Endocrinology

Question 1

Pathophysiology of Type 2 Diabetes Mellitus

Answer 1

pancreatic beta cell production becomes insufficient due to insulin resistance

Question 2

Diagnosis criteria for T2DM

Answer 2

HbA1c >=48mmol/mol (6.5%)
Random blood glucose >=11.1mmol/l
Fasting plasma glucose >=7mmol/l
2 hour glucose tolerance >=11.1mmol/l

If patient is asymptomatic, two results needed on different days

Question 3

Complications of Diabetes

Answer 3

Retinopathy
Gastroparesis
Autonomic Neuropathy
Peripheral Artery Disease
Diabetic Foot Infections
Sexual Dysfunction
Cardiac Complications

Question 4

Management of T2DM

Answer 4

Initial: Metformin (up to 2500mg normal or 2000mg slow release)
Add in SGLT-2s (especially if Qrisk)
Pioglitazone (not in HF)
DPP-4 inhibitors
Gliclizide (sulphonylurea)

Insulin if still cannot control

Question 5

Dysfunction of what cells causes diabetes?

Answer 5

Beta cells in the Islets of Langerhans that are responsible for insulin secretion

Question 6

Target BP for T2DM?

Answer 6

<= 140/90mmHg

Question 7

Pathophysiology of T1DM?

Answer 7

Autoimmune condition in which the immune system targets and destroys the insulin-producing cells of the pancreas - beta cells in the Islets of Langerhans

Question 8

Presentation of T1DM?

Answer 8

Polyuria, polydipsia and weight loss

Question 9

Diagnosis of T1DM?

Answer 9

Random BM >11mmol/L or raised fasting glucose >7mmol/L

Question 10

Management of T1DM?

Answer 10

Insulin replacement with personalised regimen of short-acting (after meals and snacks) and long-term (at night) insulin replacement.

1st line: Basal bolus insulin regimen (2/5th long acting, 3/5ths short acting - 1/5th per meal)

Question 11

Presentation of hypoglycaemia

Answer 11

Irritability, abdo pain, sweating, dizziness, loss of consciousness and even fits

Question 12

Management of hypoglycaemia

Answer 12

If alert: sugary drinks, gels and snacks

If unconscious:
- out of hospital = intramuscular glucagon
- in hospital = IV dextrose

Question 13

Complications of T1DM

Answer 13

Delay in puberty and obesity
Hypertension
Renal disease
Retinopathy
Feet

Question 14

Associated illnesses with T1DM

Answer 14

Thyroid disease (most associated; screening recommended)
Coeliac disease

Question 15

What is diabetic ketoacidosis?

Answer 15

medical emergency characterised by hyperglycaemia, acidosis and ketonaemia

Question 16

Diagnosis of DKA

Answer 16

Ketonaemia >= 3mmol/L
Bicarbonate < 15 mmol/L or venous pH < 7.3

Sometimes: Blood glucose >11mmol/L

Question 17

Presentation of DKA

Answer 17

Fruity breath
Vomiting
Dehydration
Abdominal pain
Hyperventilation
Hypovolaemic shock
Drowsiness
Coma