LTC

Question 1

Diagnostic criteria for diabetes

Answer 1

Random blood glucose >11.1mmol/L with osmostic Sx

Fasting blood glucose >7mmol/L

OGTT >11.1mmol/L

HbA1c >48mmol/mol (6.5%)

Question 2

Process of OGTT

Answer 2

Fast for 8-12h before test - no food/ just water
Given sugary drink containing 75g glucose
Blood glucose taken either every 30 mins or just once at 2h

Question 3

Gene associated with t1dm

Answer 3

HLA DR3/DR4

Question 4

Risk factors for t2dm

Answer 4

Increasing age
Smoking
Obesity
PCOS
Hypertension
Ethnicity - south asian / afrocarribean
Family history
Hx of GDM

Question 5

Biguanide example, mechanism and side effects

Answer 5

Metformin

Decreases gluconeogensis, increases insulin sensitivity

S/E - Nausea, GI upset inc diarrhoea, abdo pain
Lactic acidosis if reduced renal function

Question 6

Sulphonylurea example, mechanism and side effects

Answer 6

Gliclazide
Increases insulin secretion

S/E - main one is hypoglycaemia, also causes weight gain

Question 7

DPP4 Inhibitor example, mechanism and side effects

Answer 7

Sitagliptin

Increases incretin, therefore decreases glucagon

S/E - headache, myalgia

Question 8

Pioglitazone mechanism and side effecs

Answer 8

Increases PPAR-gamma expression, hence decreasing insulin resistance and decreasing gluconeogenesis

S/E - weight gain, increased infection risk, numbness, fluid retention

Question 9

Suffix of DPP4 inhibitor drugs

Answer 9

Gliptin

Question 10

Suffix of SGLT2 inhibitors

Answer 10

-Gliflozlin

Question 11

SGLT2 inhibitor examples, mechanism, S/E

Answer 11

Empagliflozlin

Blocks glucose reabsorption in kidneys

S/E - increased infection risk

Question 12

GLP analogue examples

Answer 12

Exenatide

Liraglutide

Question 13

GLP analogue mechanism

Answer 13

Decreases gluconeongenesis, increases insulin production, decreases hunger, decreases GI motility (feel fuller)

Question 14

Rapid acting insulins

Answer 14

Novorapid

Humalog

Question 15

Short acting insulins

Answer 15

Actrapid

Humulin S

Question 16

Intermediate insulins

Answer 16

Insulitard

Humulin I

Question 17

Long/Ultralong Insulins

Answer 17

Determir

Glargine

Question 18

Describe 3 insulin regimes

Answer 18

Once-daily basal insulin

Twice-daily mix insulin - breastfast and tea time, usually with Humulin M3

Basal-Bolus therapy - long acting basal with rapid/short boluses with meals

Question 19

4 injection sites for insulin

Answer 19

Abdomen
Upper arm
Thigh
Buttock

Question 20

Symptoms of HHS

Answer 20

History >1 week
Dehydration
Altered GCS
Neurological signs - blurred vision, tremor
N+V
Malaise, weakness

Question 21

Diagnostic features of HHS

Answer 21

Clinical dehydration
Glucose >30mmol/L
Low ketones
pH >7.3
Osmolality >320mOsmol/kg

Question 22

Management of HHS

Answer 22

Fluids
LMWH prophylaxis
K+ replacement
IV insulin if no improvement with fluids

Question 23

Symptoms of DKA

Answer 23

Drowsiness
N+V
Abdominal pain
Sweet smelling breath
Kussmaul breathing - deep and laboured

May be history of trigger e.g. infection, MI, chemo, poor insulin compliance.

Question 24

Diagnosis of DKA

Answer 24

Acidaemia - pH <7.3
Hyperglycaemia - glucose >11.0mmol/L
Ketonaemia - >=3mmol/L or ketonuria >++

Question 25

Management of DKA

Answer 25

Fluids IV insulin Assess for K+ replacement

Question 26

Management of hypoglycaemia

Answer 26

10-15g fast acting CHO e.g. 200ml orange juice Buccal glucose gel if inconscious / drowsy Reassess BM in 10-15 mins, can repeat CHO after IV therapy: 1. IV dextrose 2. IV glucagon - won't work if pt malnourished After BM has been corrected (>=4mmol/L), give long-acting CHO e.g. toast

Question 27

Diagnosis of diabetic nephropathy

Answer 27

Microalbuminuria - Albumin:Creatinine Ratio >=3

Question 28

Two tests used to screen for diabetic nephropathy

Answer 28

Albumin-Creatinine Ratio | Serum creatinine - to estimate eGFR

Question 29

Management of diabetic nephropathy

Answer 29

Control DM Consider ACEi/ARB Statin - to manage cardiovascular risk

Question 30

Stage 1, 2 and 3 diabetic retinopathy and management

Answer 30

Stage 1 = background retinopathy. Dots - red microaneurysms, blots = haemorrhage Stage 2 = pre-proliferative retinopathy Cotton wool spots - white ischaemia Stage 3 = proliferative retinopathy Ischaemia --> growth factor release --> formation of new, fragile blood vessels Stage 2+ should be referred to ophthalmology for pan-retinal photocoagulation

Question 31

9 things done in yrly diabetic review

Answer 31

1. BP 2. BMI 3. Serum cholesterol 4. Serum creatinine 5. Albumin:Creatinine Ratio 6. Smoking history 7. Diabetic foot review 8. Eye screening 9. HbA1c