epidemiology: 80 70 60 90( 80, 70, 60, 90 )% of diabetes patients are type 2. 2-3 1-2 3-4 4-5( 2-3, 1-2, 3-4, 4-5 ) million people in the UK know they have diabetes. diabetes affects 2 1 3 4( 2, 1, 3, 4 )% of the British population with prevalence increasing.
which of the following is not a symptom of diabetes?
polyuria
polydipsia
nocturia
weight loss
lethargy
increased frequency of infections
wounds that won't heal
polyphagia
diarrhoea
what are the diagnostic results that would indicate diabetes? random glucose > fasting glucose > HbAc1 >
which of the following tests is gold standard for diabetes insipidus?
fasting glucose
random glucose
OGTT
HbA1c
water deprivation test
which of the following would not cause an inaccurate HbA1c result?
pregnancy
HIV positive
end stage CKD
patients <18
symptoms for <2 months
T1DM
people on steroids
liver cirrhosis
symptomatic patients need or more positive results out of RBG, FBG and HbA1c. asymptomatic patients need or more.
diet education for management of diabetes: T2 = ❌ T1 = ❌
match the insulin to the correct box
match the type 2 diabetes medication to its action: ❌ - reduces hepatic glucose output and increases insulin sensitivity ❌ - stimulate insulin secretion but can cause weight gain and hypoglycaemia ❌ - inhibits breakdown of CHO and prevents glucose absorption by slowing carbohydrate digestion and increasing length of satiety ❌ - stimulate insulin production, enhances beta cells proliferation, reduces appetite, suppresses glucagon secretion, reduces hepatic glucose output, slows gastric emptying, and causes weight reduction ❌ - block reabsorption of glucose at the proximal tubules of the kidney to increase glucose excretion in urine
match the type of T2DM to the example GLP1 - ❌ SGLT2 - ❌ sulphonylureas - ❌
which of the following is not a diagnostic test for type 1 diabetes?
islet cell autoantibodies
anti-GAD
C-peptide
anti-VEGF
in diabetic pre-pregnancy planning the patient must have tight glycaemic control for a minimum of months preconception.
which of the following is not a common complication of pregnancy with diabetes?
hypermesis
miscarriage
congenital heart disease
increased risk of placental insufficiency
increased risk of pre-eclampsia
macrosomia
still births
DKA
spina bifida
which of the following is not a risk factor for gestational diabetes?
BMI >30
family history
South-East Asian/African origin
previous macrosomia >4.5kg
previous gestational diabetes
age
all high risk women are screened for diabetes at 16 weeks
DKA definition: glucose is above 15 10 12 17( 15, 10, 12, 17 )mmol/L and ketones are above ++ + +++( ++, +, +++ ), venous bicarb is below 15 20 25 10( 15, 20, 25, 10 ) or pH is below 7.3 7.4 7.35 7.25( 7.3, 7.4, 7.35, 7.25 )
increased decreased( increased, decreased ) plasma glucose --> positive negative( positive, negative ) feedback on beta cells of the pancreas --> decreased increased( decreased, increased ) insulin production --> positive negative( positive, negative ) feedback on the liver, muscle and adipose tissue --> negative positive( negative, positive ) feedback on glycolysis, glycogenesis, lipogenesis and glucose transport --> decreased increased( decreased, increased ) plasma glucose --> negative positive( negative, positive ) feedback on beta cells of the pancreas
which of the following does not counteract the action of insulin?
glucagon
catecholamine
growth hormone
cortisol
oestrogen
insulin deficiency --> lipolysis --> increased free fatty acids --> ketone body production --> metabolic acidosis
which of the following is not a trigger for a DKA?
infection
MI
stroke
trauma
SGLT2 inhibitors
lithium
clozaline
cocaine
beta blockers
which of the following is not a symptom of DKA?
confusion
abdominal pain
pear drop breath
vomiting
obtundation
rapid weight loss
which of the following is not a part of management for DKA?
IV fluids
IV insulin
VTE prophylaxis
potassium supplement
magnesium supplement
hypoglycaemia is blood glucose <mmol/L
30 10 20 5( 30, 10, 20, 5 )% of diabetics experience a hypoglycaemic coma once during their lives. 10 5 15 20( 10, 5, 15, 20 )% of type 1 diabetics suffer 1 episode of severe hypoglycaemia per year. 50 30 40 60( 50, 30, 40, 60 )% of type 1 patients have a blood glucose <3.5 on any one night.
which of the following is not a symptom of hypoglycaemia?
tremor
sweating
tachycardia
slurred speech
agression
falls
TIA
irritability
palpitations
if glucose is <4mmol/L give 100ml of 20% glucose
which of the following is not a nerve palsy associated with diabetes
peripheral neuropathy
double vision
foot drop
erectile dysfunction
loss of sensation in the tongue
up to 50 30 40 20( 50, 30, 40, 20 )% of people with a diabetic foot ulcer will die within 5 1 2 3 4( 5, 1, 2, 3, 4 ) years of their index ulcer.
charcots foot occurs due to small ❌ in the foot leading to altered ❌. this leads to foot and ankle ❌ which could potentially need to be ❌. treat by ❌ the foot and giving ❌ and specialised footwear.
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