Diabetes Mellitus

Question 1

What factors contribute to the diagnosis of DM?

Answer 1

Polyuria
Polydipsia 
Weight loss
Lethargy
Blurred vision
Hyperglycaemia (fasting glucose >6.9 mmol/L or random plasma glucose >11mmol/L)
HbA1c > 48mmol/L

Question 2

What is Hb1Ac?

Answer 2

Glycated Hb- reflects the blood sugar over the last 10-12 weeks

Question 3

How is diabetic ketoacidosis characterised?

Answer 3

Biochemical triad: hyperglycaemia, ketonaemia and acidosis

Question 4

Who is diabetic ketoacidosis most commonly diagnosed in?

Answer 4

Those with T1DM and usually children

Question 5

What should you do if you suspect DKA

Answer 5

Test for ketones in the urine or blood

Question 6

You should suspect DKA if?

Answer 6

Blood glucose >11mmol/L
Polydypsia
Polyuria
Abdominal pain
Lethargy
Confusion
Acetonic breath

Question 7

How should DKA be treated?

Answer 7

IVI fluids
IVI soluble insulin
K+ correction in additional fluids

Question 8

How are therapeutic insulins taken?

Answer 8

Parenterally to avoid digestion

Question 9

What dosages do therapeutic insulins come in?

Answer 9

100, 300 and 500 units/ml

Question 10

How is insulin routinely delivered?

Answer 10

Via subcutaneous injections into the upper arms, thighs, buttocks or abdomen

IVI in emergency treatment

Question 11

How may insulin be prepared to allow slow absorption?

Answer 11

Protamine/zinc complex with natural insulins
Soluble insulin forms hexameters
Insulin analogues with few amino acid changes

Question 12

What are the potential oal adverse side effects of taking insulin?

Answer 12

Hypoglycaemia

Lipodystrophy

Question 13

What are the possible contradictions of insulin therapy?

Answer 13

Renal impairment

Question 14

Give an important drug interaction of insulin therapy

Answer 14

Dose needs increasing with systemic steroids

Be careful with other hypoglycaemic agents

Question 15

What is diabulimia?

Answer 15

When a type 1 diabetic stops or reduces their insulin to control their weight

Question 16

How is T2DM managed?

Answer 16

Lifestyle
Education
Weight loss
Non-insulin therapies
Treat co-morbidities

Question 17

Name a biguanide used to treat diabetes?

Answer 17

Metformin

Question 18

How do biguanides work?

Answer 18

Decrease hepatic glucose production by inhibiting gluconeogenesis.
They also suppress appetite so weight gain is limited

Question 19

What are the side effects of taking biguanides?

Answer 19

GI upset

Question 20

What may be the contradictions of taking biguanides?

Answer 20

Excretion unchanged by the kidneys

Question 21

Name some important biguanide drug interactions

Answer 21

ACEi
NSAIDs
Drugs that impair renal function
Loop and thiazides like diuretics

Question 22

How do sulfonylureas act?

Answer 22

Stimulate B cells to secrete insulin and block ATP-dependant K+ channels

Question 23

What is required for SUs to work?

Answer 23

Residual pancreatic function

Question 24

Name an important SU

Answer 24

Gliclazide

Question 25

What are common SU side effects?

Answer 25

Mild GI upset

Question 26

What are the possible SU contradictions?

Answer 26

Hepatic and renal disease

Question 27

Name 2 important thiazolidinediones (glitazones)

Answer 27

Pioglitazone

Rosiglitazone