Endocrine

Question 1

what is the difference between type 1 and 2 of diabetes

Answer 1

• 1 = deficient insulin secretion
• 2 = insulin resistance

Question 2

what are the HbA1c values for diabetes

Answer 2

• 42 = normal
• 48 = diabetic
• 53 = two or more anti-diabetic drugs (hypo)

Question 3

glucose levels in type 1 in mmol/L

Answer 3

• fasting = 5-7
• before meals = 4-7
• after eating = 5-9 (90 minutes after)
• at least 5 when driving

Question 4

what is the 1st line insulin given in type 2 diabetes

Answer 4

• isophane insulin (NPH)

Question 5

when should monitoring be useful in type 2

Answer 5

• pregnant
• driving
• on insulin
• a lot of hypos

Question 6

what are the conditions to add a GLP-1 in type 2 diabetes

Answer 6

• BMI = 35 or more & problems assoc. with obesity
• BMI = lower than 35 if no insulin for occupational reasons/weight loss benefit for co-morbidities

Question 7

what are the problems with pioglitazone

Answer 7

• bladder cancer
• heart failure

Question 8

what is the problem with gliptins

Answer 8

• pancreatitis
• liver toxicity

Question 9

what are the problems with glifozins

Answer 9

• necrotising fasciitis
• thrush

Question 10

hypos and driving

Answer 10

• stop the car
• go to passenger seat
• short acting (orange juice/glucose liquid)
• after 10-15 minutes, check again
• wait until 45 minutes after return to normal to drive

Question 11

hypos short acting options

Answer 11

• lift liquid
• 4-5 glucose tabs
• 1.5-2 tubes of glucose 40% gel
• 150-200mL pure fruit juice (no orange in low K+)
• 3-4 heaped teaspoons of sugar in water (not in acarbose pts)
• no chocolates/biscuits = high fat & delayed emptying

Question 12

what are the sick day rules

Question 13

what are the drugs that must be stopped temporarily in sickness in diabetes (SADMAN)

Answer 13

• SGLT2 inhibitors = DKA
• ACEi, diuretics, ARBs, NSAIDs= AKI
• metformin = lactic acidosis