Wk 16: Diabetes

Question 1

What are the macrovascular complications associated w/ diabetes?

Answer 1

• Ischaemic HD
• Stroke
• Peripheral arterial disease

Question 2

What are the microvascular complications associated w/ diabetes?

Answer 2

• CKD
• Retinopathy
• Neuropathy

Question 3

What are the foot complications associated w/ diabetes?

Answer 3

• Ulcers
• Deformities
• Infections

Question 4

What are the Metabolic complications associated w/ diabetes?

Answer 4

• Dyslipidemia
• Diabetic ketoacidosis
• Hyperosmolar hyperglycaemic state

Question 5

What are the lifestyle advice you’d give a diabetic patient?

Answer 5

• Diet, exercise + weight
• DAFNE (T1) or DESMOND (T2)
• Annual foot + retinal check
• Alcohol
• Smoking

Question 6

What is type 1 diabetes?

Answer 6

• Absolute insulin deficiency
• Immune mediated destruction of pancreatic B cells

Question 7

What symptoms indicate Type 1 diabetes?

Answer 7

• Random plasma glucose ≥11.1mmol/L
• Ketosis
• Rapid weight loss
• > 50
• BMI >25
• Fx autoimmune disease

Question 8

What is the target of type 1 diabetes?

Answer 8

48mmol/mol - measure every 3-6 months

Question 9

What is first line for T1 diabetes?

Answer 9

Multiple daily injection basal-bolus insulin regime

Basal:
- BD detemir OR

• OD glargine OR
• OD degludec (if worried bout nocturnal hypo)

Bolus:
- Rapid acting before meals

Question 10

How often do T1 diabetics monitor their blood glucose + when do you increase?

Answer 10

• 4x (before meals + bed)
• Inc: ill, sport, driving, pregnant

Question 11

What are the targets for T1 diabetes for every day blood glucose monitoring?

Answer 11

• Waking: 5-7
• Before meals: 4-7
• After meals: 5-9

Question 12

Which devices measure interstitial glucose levels?

Answer 12

• Flash monitor: 14 days, measured every min + scan w/ phone
• Continuous glucose monitoring: 10-14 days, sends signals to phone every 5 mins

Question 13

What is hypoglycaemia + what are the signs?

Answer 13

< 3.5mmol/L

• Hunger
• Palpitations
• Tingly lips
• Weakness
• Convulsion
• Coma

Question 14

What is the management of hypoglycaemia?

Answer 14

• 10-20g fast acting carbs: dextrogel, 3-6 glucose tabs
• Recheck blood glucose 10-15 mins
• No response, repeat glucose + retest after 15 mins
• If unconscious/can’t swallow: 1g glucagon IM
• No response w/in 10 mins, hospital w/ IV glucose

Question 15

What are the limitations of HbA1c?

Answer 15

Can’t diagnose in:
- <18

• T1 diabetes suspected/symptoms <2 months
• Corticosteroid
• Acute pancreatic damage, end stage renal disease, HIV

Question 16

On which type of people would you be cautious of using HbA1c?

Answer 16

Severe anaemia + recent transfusion (use blood glucose)

Question 17

What symptoms indicate Type 2 diabetes?

Answer 17

• HbA1c: >48
• Fasting glucose: >7
• Random glucose: >11.1
• Polydipsia + uria
• Blurred vision
• Unexplained weight loss