely ill (e.g. requiring hospital admission)
Medication that may cause rapid glucose rise e.g. steroids, antipsychotics
Acute pancreatic damage, including pancreatic surgery
In pregnancy
Presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement
CKD 4/5

Question 3

Which diabetes is ketoacidosis seen

Answer 3

type 1

Question 4

What are the most common causes of death in ketoacidodis

Answer 4

cerebral oedema (paediatric, young adults)
Hypokalaemia
co-morbid conditions

Question 5

dka causes

Answer 5

new diagnosis
non compliance
inter current illness
insulin/equipment issues

Question 6

clinical features of dka

Answer 6

Osmotic symptoms
Weight loss
Breathlessness – Kussmaul resps
Abdo pain – children in particular
Leg cramps
Nausea and vomiting
Confusion
Drowsiness

Question 7

diagnosis of DKA>

Answer 7

glucose >11
capillary ketones >3
venous pH <7.3 or venous bicarb <15

Question 8

management dka

Answer 8

IV insulin
iv fluid
iv electrolyte replacement
monitoring

Question 9

HHS?

Answer 9

Hypovolaemia
Hyperglycaemia without hyperketonaemia or acidosis,
Bicarb >15
Osmolality >320/kg

Question 10

cns presentations of HHS

Answer 10

seizures, aphasia, hemianopia, unilateral hyperreflexia, extensor babinski, myoclonic jerks, nystagmus

Question 11

Vascular complications HHS

Answer 11

MI
CVA
Arterial thrombosis 
Seizures 
Cerebral oedema 
Osmotic demyelination 
Foot complications

Question 12

Management of HHS

Answer 12

IV fluid replacement 
Iv electrolyte replacement 
IV insulin 
Prophylactic LMWH 
Monitoring

Question 13

Causes hypoglycaemia in hospital

Answer 13

Missed meals 
Reduced appetite 
NBM 
AKI 
Prescription errors: doses, timing, type of insulin

Question 14

What to do in hypoglycaemia in pt who is abl to swallow

Answer 14

Give 15-20g quick acting carbs e.g. glucose gel

Once glucose >4 give long acting carbs

Question 15

What to give in hypo if someone is unconscious/aggressive/un-cooperative

Answer 15

Glucagon IM takes 15 mins to act.
or
100mls glucose over 15mins

Question 16

what is glucagon less effective in in hypo

Answer 16

Malnourished
Those with prolonged starvation
Severe liver disease (as don’t have glycogen stores)

Question 17

Autonomic neuropathy seen in diabetes

Answer 17

Postural hypotension
Tachycardia
Bowel and bladder dysfunction
Gastroparesis
Erectile dysfunction
Sweating- gustatory, anhidrosis

Question 18

What is the aetiology of diabetic foot ulcers

Answer 18

Vascular, neuropathic or both (mixed)