Diabetes

Question 1

T1DM presentation?

Answer 1

polyuria
polydipsia
wt loss
dka

Question 2

T1DM genetics?

Answer 2

30% concordance

HLA-D3 and –D4

Question 3

T1DM antibodies?

Answer 3

anti-islet,

anti-GAD

Question 4

T2DM presentation?

Answer 4

polyuria
polydipsia
complications

Question 5

Genetics of T2DM?

Answer 5

concordance in 80%

Question 6

Risk factors for T2DM

Answer 6

obesity,
reduced exercise
calorie and alcohol excess

Question 7

Diagnosis of diabetes?

Answer 7

I. symptoms + one reading of fasting glucose above 7 or random above 11.1

II. asymptomatic + 2 readings of raised plasma glucose
or OGTT: above 11.1 mM

Question 8

OGTT: Normal people fasting glucose level?

Answer 8

<6.1

Question 9

OGTT: Normal people 2hrs post 75g sugar glucose level?

Answer 9

<7.8

Question 10

OGTT: diabetes fasting glucose level?

Answer 10

equal or greater than 7

Question 11

OGTT: diabetes 2hrs post 75g sugar glucose level?

Answer 11

equal or greater than 11.1

Question 12

Drugs causing DM?

Answer 12

• steroids,
• anti-HIV,
• atypical neuroletics,
• thiazides

Question 13

Metabolic Syndrome

Answer 13

↑ risk of MI
Central obesity (↑ waist circumference) and two of:   
- ↑ Triglycerides
- ↓ HDL
- HTN
- Hyperglycaemia: DM, IGT, IFG

Question 14

Principles of monitoring of diabetes?

Answer 14

Monitor 4Cs every 6mo/year

• glycaemic Control
• Complications
• Competency (injection)
• Coping (psychosocial)

Question 15

Diet modifications for diabetes?

Answer 15

• ↓ total calorie intake
• ↓ refined CHO, ↑ complex CHO
• ↑ soluble fibre
• ↓ fat (esp saturated)
• ↓Na

Question 16

Statins in pts with DM?

Answer 16

if >40yrs regardless of lipids

Question 17

Aspirin in pts with DM?

Answer 17

if >50yrs

or <50 with other CVD RFs

Question 18

Oral hypoglycaemics?

Answer 18

• metformin

- sulfonylurea

Question 19

Side effects of metformin?

Answer 19

• nausea,
• diarrhoea,
• abdo pain,
• lactic acidosis

Question 20

CIs to metfromin?

Answer 20

• GFR<30,

- tissue hypoxia (sepsis, MI),

Question 21

Solfonylurea example and dose?

Answer 21

gliclazide MR 30mg with breakfast

Question 22

SE of gliclazide?

Answer 22

• hypoglycaemia

- wt gain

Question 23

1st line treatment of T2DM?

Answer 23

oral hypoglycaemics + insulin

Question 24

2nd line treatment of T2DM

Answer 24

• if insulin
  unacceptable
• metformin + sulfonylurea + sitagliptin (DPP-4 inhibitor) / pioglitazon (thiazolidinedione)

Question 25

3rd line treatment of T2DM?

Answer 25

- Add exenatide (SC) if insulin unacceptable or BMI>35 | - metformin + sulfonylurea + exenatide

Question 26

Common insulin regimes?

Answer 26

- BD biphasic regime - basal-bolus regime - OD long-acting before bed

Question 27

BD biphasic insulin regime?

Answer 27

- BD insulin mixture 30min before breakfast and dinner (for regular lifestyle eg elderly and tom) - Rapid-acting: e.g. actrapid - Intermediate- / long-acting: e.g. insulatard

Question 28

Basal-bolus regime?

Answer 28

- Bedtime long-acting (e.g. glargine) + short acting before each meal (e.g. lispro) - T1DM allowing flexible lifestyle

Question 29

OD Long-Acting Before Bed

Answer 29

Initial regime when switching from tablets in T2DM

Question 30

Insulin requirements during illness?

Answer 30

- Insulin requirements usually ↑ (even if food intake ↓) | - (liver always making glucose even when not eating)

Question 31

Side effects of insulin therapy?

Answer 31

- hypoglycaemia - lipohypertrophy - wt gain in T2DM (give metformin to reduce wt)

Question 32

Diabetes complications?

Answer 32

- Hyperglycaemia: DKA, HHS - Hypoglycaemia - Infection - Macrovascular - Microvascular

Question 33

Macrovascular complications of diabetes?

Answer 33

- MI (may be silent due to autonomic neuropathy) - PVD: claudication, foot ulcers - CVA

Question 34

Diabetic feet ischaemic features?

Answer 34

- critical toes - pulseless - painful ulcers

Question 35

Diabetic feet neuropathic features?

Answer 35

- loss of sensation - deformity: charcot's joints, pes cavus, claw toes - painless ulcers

Question 36

Abx of diabetic foot infection?

Answer 36

benpen + fluclox ± metronidazole

Question 37

Nephropathy pathophysiology in DM?

Answer 37

Hyperglycaemia → nephron loss and glomerulosclerosis

Question 38

Feature of nephropathy in DM?

Answer 38

Microalbuminuria | - urine albumin:Cr (ACR) ≥30mg/mM

Question 39

Presentation of eye complications of diabetes?

Answer 39

- Retinopathy and maculopathy - Cataracts - Rubeosis iris: new vessels on iris → glaucoma - CN palsies

Question 40

Ix for diabetic retinopathy?

Answer 40

fluorescein angiography

Question 41

Background diabetic Retinopathy features?

Answer 41

- Dots: microaneurysms - Blot haemorrhages - Hard exudates: yellow lipid patches

Question 42

Pre-proliferative diabetic Retinopathy features?

Answer 42

- Cotton-wool spots (retinal infarcts) - Venous beading - Haemorrhages

Question 43

Proliferative diabetic Retinopathy features?

Answer 43

- New vessels | - Pre-retinal or vitreous haemorrhage

Question 44

Diabetic Maculopathy features?

Answer 44

- ↓ acuity may be only sign | - Hard exudates w/i one disc width of macula

Question 45

Neuropathy pathophysiology?

Answer 45

I. Metabolic: - glycosylation, - Reactive Oxygen Species (ROS), II. Ischaemia: loss of vasa nervorum

Question 46

Diabetic symmetric sensory neuropathy signs and symptoms?

Answer 46

- Glove and stocking loss - absent ankle jerks - numbness, tingling and pain

Question 47

Treatment of Diabetic symmetric sensory neuropathy?

Answer 47

- Paracetamol - Amitriptylin, Gabapentin, SSRI - Capsaicin cream - Baclofen

Question 48

Diabetic Autonomic neuropathy

Answer 48

1. Postural hypotension 2. Gastroparesis → early satiety, GORD, bloating 3. Diarrhoea 4. Urinary retention 5. Erectile dysfunction

Question 49

Rx of Postural hypotension?

Answer 49

fludrocortisone

Question 50

Dose of metformin?

Answer 50

500mg after evening meal, ↑ing to 2g max.