Endo

Question 1

Causes of DM

Answer 1

1) Primary (T1DM, T2DM)
2) Gestational diabetes
3) Secondary:
a. Iatrogenic - steroids, anti-HIV, atypical neuroleptics, thiazides
b. Pancreatic - CF, chronic pancreatitis, HH, pancreatic cancer
c. Endo - cushings, phaeo, acromegaly, T4
d. Other - glycogen storage disorder

Question 2

Glucose testing parameters for diabetes:
A) Fasting
B) 75g OGTT
C) HbA1c

Answer 2

A) >/= 7
B) >/= 11.1
C) 6.5%

Question 3

Glucose testing parameters for normal:
A) Fasting
B) 75g OGTT

Answer 3

A) 6.1

B) 7.8

Question 4

Management of diabetes - STEP 1 = lifestyle modifications. These include….?

Answer 4

DELAYS
D - diet –> healthy eating, complex carbs, decrease sugars, decrease calories, decreased fat and sodium, avoid binge drinking…
E - exercise
L - lipids: 1º prevention if over 40 with statin (regardless of levels)
A - ABP: aim for >130/80. Treat with ACE-I. Beta blockers mask hypos and thiazides increase glucose.
A - Aspirin: 1º prevention if over 50 or other cardiac RFx
Y - yearly/6 monthly check ups (4Cs)
S - smoking cessation

Question 5

Diabetic monitoring should include…?

Answer 5

The 4 C’s

1. Control, glycaemis - record complications, test capillary glucose and HbA1c, BP and lipids.
2. Complications: macro (BP, cardiac exam and pulses) and micro (fundoscopy, U&Es and ACR, sensory testing)
3. Competency: with injections, BM monitoring
4. Coping: psychological, domestic, occupation

Question 6

Define the metabolic syndrome

Answer 6

Central obesity and two of:

1) Increased triglycerides
2) decreased HDL
3) HTN
4) Hypergycaemia (DM, IGT, IFG)

Question 7

Glucose testing parameters for IGT:
A) Fasting
B) 75g OGTT

Answer 7

A) nil

B) 7.8 - 11.1

Question 8

Glucose testing parameters for IFG:
A) Fasting
B) 75g OGTT

Answer 8

A) 6.1-6.9

B) nil

Question 9

Diabetes management pathway

Answer 9

1) Lifestyle: DELAYS
2) Metformin. Aim HbA1c 6-7.5%. 500mg after evening meals up to max 2g.
3) Metformin + sulphonylurea (e.g. gliclazide 30mg with breakfast)
4) Options in order of preference:
a. Metformin + sulphonylurea + insulin
b. metformin + sulfonylurea + sitagliptin/pioglitazone (if insulin unacceptable)
c. metformin + sulphonylurea + exenatide (if insulin unacceptable or BMI >35)
d. consider acarbose if unable to use anything else.

Question 10

Diabetic complications:

Answer 10

1) General: Infection, hypo’s, DKA and HONK
2) Brain: TIA/CVA
3) Eyes: Retinopathy, maculopathy, cataracts, glaucoma
4) BP: HTN, postural hypotension
5) Heart: coronary syndrome, MI, congestive heart failure
6) Renal: nephropathy
7) Peripheral vascular disease
8) Peripheral neuropathies (Autonomic dysfunction, mononeuropathies, sensory neuropathies, femoral neuropathy)
9) 7+8 = diabtic foot

Question 11

Features of autonomic dysfunction in diabetes

Answer 11

1) Gastroparesis leading to GORD, early satiety…
2) Autonomic diarrhoea
3) Urinary retention
4) Postural hypotension treated with fludrocortisone
5) Erectile dysfunction
6) Anhidrosis and gustatory sweating.

Question 12

Retinopathy grading according to NSC

Answer 12

R0 - none
R1 - background/mild non-prloferative: micro-aneurysms, retinal haemorrhages +/- exudates
R2 - moderate non-proliferative: multiple haemorrhages, IRMA, venous beading
R3 - proliferative
M1 - maculopathy/M0 - no maculopathy

Question 13

Diabetic retinopathy risk factors

Answer 13

Modifiable risk factors:
1) Glucose control
2) BP
3) Lipids
4) Smoking in T1DM
Non-modifiable
1) Pregnancy
2) Age
3) Duration of DM
4) Genetic predisposition