What clinical features support a diagnosis of type 1 diabetes in adults?
Onset before age 50, BMI <25 kg/m², rapid weight loss, and presentation with ketosis
How is type 1 diabetes diagnosed biochemically?
Hyperglycaemic symptoms plus random plasma glucose ≥11.1 mmol/L—or fasting ≥7.0 mmol/L; diagnosis confirmed with repeat or second test. (HbA1c not recommended for rapid-onset type 1.)
What key areas should annual review for diabetic adults include?
HbA1c, BP (target varies by albuminuria), lipids, urine ACR, renal function, TSH, foot/eye exams, injection sites, dental checks due to periodontitis risk
How should hypoglycaemia be managed acutely?
If conscious and able to swallow: 10–20 g fast-acting carbohydrate (e.g., 5 glucose tablets, 200 mL juice); recheck in 10–15 minutes and repeat if needed; follow with longer-acting carbs. If unconscious: IM glucagon (≥8 yrs or >25 kg = 1 mg); call emergency services if no response
When might an SGLT-2 inhibitor be considered as monotherapy?
If metformin is contraindicated, or if there’s high CVD risk (QRISK2 ≥10% or lifetime risk factors), and if a DPP-4 inhibitor would otherwise be chosen, and sulfonylurea/pioglitazone aren’t appropriate
What are the key features of DPP-4 inhibitors (“gliptins”)?
Weight-neutral, low hypoglycaemia risk, safe in mild/moderate CKD (dose adjustment needed), contraindications minimal
Benefits and cautions of pioglitazone?
Improves insulin sensitivity; may cause weight gain, fluid retention, risk of heart failure, fractures, and bladder cancer risk
SGLT-2 inhibitors advantages and cautions?
Weight loss, low hypoglycaemia risk, cardiovascular and renal benefits. Risks include DKA, UTIs, and caution in CKD with dose adjustment
Key features of sulfonylureas (Gliclazide)?
Risk of weight gain and hypoglycaemia; inexpensive; useful for rapid glucose lowering
Who should be offered thyroid testing even without classic symptoms?
Adults with type 1 diabetes/other autoimmune disease and those with new-onset atrial fibrillation. Consider testing in depression or unexplained anxiety
Define subclinical hypothyroidism (SCH)
TSH above reference range with T4 within the reference range
What TFT pattern suggests central (secondary) hypothyroidism?
Low FT4 with low/normal (inappropriately normal) TSH → consider pituitary disease; refer.
How often to monitor TSH after starting/changing T4 in adults?
Every 3 months until stable (two similar results 3 months apart), then annually
How quickly can TSH normalise after initiating levothyroxine if baseline TSH was very high?
It may take up to 6 months—bear this in mind when adjusting doses
When should adults with SCH be offered levothyroxine?
If TSH ≥10 mIU/L on two occasions 3 months apart
If SCH is untreated in adults, how often to recheck?
Annually if features suggesting thyroid disease (e.g., autoantibodies or prior surgery); otherwise every 2–3 years.
Name two situations where you start lower LT4 doses and up-titrate slowly.
Older adults (≥65) and those with cardiovascular disease
Give two counselling points to avoid levothyroxine malabsorption.
Take consistently, usually on an empty stomach, and separate from interacting medicines (e.g., iron/calcium) by several hours
Which antibody is diagnostic for Graves’ disease?
TSH-receptor antibodies
Which antithyroid drug is preferred in the first trimester of pregnancy?
Propylthiouracil (PTU) in early pregnancy (then consider switching to carbimazole later).
Which definitive therapy is preferred in young pregnant women with severe hyperthyroid disease?
Surgery (thyroidectomy) — radioiodine is contraindicated in pregnancy.
When is treatment of subclinical hyperthyroidism recommended?
Consider treatment if age >65, presence of atrial fibrillation, or increased risk of osteoporosis/fracture.
How often should TFTs be checked after starting an antithyroid drug?
Initially every 4–6 weeks to titrate dose, then less frequently once stable.
What are the key features of myxoedema coma?
Hypothermia, altered mental status, bradycardia, hyponatraemia — emergency IV levothyroxine + supportive care.
