Endocrinology: Diabetes Mellitus Overview

Practice flashcards covering the clinical features, investigations, management, and complication monitoring for Diabetes Mellitus Type I and Type II based on lecture notes.

What are the clinical features of Diabetes Mellitus type I?

Acute onset of polydipsia, polyuria, polyphagia, weight loss, fatigue, secondary enuresis, and ketoacidosis.

What are the next and best step investigations for Diabetes Mellitus type I?

The next step is a urine dipstick for sugar; the best step is a random glucose measurement of $\ge 11.1\,mmol/L$.

What is the initial management and follow-up target for Diabetes Mellitus type I?

Admit to hospital for insulin therapy and follow-up with $HbA1c$ every $3$ months with a target of $\le 7\%$.

What are the specific clinical features and associations of Diabetes Mellitus type II?

Asymptomatic presentation, metabolic syndrome, Acanthosis nigricans, skin tags, hirsutism, recurrent skin/genital infections, and chronic fatigue.

What are the diagnostic thresholds for Diabetes Mellitus type II?

Random blood glucose $\ge 11.1\,mmol/L$, fasting blood glucose $\ge 7.0\,mmol/L$ (repeated), or HbA1c \b ≥ 6.5\% on two occasions.

In which scenarios might $HbA1c$ lack accuracy for diagnosing type 2 diabetes?

Acute-onset glycaemic states (pancreatitis, sepsis, steroid use), within four months post-partum, haemoglobinopathy, haemolysis, advanced chronic kidney disease, iron deficiency (artificially elevated), or recent blood/iron transfusion.

According to Table 2, what is the role of the Oral Glucose Tolerance Test (OGTT)?

Specifically used when there is an uncertain level of blood glucose, it is the only method able to detect impaired glucose tolerance (IGT).

Which vaccinations are recommended for patients with both Type I and Type II Diabetes Mellitus?

Pneumococcal, Influenza, and dTPA.

How is diabetic nephropathy monitored and managed in its early stages?

Monitor via yearly albumin/creatinine ratio in a spot urine sample and yearly GFR. Start ACE inhibitors if microalbuminuria ($3$ to $29\,mg/mmol$) is present.

When should a diabetic patient be referred to a nephrologist?

When the $eGFR < 30\,mL/min$.

What is the follow-up schedule for diabetic retinopathy if no retinopathy is initially present?

Screening should occur not later than $5$ years after diagnosis and be repeated at least every two years.

What are the referral timeframes for proliferative retinopathy and vitreous haemorrhage?

Proliferative retinopathy or macular oedema requires an urgent referral to an ophthalmologist; vitreous haemorrhage requires a same-day referral.

What is the recommended frequency for foot care assessments based on neuropathy status?

If no neuropathy is present, perform an annual foot assessment; if neuropathy is present, a podiatry review is required every $3$ to $6$ months.