Diabetes mellitus and other disorders of metabolism

19 Diabetes mellitus and other disorders of metabolism



Questions




Question 1


I would like to know the exact mechanism of entry of potassium into cells under the influence of insulin.



Question 2


I am seeing an increasing number of diabetic patients in primary care who have elevated fasting blood glucose readings but postprandial measurements that are normal or only slightly high. Does this indicate insulin resistance in these patients? What is the reason for this trend?



Question 3


What are the latest diagnostic criteria for the diagnosis of diabetes mellitus?



Question 4


What test is recommended for diabetes and can the same be used to diagnose diabetes in a child?



Question 5


What is the value of glycosylated haemoglobin (HbA1C) in diabetes mellitus?



Question 6


I read in a book that in diabetics the random blood sugar is more important than the fasting; on a medical website I noted that, for a patient with type 2 diabetes, the fasting blood sugar level is more important. What do you say?


Is it acceptable to let the fasting blood sugar remain at approximately 1.5mmol/L above the upper limit in a patient of >60 years with type 2 and presently on oral therapy?



Question 7


In type 2 diabetes, which blood sugar – fasting or random – is more revealing prognostically?



Question 8


Why are the fasting and 2-hour blood glucose levels needed in a diabetic patient being treated with oral antidiabetic drugs?



Question 9


Is it sufficient to use a fasting blood sugar and glycosylated haemoglobin (HbA1C) level as a guide to modify the insulin or oral antidiabetic dose without considering the 1 and 2 hour postprandial values?



Question 10


What is the value of the 2-hour postprandial blood sugar level above which the dose of an oral antidiabetic should be increased if this value is exceeded several times despite dietary modification?



Question 11


What does BM mean in relation to blood sugar monitoring?



Question 12


What is the role of urine examination in diabetic control?



Question 13


Diabetes and diet: could the authors of my favourite medical text please advise whether or not it is acceptable to have controlled quantities of refined sugar, providing the total calorie intake is kept under control?



Question 14


Do non-obese patients with impaired fasting glucose, i.e. a glucose level of 6.1-6.9mmol/L, need drug treatment with biguanides if lifestyle modifications fail to normalize?



Question 15


Do non-obese patients with impaired glucose tolerance (but not fulfilling the criteria for diabetes mellitus) need drug treatment with biguanides if lifestyle modifications fail to normalize their post-prandial blood glucose measurements?



Question 16


It is the Muslim month of fasting currently. I would be grateful if you could advise on how to adjust the insulin regimen of a type 1 diabetic patient, for example a 21-year-old girl who is on subcutaneous Actrapid (short-acting soluble insulin) 22 units t.d.s.



Question 17


I would like to know more about the use of the glitazone group in type 2 diabetes: its action, side-effects, precautions taken on using them.



Question 18


In a patient receiving oral antidiabetics, should the drug be administered just after taking the blood sample for fasting blood glucose level (and before a meal), or just prior to the sample being taken?



Question 19


What oral antidiabetics are safe in pregnancy?



Question 20


Is it necessary to put all type 2 diabetics on aspirin?



Question 21


In the chapter on diabetes you wrote that you should avoid tablets before age of 40 years in non-insulin-dependent diabetes mellitus (NIDDM). Why is this, because in our country most doctors are prescribing this?



Question 22



1. Should a patient poorly controlled on glibenclamide 15mg a day and metformin 1500mg a day be moved onto insulin?

2. What are the indications for insulin in type 2 diabetics?


Question 23


What happens to the insulin-secreting capacity of a type 2 diabetic placed on insulin therapy earlier than recommended? Can the external supply of insulin improve the functional capacity of the insulin-secreting cells, to some extent by providing some rest to these cells?



Question 24



1. Is inhaled insulin a suitable substitute for injectable insulin?

2. Is there, or will there soon be, insulin in the form of a tablet?


Question 25


What are the complications of insulin other than hypoglycaemia and injection?



Question 26


I would like to know the processes that go into administering the Alberti’s/modified Alberti’s regime in patients with uncontrolled diabetes mellitus.



Question 27


Is there any role for steroids in the management of resistant diabetes mellitus (daily insulin requirement exceeding 100 units/day)? Don’t they make glycaemic control worse?



