Diabetes

Question 1

What Plasma glucose readings are needed for a diagnosis of diabetes

Answer 1

Fasting glucose > 7. Random glucose > 11

If symptomatic need one reading
if asymptomatic need two readings

Question 2

Why is gastroparesis seen in diabetics?

Answer 2

Neuropathy of the vagus nerve due to poor glycaemic control -> causing abnormal gut movement

Typical signs: Erratic blood glucose control, bloating and vomiting

Question 3

What is the HbA1c for diagnosis of pre-diabetes vs diabetes

Answer 3

Pre-diabetes = 42-47 mmol/mol

Diabetes = >48 mmol/mol

Question 4

Which anti-hypertensive is renal-protective and used in diabetics

Answer 4

ACE inhibitors

Question 5

Which nerve palsy is seen in diabetes characterised by drooping of eye lid and eye moving down and out

Answer 5

3rd nerve palsy (occulomotor)

Eye is deviated ‘down and out’
ptosis
Pupil may be dilated

Question 6

Which nerve palsy is seen in diabetes characterised by drooping of eye lid and eye moving inwards with double vision

Answer 6

6th nerve palsy (Abducens)

Diplopia
Eye moves inward

Question 7

Treatment of neuropathic pain in diabetics

Answer 7

first-line: amitriptyline, duloxetine, gabapentin or pregabalin
Rescue therapy for exacerbations: tramadol

Question 8

Gastrointestinal autonomic neuropathy might cause symptoms including..

Answer 8

Gastroparesis
Diarrhoea
GORD

Question 9

Maturity onset diabetes of the young (MODY)

Answer 9

Typically develops in patients < 25 years
FHx early onset diabetes is often present
Very sensitive to sulfonylurea

Question 10

SGLT2 inhibitor side effect

Answer 10

thrush (peeing out glucose)

Question 11

Hypoglycaemic unawareness can be caused by..

Answer 11

Autonomic neuropathy 
Beta blockers (blunt the effect of adrenalin - may not experience warning symptoms such as tremor and palpitations)