T2DM

Question 1

Symptoms

Answer 1

tiredness, weight loss, polyuria

Question 2

Any other features

Answer 2

Acanthosis nigricans
Diabetic dyslipidemia
HTN
Abdo obesity

Question 3

What causes the thirst?

Answer 3

Osmotic diuresis

Question 4

Suggest lifestyle advice

Answer 4

Diet should be low salt, low fat and include plenty of fresh fruit and vegetables. The diet should also include high fibre, low-glycaemic index carbohydrates such as pulses etc. Refined sugars should be avoided.

Question 5

First line therapy and dose

Answer 5

Metformin

Gradually increased dose to avoid SE

Question 6

What do you do if metformin is not tolerated?

Answer 6

Switch to modified release form

Question 7

What must be monitored when taking metforming and when does it have to be monitored?

Answer 7

Before and during metformin use, renal function must be monitored

Question 8

Name a side effect of thiazolidinediones

Answer 8

Fluid retention, leading to HF

Question 9

SE of metformin

Answer 9

Nausea and diarrhoea
Loss of appetite
Stomach pain
NOT weight gain

Question 10

What happens when metformin is prescribed in the presence of renal failure?

Answer 10

Lactic acidosis

Question 11

Which side effects are not seen in metformin use?

Answer 11

Hypoglycaemia

Weight gain

Question 12

Which diabetic drug can cause hypoglycaemia and why?

Answer 12

Sulphonylurea therapy as it increases endogenous insulin secretion

Question 13

Target bp in diabetes is

Answer 13

The target blood pressure in diabetes is: systolic <140 mmHg and diastolic <90 mmHg, around 130/80

Question 14

What happens during diabetic screening?

Answer 14

Retinopathy screening
Foot assessment for sensation and doppler testing of vascular supply
Albumin:creatinine ratio to check for nephropathy 
U&Es 
Serum cholesterol 
HbA1c 
Review of glucose monitoring 
Weight assessment 
Smoking status

Question 15

What is the normal range for albumin:creatinine ratio?

Answer 15

less than 30mcg/L

Question 16

If the patient has both hypertension as well as albuminiuria, what should be their first line treatment?

Answer 16

ACEi, even if the pt is black

If not well tolerated, ARB

Question 17

How do ACE/ARB work to reduce proteinuria?

Answer 17

Reduce glomerular filtration pressure; this slows down progression of renal disease better than other BP management

Question 18

What would you do if the patient had renal artery stenosis and the pt needs ACEi or ARB to manage their proteinuria? What would be seen?

Answer 18

Take U&E after 10-14 days to check for acute kidney injury
More than 20% rise in serum creatinine would indicate renal artery stenosis and the drug should be stopped, and the renal arteries should be imaged

Question 19

What else can be deranged after ACE/ARB treatment? What do you do if this is the case?

Answer 19

Hyperkalemia
Stop or reduce dose
Consider if other treatments could be stopped to allow ACE/ARB use

Question 20

How do you treat renal artery stenosis?

Answer 20

Angioplasty and stenting