Endocrine - Diabetes and Complications

Question 1

what causes T1DM?

Answer 1

autoimmune destruction of the pancreatic islet cells
causes beta cell failure
absolute insulin deficiency results

Question 2

what autoantibodies can those with T1DM have?

Answer 2

GAD

islet auto antigen 2 (IA-2)

Question 3

symptoms of T1DM?

Answer 3

wt loss
tired
thirsty
thrush
blurred vision
polyuria
sweet smelling urine

Question 4

Ix for T1DM? what level is needed for diagnosis?

Answer 4

HbA1c ≥48
fasting glucose ≥7
OGTT ≥11.1
random glucose ≥11.1

Question 5

what treatment regime is used for T1DM? names of drugs?

Answer 5

basal bolus regime
long acting e.g lantus
rapid acting e.g humalog

Question 6

what are the mealtime targets for T1DM? how many times should BM be checked?

Answer 6

pre meal 4-7
1-2hrs after <10

atleast 4 times a day

Question 7

what should T1DM aim for with their HbA1c?

Answer 7

48

Question 8

at a DM annual review, what is covered?

Answer 8

weight
BP
HbA1c
U+Es, eGFR, A:C, lipids
urinalysis
insulin injections
retinal + foot screening

Question 9

features of a DKA?

Answer 9

thirst
tired
blurred vision
polyuria
vomiting 
kussmaul's respiration

Question 10

Ix in DKA and results?

Answer 10

ketones >3
BM >11
bicarbonate <15/pH <7.3 (acid)
high K, low Na
high creatinine
high lactate
high amylase

Question 11

Tx for a DKA?

Answer 11

500ml NaCl + KCl
Insulin with 0.9% NaCl
continue long acting subcut regime 
Glucose 10% once BM <14
LMWH

FIND CAUSE

Question 12

what bloods should be monitored in DKA?

Answer 12

K
BM
blood ketones

Question 13

features of a hypo?

Answer 13

sweating 
pale
tremor
palpitations
nausea
hungry
confused

Question 14

Tx for a hypo?

Answer 14

20-30g glucose IV/buccal/oral (depending on consciousness level)

Question 15

what is charcot’s athropathy?

Answer 15

destructive inflammatory process of a foot with neuropathy

Question 16

how is MODY inherited?

Answer 16

aut dom

Question 17

what causes MODY?

Answer 17

gene defect causing impaired insulin secretion from pancreatic beta cells

Question 18

risk factors for T2DM?

Answer 18

FHx
CVD
HT
PCOS
obesity
inactivity
GD

Question 19

pathology behind T2DM?

Answer 19

progressive loss of beta cells

background of insulin resistance due to adiposity and lipotoxicity

Question 20

blood test and results for diagnosis of T2DM?

Answer 20

HbA1c ≥48
fasting ≥7
OGTT ≥11.1
random ≥11.1

Question 21

what is the HbA1c aim for T2DM?

Answer 21

<53

Question 22

drug pathway for T2DM?

Answer 22

metformin
+ DPP-4 or TZD or SU

metformin + DPP-4 +SU
OR
metformin + TZD + SU

insulin

Question 23

example of a DPP-4, SU, TZD?

Answer 23

DPP-4 = sitagliptin
SU = gliclazine
TZD = pioglitazone

Question 24

what cholesterol lowering drugs are given in T2DM? when?

Answer 24

20mg atorvastatin

Question 25

BP target for T2DM?

Answer 25

135/85mmHg (at home) 140/90 in GP (10 above if over 80)

Question 26

what complications can diabetes lead to?

Answer 26

macrovascular - stroke - CVD - PVD - ED microvascular - retinopathy - nephropathy - neuropathy (peripheral and autonomic)

Question 27

who usually presents with hyperglycaemic hyperosmolar syndrome?

Answer 27

old patients frail high carb intake

Question 28

how does hyperglycaemic hyperosmolar syndrome present?

Answer 28

hypovolaemia hyperglycaemia no ketonaemia high osmolality

Question 29

what is the pathology behind diabetic nephropathy?

Answer 29

afferent arteriole dilates hyperfiltration and increased GFR high glucose causes renal hypertrophy nephrotic syndrome can result

Question 30

what are the features of nephrotic syndrome?

Answer 30

proteinuria hypoalbuminaemia oedema

Question 31

Ix for diabetic nephropathy?

Answer 31

urinalysis albumin:creatinine ratio eGFR U+Es

Question 32

BP aim for those with diabetic nephropathy?

Answer 32

130/80mmHg

Question 33

Tx for diabetic nephropathy?

Answer 33

ACE/ARB statins BP and BM control transplant

Question 34

who gets hyperosmolar hyperglycaemic state?

Answer 34

old people | T2DM with some insulin deficiency

Question 35

what can increase risk of hyperosmolar non ketotic coma?

Answer 35

diuretics | steroids

Question 36

features of hyperosmolar non ketotic coma?

Answer 36

dehydrated coma polyuria polydipsia

Question 37

Ix for hyperosmolar non ketotic coma?

Answer 37

``` BM (>50) ABG FBC U+Es ketones plasma osmolarity ```

Question 38

Tx for hyperosmolar non ketotic coma?

Answer 38

``` NaCl + KCl (if neede) Insulin Glucose (once BM lowers) heparin warfarin ```

Question 39

what blood results are needed to a T1DM diagnosis?

Answer 39

hyperglycaemia symptoms + fasting/random once OR fasting/random twice OR OGTT

Question 40

what levels are defined as an impaired fasting glucose?

Answer 40

fasting <7 OGTT >7.8 but <11.1

Question 41

what levels are defined as an impaired glucose tolerance?

Answer 41

fasting >6.2 but <7

Question 42

what is the management for those with an impaired fasting glucose/glucose tolerance?

Answer 42

lifestyle | annual review

Question 43

what drug is favoured in treating MODY?

Answer 43

SU (e.g gliclazide)

Question 44

at what HbA1c should a second drug be added in T2DM?

Answer 44

58

Question 45

what drugs causes hypos?

Answer 45

SU | incretins (exanatide)

Question 46

what drug increases risk of thrush?

Answer 46

SGLT-2 (dapagloflozin)

Question 47

what drugs to avoid in CKD?

Answer 47

SU

Question 48

what drugs cause wt gain?

Answer 48

SU | TZDs