Diabetes

Question 1

Diabetes diagnosis by random BG

Answer 1

over 11.1 = diabetes

Question 2

Risks of uncontrolled T1DM during pregnancy

Answer 2

Teratogenic, CNS deformities (spina bifida, anencephaly), great vessels abnormalities, larger birth weight, stillbirth, pre-eclampsia, prematurity

Question 3

Management of diabetes in pregnancy

Answer 3

T1DM: insulin
T2DM: Metformin or insulin (for pregnancy)
Stop smoking/alcohol, take folic acid

Question 4

Autoimmune diseases associated with diabetes

Answer 4

Cushings, Acromegaly, Addisons, aplastic anaemia

Question 5

When can you start diabetes drugs?

Answer 5

If lifestyle changes have been tried for at least 1 month

Question 6

Which pathway is responsible for macroscopic vascular complications of diabetes?

Answer 6

Poyol pathway/aldose-reductase pathway (active when high IC glucose)

Question 7

Aldose reductase has a _____ Km compared with glucokinase

Answer 7

High

Question 8

How often is creatinine checked in diabetes and what does it mean?

Answer 8

Once a year - AKI

Question 9

Effect of insulin on BP

Answer 9

increases BP (Na retention)

Question 10

BP target in diabetes

Answer 10

140/80

Question 11

Capillary microangiopathy

Answer 11

Thickened, permeable, dilated BVs –> neuropathy, nephropathy, retinopathy

Question 12

Neuropathic foot ulcer

Answer 12

Over areas of high pressure, metatarsal heads or big toe

Question 13

Ischaemic foot ulcer signs/symptoms

Answer 13

Margins of feet, cold feet, absence of pulses, loss of hair, skin thinning, gangrene

Question 14

X-ray appearance of charcot arthropathy

Answer 14

bag of bones appearance

Question 15

Max dose of Metformin

Answer 15

3g per day

Question 16

When do you have to inform the DVLA?

Answer 16

If on insulin, had >1 severe hypo in last year, neuropathy, retinopathy

Question 17

Management of DKA

Answer 17

1) Fluids - 500ml 0.9% NaCl in 30 mins (3L by 4 hours)
2) IV insulin 6 units/hour
3) 10% dextrose
3) NG tube, ECG, screen for MI, antibiotic prophylaxis, CXR
4) BG hourly, BK 4 hourly, UandEs every 2 hours
5) K replacement once if less than 5

Question 18

ECG signs of hyperkalaemia

Answer 18

Tall tented T waves, broad QRS

Question 19

Why is there hyperkalaemia in DKA?

Answer 19

No insulin to drive K into cells = high EC K, but total body K is low

Question 20

How long should you wait to stop IV insulin after subQ Insulin given?

Answer 20

30 mins (takes 30 mins for subQ to start working and IV has a half life of a few mins)

Question 21

When do you stop IV Insulin?

Answer 21

Patient is eating and drinking
Ketones cleared
Bicarbonate is normal

Question 22

Fasting BG in diabetes

Answer 22

over 7 = diabetes
6 or less = normal
6.1-6.9 = pre-diabetes

Question 23

Differences in managing DKA in adults and kids

Answer 23

10ml/kg fluids
Fluid restriction (risk of cerebral oedema)
Insulin 1 hour after IV fluids started

Question 24

How much insulin should you give (carb counting)?

Answer 24

1 unit per 10g

1 unit drops by 2mmol

Question 25

Macrosomia

Answer 25

Larger birth weight over 4kg

Question 26

Treatment of MODY

Answer 26

SU - Glibenclamide

Question 27

Management of gestational DM

Answer 27

Lifestyle, Metformin, Insulin | OGTT 6 weeks post natal

Question 28

Gestational DM

Answer 28

Mother has a degree of insulin resistance and placental hormones tip over the edge Increased risk of developing T2DM Presents in 3rd trimester

Question 29

BP treatment in pregnancy

Answer 29

Methyldopa, Nifedipine

Question 30

Diabetes complications

Answer 30

Macrovascular: IHD, Stroke Microvascular: neuropathy, nephropathy, retinopathy Psychiatric ED

Question 31

Peripheral neuropathy

Answer 31

Pain/loss of feeling in feet or hands

Question 32

Autonomic neuropathy

Answer 32

Changes in bower/bladder function, sexual response, sweating, HR, BP, hypoglycaemic unawareness Gastric slowing/gastroparesis, dysphagia

Question 33

Proximal neuropathy

Answer 33

Pain in thighs/hips/buttocks = weakness in legs (amyotrophy)

Question 34

Focal neuropathy

Answer 34

sudden weakness in nerve/group of nerves = muscle weakness/pain e.g. CTS, foot drop

Question 35

Only drug used in end stage kidney failure/dialysis

Answer 35

Pioglitazone (TZD)

Question 36

Treatment of ED

Answer 36

Lose weight, less alcohol, improve lipids, review drugs, Sildenafil

Question 37

Treatment of hypoglycaemia

Answer 37

15g carbs/glucose (glucose tabs, gel, lucozade, sweets) | Glucagon 1mg

Question 38

Hypoglycaemic unawareness

Answer 38

Inability to detect hypo, no symptoms, longstanding DM

Question 39

Biochemical diagnosis of DKA

Answer 39

``` Ketnonaemia over 3 (0.06 or less is normal) BG over 11 Bicarbonate less than 15 K over 5.5 Low Na High lactate pH less than 7.3 ```

Question 40

Complications of DKA

Answer 40

Cardiac arrest Cerebral oedema ARDS Gas in stomach -> aspiration and gastric dilation -> ARDS

Question 41

HHS

Answer 41

``` Elderly, MI, sepsis, steroids/diuretics, fizzy drinks T2DM Higher glucose than DKA Bicarbonate raised Elevated osmolality (normal 285-295) ```

Question 42

How to calculate osmolality

Answer 42

2 x (Na + K) + urea + glucose

Question 43

Treatment of HHS

Answer 43

Cautious fluids Slow insulin Screen for vascular event Diet

Question 44

How is lactate formed?

Answer 44

Anaerobic metabolism of glucose

Question 45

Lactic acidosis

Answer 45

``` High lactate High anion gap Type B - diabetes Type A - tissue hypoxia Hyperventilation, confusion, coma ```

Question 46

How to calculate anion gap

Answer 46

[Na + K] - [HCO3- + Cl-]

Question 47

Diagnosis of diabetes by HbA1c

Answer 47

Over 48 = diabetes | 42-47 = pre-diabetes