Question 28


What is the importance of potassium chloride (KCl) in the treatment of a diabetic patient (pre-operative care)? The formula in the text is explained as 16 U of insulin + 10mmol of KCl + 500mL 10% glucose.



Question 29


What is the cut-off point of daily albumin excretion above which a diabetic patient without hypertension should be given an angiotensin-converting enzyme (ACE) inhibitor?



Question 30


What is the urinary concentration or 24-hour urine albumin content above which angiotensin-converting enzyme (ACE) inhibitors should be started in diabetic patients? Does an albumin (in microgram)/creatinine (in milligrams) ratio above 30 in the morning sample indicate a need for this?



Question 31


Do potassium channel activators such as nicorandil have any benefit in the treatment of a diabetic patient with cardiovascular complications?



Question 32


Is a dosage of 2.5mg/day of methyltestosterone, as a component in some multivitamin formulae, safe to give to diabetics or will it make the diabetes more difficult to control (see also Chapter 5, question 5)?



Question 33


How does diabetes mellitus cause atherosclerosis?



Question 34


How does diabetes cause renal damage, especially diabetic nephropathy with the presence of microalbuminuria?



Question 35


Type 1 diabetes causes nephropathy in 40% of cases and type 2 causes it in 20% of cases but the most common cause of nephropathy we see is type 2, why?



Question 36


Why is intractable vomiting seen in diabetes mellitus and how can it be managed?



Question 37


Is gabapentin superior to carbamazepine in terms of efficacy in the treatment of painful diabetic neuropathy? What are its side-effects?



Question 38


Why is diabetic ketoacidosis more common in type 1 diabetes?



Question 39


Why is there abdominal pain in diabetic ketoacidosis?



Question 40


Grades of ketonuria are sometimes mentioned. I have not been able to locate a detailed description in textbooks and would be grateful if you could explain the grades of ketonuria or recommend suitable reading material.



Question 41


What false-positive factors could cause ketone bodies to appear in the urine in a non-diabetic patient?



Question 42


Why is tetanus not seen in a diabetic foot wound?



Question 43


Can impaired glucose tolerance cause recurrent lower motor facial palsy?



Question 44


Can long-term diabetes mellitus cause vertigo not accompanied by other brainstem signs?



Question 45


We know that type 2 diabetes mellitus provokes left ventricular diastolic dysfunction. Does chronic stable angina, associated with type 2 diabetes mellitus, further increase the prevalence of left ventricular diastolic dysfunction?



Question 46


Is there adequate evidence for choosing an angiotensin-converting enzyme (ACE) inhibitor or antagonist for the initial management of raised blood pressure in type 2 diabetes, or is it now advisable to choose any tolerated antihypertensive?



Question 47


Why is there immunosuppression in diabetes?



Question 48


Dextrose infusion in quinine induced hypoglycaemia causes more hypoglycaemia, so what is to be used?



Question 49


Does the serum cholesterol level rise with age?



Question 50


Please explain the significance of having normal total high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol but a raised lipoprotein (a) [Lp(a)] in a normotensive, non-smoking patient?



Question 51


In the diet of hypercholesterolaemic patients, should milk and other dairy products be restricted?



Question 52


Should a 20-year-old, either male or female, with a blood cholesterol level of 300mg/dL and with hypercholesterolaemic parents, be treated?



Question 53


Why are lipid-lowering drugs (statins) administered at bed time?



Question 54


What is the best statin now and what is your opinion about Crestor 10mg (rosuvastatin) and Lescol XL (fluvastatin sodium)?



Question 55


How long do statins take to achieve their maximum benefit?



Question 56


If, after 4 months of taking simvastatin (20mg daily), a patient with hyperlipidaemia and hypertension has an increased aspartate transferase (AST) of up to 60U/L, with a normal alanine transferase (ALT), what action should I take?



Question 57


How long should the statins be continued once the lipid profile returns to normal? Can we stop the statins once normal levels are attained and then continue with diet modification?



Question 58


What is the exact mechanism of corneal arcus? What is its clinical significance? What is its relationship to hyperlipidaemia? Is there any effective treatment in medicine or alternative medicine to remove corneal arcus?

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Diabetes mellitus and other disorders of metabolism

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