Diabetes

Question 1

Diabetes diagnosis

with symptoms

Answer 1

fasting > 7
random > 11.1
HbA1c > 48 mmol/mol

Question 2

pre-diabetes

Answer 2

HbA1c 42-47 mmol/mol

Question 3

T1 diabetes gene assoc?

Answer 3

HLA DR3, DR4

Question 4

Diabetes management

Answer 4

1. Metformin
2. DPP-4i - sitagliptin
3. Pioglitazone (ttd)
4. Sulfonylurea - gliclazide
5. SGLT-2i - (glifozin)

Question 5

sulfonylureas action

Answer 5

enhance endogenous insulin secretion (B-cells)

Question 6

sulfonylureas examples

Answer 6

Gliclazide

Question 7

biguanides action

Answer 7

• increase glucose uptake
• decrease hepatic gluconeogenesis
• increase peripheral insulin sensitivity

Question 8

biguanides example

Answer 8

METFORMIN

Question 9

sulfonylureas side effects

Answer 9

weight gain
hypoglycaemia
hyponatraemia

Question 10

biguanides side effects

Answer 10

GI upset: nausea, diarrhoea

lactic acidosis

Question 11

DPP-4 inhibitors example

Answer 11

sitagliptin

Question 12

DPP-4 inhibitors action

Answer 12

• increase incretin levels
• prevents peripheral breakdown (longer action)
• inhibits glucagon secretion

Question 13

DPP-4 inhibitors side effects

Answer 13

well tolerated

pancreatitis risk

Question 14

thiazolidinediones action

Answer 14

Activate PPARG receptor in adipocytes

adipogenesis & FA uptake

Question 15

thiazolidinediones side effects

Answer 15

weight gain
fluid retention
bladder cancer

Question 16

thiazolidinediones example

Answer 16

pioglitazone

Question 17

SGLT-2 inhibitors

Answer 17

selective sodium glucose contransporter 2 inhibitors

inhibits glucose reaborption in kidney

Question 18

SGLT-2 inhibitors example

Answer 18

-gliflozins

empagliflozin

Question 19

SGLT-2 inhibitors side effects

Answer 19

UTI (bacteria love sugar)

weight loss

Question 20

GLP-1 agonists action

Answer 20

mimics incretin

inhibits glucagon secretion

Question 21

GLP-1 agonists example

Answer 21

-tide

Question 22

GLP-1 agonists side effects

Answer 22

N & V

pancreatitis

Question 23

who do I NOT give metformin to

Answer 23

GFR <30

increased chance of lactic acidosis

Question 24

if HbA1c still >58

Answer 24

add gliptin first, then another

if 3 not effective add a GLP-1 agonist

Question 25

ACE inhibitors in T2D

Answer 25

reno-protective against nephropathy afrocarribean (offer + CCB/thiazide)

Question 26

BP target in T1D, albuminuria, metabolic syndrome

Answer 26

130/80 | 140/90 - otherwise

Question 27

what drug do I avoid when already on thiazide

Answer 27

beta blockers impaired insulin secretion insulin resistance impaired response to hypoglycaemia

Question 28

basal bolus

Answer 28

rapid acting insulin with meals | long acting insulin at bedtime

Question 29

biphasic 30/70 mixed insulin - T2D uncontrolled

Answer 29

30% rapid 70% intermediate increase night dose slowly?

Question 30

acanthosis nigricans

Answer 30

associated w T2 diabetes

Question 31

best investigation for dm

Answer 31

HbA1c glycated Hb reflects exposure over last 6-8wks

Question 32

serum osmolality

Answer 32

2x (Na + K) + Urea + Glucose

Question 33

DKA path?

Answer 33

infection, missed insulin, MI uncontrolled lipolysis FFAs --> ketones

Question 34

DKA features

Answer 34

``` abdominal pain polyuria, dipsia dehydration kussmaul resp acetone breath ```

Question 35

DKA diagnosis

Answer 35

glucose >11 ph <7.3 ketones >3 or ++ bicarb <15

Question 36

DKA mgmt?

Answer 36

0.9% saline 1L over 30 minutes (if sbp <90) when glucose <15mmol/L start 5% dextrose infusion IV insulin 0.1 units/kg/hr K replacement (insulin)

Question 37

HHS path?

Answer 37

hyperosmolar hyperglycaemia state - T2D osmotic diuresis w loss of Na/K - severe dehydration, high glucose - raised serum osmolarity >320 - hyper-viscous blood - clot risk

Question 38

HSS diagnosis

Answer 38

hypovolaemia hyperglycaemia >30mmol/L without sig ketone/acidosis serum osmolarity >320

Question 39

HSS management

Answer 39

IV 0.9% saline - gradually normalise osmolality if need to normalise glucose - insulin LMWH

Question 40

Insulin side effects

Answer 40

weight gain | ...

Question 41

complications of DM

Answer 41

end-stage renal failure

Question 42

autonomic symptoms of hypoglycaemia

Answer 42

``` Sweating Hunger Anxiety Tremor Palpitations ```

Question 43

neuroglycopenic symptoms of hypoglycaemia

Answer 43

``` Confusion Drowsiness Seizures Coma Personality change ```

Question 44

causes of hypoglycaemia

Answer 44

``` exogenous insulin/gliclazide insulinoma liver failure addisons alcohol ```

Question 45

investigating DKA in ED

Answer 45

VBG

Question 46

Diabetes insipidus

Answer 46

- nephrogenic = no response to ADH | - cranial = pit dysfunction, no ADH (treat w desmopressin)

Question 47

Water deprivation test

Answer 47

low, high = cranial | low, low = nephrogenic

Question 48

T1D antibodies

Answer 48

Anti-islet | Anti-GAD

Question 49

diabetes screening for complications

Answer 49

``` Macro - Pulses - BP - Cardiac auscultation Micro - Fundoscopy - ACR + U+Es - Sensory testing plus foot inspection ```