All things Diabetes

Question 1

What features would raise suspicion of diabetes mellitus?

Answer 1

Thirst
Toileting
Tiredness
Thin
+ blurred vision, infections in T2DM

Question 2

What history features point towards T1DM over T2DM?

Answer 2

Younger
Family history of autoimmune disease
Ketosis (fruity breath, DKA)

Question 3

What blood glucose levels would indicate diabetes mellitus?

Answer 3

Random >11.1 mmol/L
Fasting: >7mmol/L

Question 4

What Hb1AC values suggest…
prediabetes
diabetes

Answer 4

prediabetes: 42-47
diabetes: >=48

Question 5

How can Hb1AC be used for diagnosis of diabetes mellitus?

Answer 5

>=48 can diagnose T2DM
NOT DIAGNOSTIC IN T1DM, YOUNG, PREGNANT, HAEMOGLOBINOPATHIES

Question 6

What do you need to diagnose Diabetes mellitus?

Answer 6

Either
1 high blood glucose + symptoms
2 high blood glucose on two separate occasions

Question 7

In what circumstances would a C-peptide or autoantibody titre be useful in diabetes mellitus?

Answer 7

Confirm T1DM if atypical or monogenic presentation
C-peptide titres would be low
Anti-GAD/islet antibodies would be present

Question 8

What is the treatment for T1DM?

Answer 8

Insulin therapy

Question 9

What is the treatment pathway for type 2 diabetes mellitus?

Answer 9

1. Metformin
2. Metformin + option*
3. Metformin + 2 options
4. Metformin + sulfonylurea + GLP-1 mimetic if BMI >35 and above 3 drugs not working

Options: Sulfonylureas (glicazide)/SGLT-2 inhibitor (flozins)/pioglitazone

Question 10

At what point would you escalate drug management of T2DM>

Answer 10

Hb1AC >=58

Question 11

Regarding GLP-1 as part of last line therapy of T2DM, what criteria needs to be met to continue on it

Answer 11

Reduction in Hb1AC by 11 AND at least 3% body weight

Question 12

What cardiovascular management should be considered in diabetes mellitus?

Answer 12

ACEi (-prils) or ARBs (-sartans) for HTN
low dose statin if Q-risk score >10%

Question 13

What would you suspect in a patient with diabetic symptoms without ketosis who was under 25 with a diabetic family history?

Answer 13

Maturity onset Diabetes of the Young
Responsive to sulfonylurea monotherapy

Question 14

What are the side effects of metformin?

Answer 14

Gastrointestinal upset

Lactic Acidosis is rare but fatal

Question 15

Regarding metformin’s action, which common drugs do you need to watch for?

Answer 15

Alcohol: hypoglycaemia, lactic acidosis

B-blockers: Can mas hypoglycaemia

Ketotifen (anti-allergic): can reduce platelet count

Topiramate: Increase metformin action

Question 16

Which T2DM drugs cause hypoglycaemia?

Answer 16

Sulfonylureas (glicazide, glibenclamide)

Low risk in GLP-1 mimetics

Question 17

Which diabetic drugs induce weight loss?

Answer 17

SGLT-2 inhibitors (-gliflozins)

GLP-1 mimetic (exenatide, liraglutide)

Question 18

Which diabetic drugs induce weight gain?

Answer 18

Thiazolinediones (pioglitazone)

Sulfonylurea (glicazide)

Question 19

Which diabetic drugs do not affect weight?

Answer 19

Metformin

DPP4-inhibitors (glitpins)

Question 20

Which diabetic drugs is most associated with glucosuria?

Answer 20

SGLT-2 inhibitors (gliflozins)

Question 21

Which diabetic drug is most associated with fluid retetion?

Answer 21

Thiazolidinediones (pioglitazone)

Question 22

Gliptins are part of x class of drug

Flozins are y kind of drugs

Answer 22

X: DPP-4 inhibitors

Y: SGLT-2 inhibitors

Question 23

What is the first line HTN therapy for a diabetic?

Answer 23

ACE inhibitor (ramipril, lisinopril)

Question 24

Regarding insulin therapy, what should

Be given foodwise if there’s a hypo

Be given to patients on commencing therapy

Be changed when sick

be calculated for a rough corrective dose when sick

Answer 24

10-20mg short acting carb (glass sugary drink, 3 glucose tabs)

Glucagon kit for emergency hypos

DONT CHANGE ANYTHING

1/6 daily dose (up to 15 units)

Question 25

What is the mechanism of action of Biguanides (metformin) Sulfonylurea (gliciazide) SGLT2 inhibitors (flozin) DPP4 inhibitors (gliptins) GLP-1 mimetics (exenatide, liraglutide) Thiazolinedione (pioglitazone)

Answer 25

Met: Decrease gluconeogenesis, increase peripheral glucose usage SU: increased insulin excretion SGLT2: Blocks reabsorption by kidneys, promotes urine excretion DPP4: Inhibits DPP4 mediated destruction of incretin GLP-1: Increases insulin and reduces glucagon secretion, slows gastric emptying Thiazolinedione: Increases glucose uptake into muscle and adipose tissue

Question 26

what T2DM medication is associated with Bladder cancer fractures Liver impairment Fluid retetion

Answer 26

Thiazolinediones Contraindicated in heart failure

Question 27

What are the Hb1AC targets when on therapy?

Answer 27

Lifestyle +/- metformin: 48 Risen past 48 or on hypoglycaemic: 53

Question 28

In diabetic therapy, when must an SGLT-2i be added?

Answer 28

Established or risk \>10% CHD Heart failure

Question 29

If metformin was contraindicated in a patient, what therapy would you give?

Answer 29

CHD/HF: SGLT-2 No CHD/HF: DPP4 (Gliptin)/ SU (gliciazide)/ Thiazolinedione (pioglitazone)

Question 30

When is GLP-1 therapy considered

Answer 30

Inadequate cover by triple therapy and either BMI \>35 + psychological/medical problems associated with obesity BMI \<35 but insulin would be an occupational hazard

Question 31

How does Ramadan affect T2DM management

Answer 31

Sunrise (Suhoor): 1/3 metformin dose, long acting carb meal Sunset (Iftar): majority metformin, gliciazide dose

Question 32

How does diabetes mellitus affect haivng a licence for Group 1 vehicles (cars, motorbikes) Group 2 (HGV)

Answer 32

Group 1 Insulin dependent or hypoglycaemics (SU, liraglutide): no more than 1 hypo needing assistance Group 2 No severe episodes in 12 months Full hypo awareness + bidaily monitoring data for past 3 months