Diabetes

Question 1

If a patient is being treated with insulin they must also have….

Answer 1

A glucagon kit for emergencies when they are unable to orally ingest short acting carbs

Question 2

Which drug reduces hypoglycaemic awareness

Answer 2

Beta blockers

Question 3

How should you manage patients who have frequent hypoglycaemic episodes

Answer 3

These patients may develop reduced awareness. If this develops then allowing glycaemic control to slip for a period of time may restore their awareness

Question 4

Lipodystrophy

Answer 4

lumps of subcut fat - can be prevented by rotating the injection site

Question 5

How do sulfonylureas work?

Answer 5

They increase pancreatic insulin secretion - so only effective if there are functional B cells present

Question 6

SE of sulfonylureas

Answer 6

1. HYPOGLYCAEMIC EPISODES
2. Weight gain
   Rare but also possible
   - Hyponatraemia (2ndary to SIADH)
   - Bone marrow suppression
   - Hepatoxicity
   - Peripheral neuropathy

Question 7

When to avoid sulfonylureas

Answer 7

In breastfeeding and pregnancy

Question 8

Gliclazide (drug class?)

Answer 8

Sulfonylurea

Question 9

What can give a falsely low HBA1C

Answer 9

• Sickle cell disease
• G6PD
• Hereditary spherocytosis
• Haemodialysis (as it can also lower the lifespan or RBCs)
  This is because all of these cause premature RBC death
  HBA1C is form of Hb that is chemically liked to sugar (and indicates the 3 month average blood sugar level)
  So any condition which alters RBC survival could lead to invalid results

Question 10

What are the 2 variables making up the HbA1c value

Answer 10

1. RBC lifespan
2. Average blood glucose level

Question 11

What can give a falsely high HbA1c

Answer 11

Anything that increases RBC lifespan:
- Vit B12/folate deficiency
- Iron deficiency anaemia
- Splenectomy

Question 12

Young man with T1DM presenting with bloating, vomiting and impaired blood glucose control
What has occurred and why?

Answer 12

Gastroparesis
This occurs due to neuropathy of the vagus nerve causing abnormal gut movement

Question 13

What are the 2 forms of diabetic neuropathy?

Answer 13

1. Peripheral neuropathy
2. GI autonomic neuropathy

Question 14

How does diabetic peripheral neuropathy present?

Answer 14

SENSORY loss not motor loss
Occurs in a glove and stocking dist. with lower legs affected first
(Can also present with pain)

Question 15

How do we manage diabetic neuropathic pain?

Answer 15

1st line = amitriptyline, duloxetine, gabapentin or pregabalin
If 1st line treatment doesn’t work then try one of the other drugs

Question 16

Localised neuropathic pain treatment

Answer 16

Capsaicin

Question 17

What can we use as “rescue therapy” for exacerbations of neuropathic pain

Answer 17

Tramadol

Question 17

How do we manage patients with resistant neuropathic pain

Answer 17

Pain management clinics

Question 18

How does GI autonomic neuropathy present?

Answer 18

1. Gastroparesis
2. Chronic diarrhoea - often occurs at night
3. GORD - caused by decreased lower oesophageal sphincter pressure

Question 19

Symptoms of gastroparesis

Answer 19

1. Erratic blood glucose control
2. Bloating
3. Vomiting

Question 20

How do we manage gastroparesis

Answer 20

1. Metoclopramide
2. Domperidone
3. Erythromycin
   (All prokinetic agents)