Diabetes

Question 1

Diagnosis of type 2 diabetes?

Answer 1

Fasting glucose >7.0
Random glucose >11.1
HbA1c >48

If asymptomatic must be demonstrated on two occasions

Question 2

What is pre-diabetic HbA1c?

Answer 2

42-47 mmol/mol

or 6.0-6.4%

Question 3

When can’t HBa1c be used?

Answer 3

Haemoglobinopathies
Haemolytic anaemia
Iron deficiency anaemia
Gestational diabetes
Children
HIV
Chronic kidney disease

Question 4

Symptoms of diabetes?

Answer 4

Polyuria
Polydipsia
Blurred vision
Fatigue
UTI

Question 5

Stimulants of insulin release?

Answer 5

Increased glucose
Amino acids
Fatty acids
Cortisol
Gastrin
Secretin
Glucagon
Incretins
Parasympathetic stimulation

Question 6

Inhibitors of insulin release?

Answer 6

Sympathetic stimulation
Decreased glucose
Somatostatin

Question 7

Actions of GLP-1?

Answer 7

Enhanced insulin secretion
Inhibition of glucagon release
Prolonged gastric emptying
Satiety

Question 8

Normal insulin release?

Answer 8

Biphasic
Immediate - stored insulin
Later - newly synthesised insulin

Question 9

Effects of insulin on the liver?

Answer 9

Increased glycogen synthesis
Increased protein synthesis
Decreased gluconeogenesis

Question 10

Effects of insulin on muscle?

Answer 10

Increased protein synthesisi
Increased glycogen synthesis
Increased glucose uptake
Increased amino acid uptake

Question 11

Effects of insulin on adipose tissue?

Answer 11

Increased triglyceride storage
Increased triglyceride synthesis
Decreased lipolysis

Question 12

Causes of hypoglycaemia?

Answer 12

EXPLAIN
EXogenous drugs - sufonylureas+insulin
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours
Non-pancreatic neoplasms

Question 13

When to add another medication after metformin therapy?

Answer 13

HbA1c >58

Question 14

Recommended blood glucose monitoring in type 1?

Answer 14

4 times a day

Including before each meal + before bed

Question 15

What can give falsely high HbA1c level?

Answer 15

Splenectomy
Iron deficiency anaemia
Vitamin B12/folic acid deficiency

Question 16

Lower than expected HbA1c level?

Answer 16

Sickle cell anaemia
GP6D deficiency
Hereditary spherocytosis

Question 17

Sick day rules for insulin?

Answer 17

Increase monitoring frequency
Drink at least 3L in 24h
Maintain carbohydrate intake

Question 18

What is diabetic ketoacidosis?

Answer 18

A state of hyperglycaemia, acidosis and ketonemia

Question 19

Mild DKA?

Answer 19

Plasma glucose >13.9
Arterial pH 7.25-7.3
Serum bicarbonate 15-18
Ketones - +
Anion gap >10
Alert

Question 20

What is MODY?

Answer 20

Maturity onset diabetes of the young
Type 2 diabetes in <25
Autosomal dominant

Question 21

MODY3?

Answer 21

HNF1A mutation
60% of cases
Risk of HCC

Question 22

MODY2?

Answer 22

Glucokinase gene mutation

20% of cases

Question 23

Features of MODY?

Answer 23

<25
Family history of early onset diabetes
Ketosis not a feature
Sensitive to sulfonylurea

Question 24

DVLA diabetes mellitus?

Answer 24

No severe hypo event in last 12 months
Full hypo awareness
Adequate control of glucose monitoring
Understanding of risks of hypoglycaemia

Question 25

How to differentiate between sulfonylurea hypo and insulin hypo?

Answer 25

Sulfonylurea - raised insulin and C-peptide

Question 26

What is C-peptide

Answer 26

Cleaved part of insulin | Only present in endogenous insulin

Question 27

Causes of secondary diabetes?

Answer 27

``` Pancreatic disease Pheochromocytoma Thyroxicosis Acromegaly Cushing's syndrome Glucagonoma Drug induced Congenital lipodystrophy Haemochromatosis Glycogen storage disease ```

Question 28

Risk factors for T2DM?

Answer 28

``` Obesity Lack of physical activity Ethnicity Gestational diabetes Low fibre, high glycemic diet Metabolic syndrome Polycystic ovary syndrome ```

Question 29

First line T2DM?

Answer 29

Dietary control | if pharmacological metformin

Question 30

Second line T2DM?

Answer 30

Sulfonylureas DPP4 inhibitors SGLT2 inhibitors Meglitinides

Question 31

Adverse of sulfonylureas?

Answer 31

Hypoglycemia | Weight gain

Question 32

Adverse of DDP4 inhibitors?

Answer 32

?

Question 33

Adverse of SGLT2 inhibitors?

Answer 33

Urinary infections DKA Weight loss

Question 34

Adverse of meglitinides?

Answer 34

?

Question 35

Features of a hypo?

Answer 35

``` Tachycardia Sweating, clammy Anxiety Numbness of extremities Sleepiness Confusion Headaches Slurred speech ```

Question 36

Treatment of hypo?

Answer 36

Glucose | Glucagon

Question 37

Treatment of hypo secondary to excess insulin secretion?

Answer 37

Diazoxide - potassium channel activator - inhibition of insulin release

Question 38

What HHS?

Answer 38

Hyperosmolar hyperglycemic syndrome Brought on by illness or poorly controlled diabetes Hyperglycemia result in body getting rid of excess sugar through urine = loss of salt

Question 39

Symptoms of HHS?

Answer 39

Thirst Fever Dry mouth

Question 40

HHS treatment?

Answer 40

0.9% NaCl Insulin Potassium

Question 41

Severe non-proliferative diabetic retinopathy?

Answer 41

Microaneurysms >20 intraretinal haemorrhage in each quadrant Cotton wool spots Venous bleeding

Question 42

Proliferative diabetic retinopathy?

Answer 42

Neovascularisation | Preretinal haemorrhage

Question 43

Advanced diabetic eye disease?

Answer 43

Fibrovascular tissue formation | Retinal detachment

Question 44

Mild non proliferative diabetic retinopathy?

Answer 44

Microaneurysms only