Diabetes

Question 1

What are the symptoms of hyperglycaemia?

Answer 1

Polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy.

Question 2

How is diabetes diagnosed?

Answer 2

1. Symptoms of hyperglycaemia

2. Raised venous glucose (fasting, random, OGTT, HbA1c)

Question 3

What are the levels of blood glucose in these tests needed to diagnose diabetes?

1. Fasting
2. Random
3. OGTT
4. HbA1c

Answer 3

1. > 7mmol/L
2. > 11.1mmol/L
3. > 11.1mmol/L
4. > 48mmol/mol

Question 4

When should you not use HbA1c to aid in the diagnosis of diabetes?

Answer 4

1. Pregnancy (favour OGTT)
2. T1DM
3. Haemoglobinopathies

Question 5

How do T1DM and T2DM differ in these features?

1. Presenting age group
2. Genetics
3. Cause
4. Presentation

Answer 5

1. T1 - before puberty, T2 - older patients
2. T1 - HLA D3/D4 linked, T2 - no HLA link
3. T1 - autoimmune B cell destruction, T2 - insulin resistance/B cell dysfunction
4. T1 - polydipsia, polyuria, weight loss, ketosis; T2 - asymptomatic/complications.

Question 6

What is latent autoimmune diabetes of adults?

Answer 6

Form of T1DM with slower progression to insulin dependence later in life.

Question 7

What is maturity onset diabetes of the young?

Answer 7

Rare autosomal dominant form of T2DM affecting young people, treated with sulphonylureas.

Question 8

How do you identify impaired fasting glycaemia?

Answer 8

Fasting glucose >6.1mmol/L but <7mmol/L

Question 9

How do you identify impaired glucose tolerance?

Answer 9

Fasting plasma glucose <7mmol/L and OGTT 2h >7.8mmol/L but <11.1mmol/L

Question 10

What are the additional causes of diabetes mellitus?

Answer 10

1. Steroids, anti-HIV drugs, newer antipsychotics
2. Pancreatitis, pancreas surgery (>90% removed), pancreatic dysfunction (haemochromatosis, cystic fibrosis), pancreatic cancer.
3. Cushing’s disease, acromegaly, phaeochromocytoma, hyperthyroidism, pregnancy
4. Congenital lipodystrophy, glycogen storage disease

Question 11

What is the medication regime for type 2 diabetes mellitus?

Answer 11

1. Lifestyle advice - healthy eating, weight control, increased exercise, diabetes education.
2. Monotherapy - metformin
3. Dual therapy - metformin + sulphonylurea/thiazolidine/DPP-4 inhibitor/SGLT2 inhibitor/GLP-1 receptor agonist/basal insulin
4. Triple therapy - metformin + two of the above
5. Combination injectable therapy - metformin + basal insulin + mealtime insulin/GLP-1 receptor agonist

Question 12

What is the treatment for type 1 diabetes mellitus?

Answer 12

1. BD insulin detemir + prandial insulin aspart/lispro
2. Encourage to check CBG at least QDS
3. Illness often increase insulin requirement despite reduced food intake
4. CSII indicated if unable to achieve target HbA1c/disabling hypoglycaemia