Carbohydrates

Question 1

Normal blood glucose?

Answer 1

3,5-5,5 mmol/l

Question 2

Name 4 hormones that increase blood glucose

Answer 2

• Glucagon
• catecholamines (adrenaline)
• growth hormone
• cortisol

Question 3

Name 3 factors that stimulate insulin release

Answer 3

•increased blood glucose
• incretin gut hormones during food intake:
-Glucagon like peptide 1 GLP 1
- glucose dependent insulinotropic peptide GIP

Question 4

Name 2 electrolyte changes in insulin deficiency

Answer 4

Hyperkalaemia
Hyper P

Question 5

Name 3 electrolyte changes in insulin therapy

Answer 5

(Increased cellular uptake)
• hypo K
• hypo p
• hypo mg

Question 6

Name 4 causes diabetes mellitis

Answer 6

• Chronic pancreatitis
•Haemochromatosis ( excess iron)
• endocrine conditions with increased cortisol eg Cushing
• endocrine conditions with increased gh eg acromegaly

Question 7

Define normal fasting glucose

Answer 7

<6,1

Question 8

Define dm glucose

Answer 8

Fasting ≥7
2h post glucose ≥11,1

Question 9

Diabetic hba1c?

Answer 9

> 6,5% (48 mmol/mol)
Repeat within 2. weeks to confirm
(If <6,5%, reassess in 6 months because high diabetes and cv risk)

Question 10

Define intermediate HbA1C values and appropriate action

Answer 10

6-6.4% (42-47 mmol/mol)
Increased risk diabetes and cv risk, reassess in 1 year

Question 11

Name 6 contraindications to using hba1c

Answer 11

• Rapidly changing glucose levels eg acute illness, new onset dm, drugs
• abnormal RBC lifespan: liver and kidney disease, hemolytic anemia, fe deficiency, b12/folate deficiency, hypersplenism, splenectomy
• pregnancy
• severe anaemia hb <6,5
• no HbA ( homozygous variant: S,C,D, E)
. Method specific interferences from certain hb variants

Question 12

First line diagnosis for gestational diabetes?

Answer 12

2h ogtt > 7,8 mmol/ L

Question 13

When should gestational diabetes be tested for

Answer 13

24-28 Weeks

Question 14

Best method of measuring ketones in diabetes?

Answer 14

Plasma 3-oh-buturate (3-0h-b) with ketone meter
(Urine detect acetoacetate and acetone, which can underestimate DkA severity)

Question 15

Which tests should be used to monitor nephropathy in diabetes (4)

Answer 15

• Creatinine
• eGFR
• screen for microalbuminaria (3-30 mg / mmol) with urine albumin: creatinine ratio
• once clinical proteinuria (acr>30), monitor with urine protein: creatinine ratio

Question 16

Electrolyte derangements in DkA? (3)

Answer 16

• Hypo Na
• hyper K
• hyper p

Question 17

Treatment DKA? (5)

Answer 17

• Insulin for hyperglycaemia
• iv saline for hyponatraemia
• k, p, Mg supplements (insulin cause hypo)
• check uce, blood glucose every 6 hours
• monitor water balance with CvP and input output chart

Question 18

Define hyperosmolar hyperglycaemic state (3)

Answer 18

• DM 2 severe hyperglycaemia > 50 mmol /l without DkA
• extreme dehydration, very high serum osmolality >320 mosm/kg
• no or minimal metabolic acidosis, no/mild ketones (unlike dka)

Question 19

Treatment hyperosmolar hyperglycaemic state

Answer 19

• Rehydration
• low dose iv insulin
• thrombosis prophylaxis

Question 20

Define Whipple’s triad of hypoglycaemia

Answer 20

• Hypoglycaemic symptoms: neuroglycopaenia
• low glucose <3
• symptoms resolve after glucose load

Question 21

How determine cause of fasting hypoglycaemia? (3)

Answer 21

Measure insulin and C peptide while hypoglycaemic
• both increase: endogenous hyperinsulinism eg islet cell tumours, drug induced, anti-insulin antibodies
• both decrease: suppressed endogenous insulin secretion: liver diseases , CkD, non-islet cell tumours, endocrine deficiencies, drug, alcohol, severe starvation
•. increase insulin, decrease C peptide: exogenous insulin, anti-insulin receptor antibodies

Question 22

How calculate expected pCO2 for metabolic acidosis?

Answer 22

1.5 x HCO3 + 8
(Range +/- 2. Max compensation may take 12-24h to reach)

Question 23

Name 9 causes neonatal hypoglycaemia

Answer 23

• Fasting
• decreased liver glycogen ; muscle protein; fat in premature and iugr
• increased consumption in birth stress, RDS, infections, hypothermia
•Persistent hyperinsulinaemic hypoglycaemia of infancy
• decreased growth hormone, cortisol
• inborn errors of intermediary metabolism
-Galactosaemia
- organic acidemias
- Fatty acid oxidation disorders
- Glycogen storage diseases, hereditary fructose intolerance

Question 24

Which test can be done on newborns to confirm presence of mono or disaccharide that can’t be metabolised

Answer 24

Screen for urine reducing sugars with copper reduction test (urine change colour)