Type 2 Diabetes

Question 1

What is the biggest environment risk factor for T2DM?

Answer 1

Obesity

Question 2

What variables are present in a absolute cardiac risk calculator?

Answer 2

Sex

Age

Systolic blood pressure

Total cholesterol

HDL

Smoking status

Diabetes status

ECG LVH

Question 3

How might someone present with T2DM?

Answer 3

Polyuria

Polydipsia

Polyphagia

Nocturia

Vision changes

Unexplained weight loss

Delayed wound healing

Fatigue

Malaise

Question 4

How often should you check Hba1c?

Answer 4

3-6 monthly

Question 5

What does SNAP stand for?

Answer 5

Smoking

Nutrition

Alcohol

Physical activity

Question 6

What relationship does T2DM have with haemochromatosis?

Answer 6

Have haemochromatosis puts people at a higher risk of developing T2DM

Question 7

What should be performed on examination of a patient with diabetes?

Answer 7

Monofilament test and reflexes

Foot examination for ulcers

Visual acuity and fundoscopy

BP and postural drop

Assessment of cardiovascular risk

BMI and weight circumference

Question 8

What is the mechanism of action of the GLP-1 analogue?

Answer 8

Increase endogenous pancreatic release of insulin in response to glucose

Slows gastric emptying and improves satiety leading to weight loss

Increases glucose uptake in muscles

Question 9

What are the various way that the diagnosis of diabetes can be confirmed?

Answer 9

Symptoms + RBG >11.1mmol/L

Fast glucose >7mmol/L

HbA1c >6.5

2 hour glucose tolerance test >11.1mmol/L

Question 10

How would you Ix a new diagnosis of diabetes?

Answer 10

Urine microalbumin

UEC - Creatinine

Lipid profile

Hba1c

Question 11

What is diabetic acute painful neuropathy/rest pain? What is it’s pattern of time course?

Answer 11

Burning pain in the feet, shins and anterior thighs, typically worse at night.

Due to microvascular changes as a complication of diabetes.

Can be present at diagnosis or can occur spontaneously when good glycaemic control is achieved. Usually remits spontaneously after 3-12 months if good control is maintained

Question 12

What are the fasting and post prandal blood glucose targets?

Answer 12

Fasting = 6-8mmol/L

2h post prandal = 6-10mmol/L

Question 13

What is a structure for answering a Mx question for the long case diabetic patient?

Answer 13

Ix

• HbA1C
• Albumin/Creatinine ratio

Mx

• Acutely first: Aim BSL 5-10, novorapid sliding scale
• Novorapid sliding scale
• Referrals to allied health

Question 14

Why does cataracts occur in T2DM?

Answer 14

Sorbitol deposition

When glucose is present in tissue at a high concentration it gets converted to sorbitol by aldose reductase