Quiz:

1. How to dx DM? Page 15

2. Lists the indications for screening of DM page 12
3. How to advice patient for OGTT?
a. Normal diet within 3 days before OGTT
b. Fast 8-10 hours. Can drink plain water only.
c. Come early morning
d. FPG
e. Drink 75g glucose + 250 ml water (drink within 5 mnutes)
f. Within 2 hours, don’t do anything, just rest at the klinik
g. After 2 hours, venous blood obtained.
4. List medications available for DM. Page 30
5. Complications of DM
a. Acute (how to manage?)
i. Hypo – Mx – dextrose 50% then dextrose 10%
ii. Hyper
iii. HONK
iv. DKA
b. Chronic
i. Macro
ii.
iii. Micro
iv. Stroke
v. MI
vi. Mix
vii. Diabetic foot
viii. Dermatopathy
ix. ED
6. List the screening tools/ix for complication DM
- Funduscope
- Retinopathy
- On dx
- Yearly
- Urine protein
- Nephropathy
- Urine microalbumin, when positive, within 3 months, repeat.
- Renal profile
- Dx and yearly
- Ecg, dx and yearly
- CVS
- BP measurement
- Cholesterol
- 6 monthly
- Lipid profile
 - Monofilament (how to use)
- Diabetic foot
- Tuning fork
- 128 (usually), 256
- (! 512 for hearing)
- Reflex
- BP sitting and standing
- Autonomic neuropathy
- Direct question
- ED
7. How to advice pt on using insulin therapy
Max dose
Pregnant lady
Preop
Stress – eg: infection
Type 1 DM
How?
Storage
In the freezer, at chiller (2-8 degrees)
Time
Site of injection
Abdomen 1 (a lot of capillary vessels)
Deltoid 3
Gluteus
Thigh 2
Complications
Kna inform
Symptoms?
Conscious – sweets, air gula
Unconscious – honey at buccal mucosa

Osce – pen insulin

If IFG or IGT > lifestyle changes plus medication (metformin or rosiglitazone only)

Metformin:

- MOA
- SE
- 500mg TD

Rosiglitazone
 - SE > hear toxicity

Glibenclamide, SUs

- Can cause beta-cells exhaustion

- Glibenclamide – easy to get hypoglycemia

Dimicron or dimicron MR

- Dimicron – BD dose, before or after meal

- Di MR – OD dose

BSP?