T2DM

Question 1

Patients tend to present with T2DM in youth/middle/late-age and are usually lean/obese?

Answer 1

Middle/late aged patients who are usually obese

Question 2

Ketonuria is strongly evident in T2DM. True/false?

Answer 2

False - it’s minimal or absent (strong = T1DM)

Question 3

Microvascular complications are typically present upon diagnosis of T2DM. True/false?

Answer 3

True - around 20% of patients will have evidence of microvascular changes

Question 4

List the risk factors for developing T2DM (8)

Answer 4

1) Obesity 2) Family history 3) Presence of gestational diabetes 4) Age 5) Ethnicity (Asian, African) 6) PMH of MI/stroke 7) Medications (e.g. antipsychotics) 8) Impaired glucose tolerance

Question 5

Type 4 diabetes is associated with which condition?

Answer 5

Pregnancy (gestational diabetes)

Question 6

True/false: Beta-cell failure occurs early in development of T2DM?

Answer 6

False - first insulin resistance, then beta cell hyperplasia, then failure.

Question 7

Is there a direct correlation between BMI and T2DM development?

Answer 7

Yes - acceleration

Question 8

T2DM is purely beta-cell related. True/false?

Answer 8

False - there are also genetic and environmental factors at play.

Question 9

Microvascular complications are generally present at stage of T2DM diagnosis.

Answer 9

True (30% of cases)

Question 10

What’s the HbA1c target for T2DM patients (<70)?

Answer 10

48-53mmol/L

Question 11

What’s the HbA1c target for older diabetics (>70)?

Answer 11

53-75mmol/L

Question 12

Close glycaemic control in T2DM can reduce macrovascular complications. True/false?

Answer 12

Unclear - limited evidence.

Question 13

Diabetics should have what areas screened & how often?

Answer 13

Kidneys, eyes, feet. Annually.

Question 14

What is the screening test for diabetic nephropathy?

Answer 14

Urinary albumin: creatinine ratio (dipstick)

Question 15

Urinary screening of albumin: creatinine ratio should be taken on what type of urine sample?

Answer 15

Random (not a 1st pass)

Question 16

Which other biochemistry should be checked when assessing urinary albumin: creatinine function?

Answer 16

U&E

Question 17

What are the risk factors for progression of diabetic nephropathy (4)?

Answer 17

1) Hypertension 2) High cholesterol 3) Smoking 4) Poor glycaemic control

Question 18

Which therapy should all patients with microalbuminuria be commenced on?

Answer 18

ACE inhibitor

Question 19

Which eye conditions are diabetics more prone to developing? (3)

Answer 19

Diabetic retinopathy, cataracts, glaucoma (2x more common in diabetes)

Question 20

Is blurry vision in diabetes always irreversible?

Answer 20

No, acute hyperglycaemia can cause blurred vision but is reversible.

Question 21

What’s the most severe form of retinopathy?

Answer 21

Proliferative

Question 22

What treatments are available for diabetic retinopathy? (3)

Answer 22

Laser ablation, vitrectomy, anti-VEGF injection

Question 23

ED presents in which % of diabetic men?

Answer 23

50%

Question 24

This fundoscopy shows what abnormality?

Answer 24

Proliferative retinopathy (notice the new blood vessels forming)

Question 25

Is T2DM preventable?

Answer 25

Yes (in 90% of cases) - by diet and physical activity

Question 26

Good glycaemic control has been shown to reduce microvascular complications by which % at 10 years?

Answer 26

25% at 10 years

Question 27

True/false: T2DM is generally less milder than T1DM.

Answer 27

False - there is no mild form of DM. T2DM can be as severe as T1DM if uncontrolled.

Question 28

What's the primary nutritional strategy for controlling T2DM?

Answer 28

Weight management

Question 29

Which % of T2DM are overweight?

Answer 29

80-90%

Question 30

In nutrition of T2DM, it's more important to consider what sources of energy are in the diet over the total amount of energy in the diet. True/false?

Answer 30

False

Question 31

How many calories in a calorie-deficit diet can safely be prescribed?

Answer 31

600kcal

Question 32

What's a reasonable expected weight-loss following consultation?

Answer 32

5-10%

Question 33

Sugars contribute more than other forms of carbohydrate in the development of DM. True/false?

Answer 33

False - no evidence for this.

Question 35

How often should diabetics have eye screening?

Answer 35

Low risk: every 12 months If retinopathy observable or maculopathy early: every 6 months If any macula haemorrhage OR \>4 retinal haemorrhage: urgent referal for opthalmology

Question 36

BP target in T2DM

Answer 36

\<130/80mmHg

Question 37

Risk factors for progression of nephropathy in diabetes?

Answer 37

Smoking, poor glycaemic control, hypertension, high cholesterol.

Question 38

SGLT drugs act how Example drug

Answer 38

Block glucose reabsorption in PCT. Example: flozin drugs

Question 39

What are the insulin secretagogue drugs

Answer 39

SUR GLP-1 agonists DPP-IV inhibitors

Question 40

Example TZD

Answer 40

Pioglitazone

Question 41

Example DPP-IV

Answer 41

Gliptin

Question 42

Example GLP-1

Answer 42

Exenatide/ Liraglutide

Question 43

Side-effects of SUR drugs

Answer 43

Deranged LFTs, weight gain

Question 44

Side effects of SLGT2s inhibitors

Answer 44

Thrush, UTI

Question 45

Side effect of TZDs

Answer 45

Fracture risk, osteoporosis, heart failure, weight gain

Question 46

Side effect of metformin

Answer 46

Lactic acidosis, GI upset

Question 47

What are the weight-neutral or loss diabetes drugs

Answer 47

Metformin (loss), SGLT2 inhibitors (loss), GLP1, DPP-IV (loss)

Question 48

What are the weight-gaining diabetes drugs?

Answer 48

SURs (e.g. gliclazide), TZDs (e.g. pioglitazone)

Question 49

What is the average BMI the typical non-insulin dependent T2DM presents at?

Answer 49

28

Question 50

At BMI of 30, the risk of developing T2DM is increased how much

Answer 50

40-fold

Question 51

What is acarbose

Answer 51

Alpha-glucoside inhibitor (prevents absorption of glucose across lumen of GI tract)