Fight Club - Endocrinology

Front 1

what percent of Australians are estimated to have diabetes?

Back 1

7.5% (half are undiagnosed)

Front 2

list five risk factors for diabetes (or more!)

Back 2

genetic susceptibility, sedentary lifestyle, obesity, visceral adiposity, inflammation, dyslipidaemia, hypertension, age > 55, FHx, GDM, PCOS, prior IGT/IFG

Front 3

what percent of diabetics are Type 1?

Back 3

15-20%

Front 4

which are T2DM more susceptible to: MiV or MaV complications?

Back 4

Macrovascular complications

Front 5

when should screening for end-organ complications begin in T2DM?

Back 5

at diagnosis, as complications are usually already present

Front 6

when should screening for end-organ complications begin in T1DM?

Back 6

from 5 years after onset

Front 7

what is the primary determinant of end-organ complications in diabetes?

Back 7

Blood Glucose Levels

Front 8

in diabetes mellitus, what is the target level for LDL-C?

Back 8

<2.6 mmol/L

Front 9

in diabetes mellitus, what is the target level for HDL-C?

Back 9

>1.0 mmol/l

Front 10

in diabetes mellitus, what is the target level for TGs?

Back 10

<1.7

Front 11

in diabetes mellitus, what is the target level for total-cholesterol?

Back 11

<4.0

Front 12

what is the most common cause of death in T2DM?

Back 12

cardiovascular disease

Front 13

what is the most common cause of vision loss in the working age?

Back 13

T2DM

Front 14

how many amputations per year (in Australia) are attributed to T2DM?

Back 14

3000

Front 15

physical activity and diet can reduce HbA1c by how much?

Back 15

1.50%

Front 16

by the WHO's definition, what Fasting Plasma Glucose level is considered 'Diabetic'?

Back 16

≥ 7.0 mmol/L

Front 17

by the WHO's definition, what 2-hour OGTT level is considered 'Diabetic'?

Back 17

≥ 11.0 mmol/L

Front 18

by the WHO's definition, what Fasting Plasma Glucose level is 'normal'?

Back 18

≤ 6.1 mmol/L

Front 19

by the WHO's definition, what 2-hour OGTT level is considered 'normal'?

Back 19

≤ 7.8 mmol/L

Front 20

what are the three cornerstones of treating T2DM?

Back 20

education, diet & exercise (and the fourth one is 'love')

Front 21

poor glycaemic control of T2DM with oral medication is an indication for augmenting treatment with?

Back 21

insulin injections

Front 22

Actrapid, Humulin R, Novorapid, Humalog, Apidra are examples of what medication?

Back 22

rapid acting insulins (to be taken prior to meals)

Front 23

Protaphane, Humilin NPH, Lente, UltraLente, Monotard, Lantus, Levemir are examples of what medications?

Back 23

Long-acting insulins (to be taken prior to bedtime)

Front 24

Mixtard, Humulin, Humalog Mix25, Novomix 30 are examples of what medications?

Back 24

Pre-mixed insulin combinations

Front 25

what is the target HbA1c level for T2DM?

Back 25

< 7.0%

Front 26

what is first line management for T2DM?

Back 26

lifestyle intervention, then metformin

Front 27

what are the three options that should be considered if diabetes is not controlled with lifestyle & metformin?

Back 27

1) basal insulin, 2) sulfonylurea, 3) glitazone

Front 28

what is the benefit of adding basal insulin to poorly controlled T2DM?

Back 28

it is the most effective option for obtaining control

Front 29

what is the benefit of adding sulfonylurea to poorly controlled T2DM?

Back 29

it is the least expensive option to add on, of second line options

Front 30

what is the benefit of adding glitazone to poorly controlled T2DM?

Back 30

there is no increased risk of hypoglycaemia

Front 31

what patients with T2DM are considered 'high risk' and should be screened for ischaemic heart disease?

Back 31

those with: a) dyslipidaemia, b) hypertension, c) family history

Front 32

what investigations should be considered for IHD, in T2DM patients?

Back 32

stress ECG, stress echo, stress nuclear scan, hi-res CT

Front 33

what management options should be considered for IHD, in T2DM patients?

Back 33

anti-hypertensives, statins, aspirin, stenting/CABG

Front 34

in detection of nephropathy, what levels are considered 'microalbuminuria'?

Back 34

20-200ug/min

Front 35

how is microalbuminuria detected?

Back 35

urinalysis: albumin/creatinine ratio

Front 36

how long does it take for microalbuminuria to commence in DM, typically?

Back 36

10-15 years

Front 37

how long does it take for macroalbuminuria to commence in DM, typically?

Back 37

15-20 years

Front 38

what is the definition of macroalbuminuria?

Back 38

> 200ug/min

Front 39

how is macroalbuminuria detected?

Back 39

urine dipstick

Front 40

which is a more sensitive indicator of renal function decline: serum or urine creatinine?

Back 40

urine; serum creatinine rises late in renal impairment

Front 41

how many times is it necessary to measure proteinuria to diagnosis nephropathy?

Back 41

2 or more times

Front 42

what is the antihypertensive of choice to protect the kidneys in diabetes?

Back 42

ACE-I/ARB

Front 43

callus formation is typically found where on diabetic feet?

Back 43

the tarsal heads

Front 44

what are risk factors for foot ulceration in diabetes?

Back 44

ischaemia, infection, patient compliance, neuropathy, deformity

Front 45

in testing diabetics for peripheral neuropathy, what is the best predictor of ulceration in the following year?

Back 45

insensate to monofilament

Front 46

how should peripheral neuropathy (the feet) of diabetics be managed?

Back 46

proper foot wear, podiatry care, pressure offloading, dress/debride

Front 47

how should moderate diabetic retinopathy be managed?

Back 47

no immediate treatment; increase frequency of checks, to annual

Front 48

diabetic retinopathy which demonstrates small haemorrhages and hard exudate, but no new vessels is classified as?

Back 48

'mild' to 'moderate'

Front 49

diabetic retinopathy which demonstrates large haemorrhages, soft exudates and dilated/tortuous veins is classified as?

Back 49

'severe', or 'pre-proliferative'

Front 50

what is the management strategy for severe diabetic retinopathy?

Back 50

increase frequency of checkups (from annual)

Front 51

diabetic retinopathy which demonstrates new vessels on the disc/elsewhere (NVD/NVE) is classified as?

Back 51

proliferative'

Front 52

what is the management strategy for proliferative diabetic retinopathy?

Back 52

Pan-retinal laser treatment (often curative)

Front 53

T1DM patients are afflicted primarily with what type of retinopathy?

Back 53

Proliferative retinopathy

Front 54

T2DM patients are afflicted primarily with what type of retinopathy?

Back 54

Macular oedema

Front 55

diabetic retinopathy which demonstrates increased diameter of the macula, proximal exudates, and haemorrhages is classified as?

Back 55

Macular oedema

Front 56

what is the management for macular oedema?

Back 56

laser treatment (though not definitive; often recurs)