diabetes

Question 1

If a patient is symptomatic of T2D then what is necessary criteria to diagnose?

Answer 1

a fasting glucose greater than or equal to 7 or a random glucose greater than or equal to 11.1

Question 2

If patient is asymptomatic how can T2D be diagnosied?

Answer 2

a fasting glucose greater than or equal to 7 or a random glucose greater than or equal to 11.1 but must be repeated on two separate occasions

Question 3

A HBA1C reading of 48 mmol/mol?

Answer 3

diagnostic of diabetes if symptomatic, if no symptoms repeat test

Question 4

Name some conditions where HbA1c may not be used for diagnosing T2D?

Answer 4

haemoglobinopathies, IDA anaemia, haemolytic anaemia, children, HIV, CKD

Question 5

a fasting glucose of what level would put a patient in the prediabetes category?

Answer 5

fasting glucose 6.1-6.9 mmol/l

Question 6

How do you define impaired glucose tolerance?

Answer 6

a fasting plasma glucose of less than 7.0 mmol/L and a OGTT 2 hour value greater than 7.8 but less than 11.1

Question 7

If a patient is taking metformin for T2DM, at what point should you add a second line drug?

Answer 7

Only if HbA1c rises to 58 mmol/mol, otherwise encourage lifestayle changes and uptitrate metformin first

Question 8

If a patient is already on one drug but their HbA1c has rised to 58 then what should their target be?

Answer 8

53 mmol/mol

Question 9

If you are starting a patient on diabetes medication that has an established cardiovascular risk, what should you give them?

Answer 9

metformin and then once established, add an SGLT2

Question 10

What to do if metformin is not tolerated due to GI side effects?

Answer 10

switch to modified release metformin

Question 11

What kind of drug is dapagliflozin?

Answer 11

An SGLT2

Question 12

Contraindications to SGLT2?

Answer 12

diabetic ketoacidosis, anyone with active foot disease, complicated UTIs

Question 13

How do SGLT2 inhibitors work?

Answer 13

Act on SGLT2 in proximal convoluted tubules to reduce reabsoprtion of glucose and promote glucose excretion

Question 14

If a T2 diabetic patient has fine glucose control but a raised ACR what should they be given?

Answer 14

SLGT2 - all patients with T2D and raised ACR should be given this, in addition to ACEI

Question 15

What kind of drug is sinagliptin?

Answer 15

DPP4 inhibitors / gliptins

Question 16

How do DPP4 inhibitors work?

Answer 16

They increase incretins GLP1 and GIP which inhibit glucagon release and in turn increase insulin release

Question 17

Which T2D meds are given by injection?

Answer 17

Insulin and GLP1 analogues (eg liraglutide, semaglutide)

Question 18

What eGFR should metformin be stopped?

Answer 18

at eGFR 30

Question 19

Examples of sulfonylureas?

Answer 19

gliclazide, glipizide, glimepiride

Question 20

How do sulfonylureas work? (gliclazide)

Answer 20

They stimulate insulin release from beta cells

Question 21

What are the downsides of sulfonylureas?

Answer 21

Hypoglycaemia and weight gain

Question 22

How does acarbose work?

Answer 22

It blocks disaccharidase in the GI tract, reducing absorption of glucose

Question 23

How do the thiazolidinediones/ glitazones work? (pioglitazone)

Answer 23

They activate PPARs, improving insulin sensitivity

Question 24

Some disadvantages of pioglitazone?

Answer 24

it can cause weight gain, oedema so avoid in HF, and also fractures and bladder cancer

Question 25

How does liraglutide (GLP1 analogue work)

Answer 25

it stimulates insulin release from pancreas and reduces appetite

Question 26

If someone has had pancreatitis before which diabetes drug should they avoid?

Answer 26

GLP1 analogues eg liraglutide

Question 27

If someone is on triple therapy for diabetes and still has HbA1C over 58 and a BMI greater than 35 kg/m2 what therapy should be started?

Answer 27

GLP-1 therapy

Question 28

If someone is on triple therapy for diabetes and still has HbA1C over 58 and a BMI lower than 35 kg/m2 what therapy should be started?

Answer 28

insulin

Question 29

BP target in T2D patient over the age of 80?

Answer 29

150/90 (if less than 80 then aim for 140/90)

Question 29

What does basal-bolus insulin therapy involve?

Answer 29

3 injections of rapid acting insulin with meals, 1 injection of long acting insulin in evening

Question 30

lipid modification drug dose for someone with T2D and known CVD?

Answer 30

atorvastatin 80mg

Question 31

lipid modification for people with T2D, no CVD but a QRISK >10%?

Answer 31

Atorvastatin 20mg

Question 32

What can we use for people who using HbA1c is invalid?

Answer 32

fructosamine

Question 33

Contraindication to prescribing sulfonylurea (glicazide)?

Answer 33

severe renal impairment, prescribe with caution in mild to moderate impairment as increased risk of hypoglycaemia

Question 34

If triple therapy wasnt effective and one of the meds were switched for a GLP1 mimetic, whats the indication for continuing with the GLP1?

Answer 34

Only continue with it if theres a reduction of HbA1c of at least 11 mol and a weight loss of at least 3% of body weight in 6 months

Question 35

Which diabetes drugs cause weight gain?

Answer 35

sulfonyureas (glicazide), pioglitazone, insulin

Question 36

What will you find when diagnosing a patient with hyperosmolar hyperglycaemic state?

Answer 36

1) hypovolaemia, 2) marked hyperglycaemia (>30 mmol/L) without significant acidosis or keonaemia, 3) significantly raised serum osmolarity >320

Question 37

How to estimate serum osmolarity?

Answer 37

2Na + glucose + urea

Question 38

Treatment for HSS?

Answer 38

fluid resus 0.9% sodium chloride, if osmolarity isnt declining then switch to 0.45%. Don't give insulin unless signif keonaemia, replace potassium as required

Question 39

Diagnostic critera for DKA?

Answer 39

glucose >11mmol/L or known diabetes, pH <7.3, bicarbonate <15mmol/L, ketones >3 or urine ketones ++ on dipstick

Question 40

Differentiating alcoholic ketoacidosis and diabetic ketoacidosis?

Answer 40

AKA usually occurs after a heavy drinking episode, followed by poor oral intake. AKA blood glucose levels usually normal or low

Question 41

insulin in DKA?

Answer 41

IV insulin infusion at 0.1 unit/kg/hour. Once blood glucose is less than 14mmol/l an infusion of 10% dextrose should be started at 125mls/hour in addition to the 0.9% sodium chloride regime. Long acting insulin should be continued, short acting stop

Question 42

Autoantibodies involved in T1DM?

Answer 42

glutamic acid decarboxylase antibodies, islet cell cytoplasmic autoantibodies, insulinoma associated 2 antibodies, and insulin autoantibodies

Question 43

When should T1 diabetics monitor their blood glucose?

Answer 43

at least four times a day including beofre each meal before bed

Question 44

what are the blood glucose targets for T1 diabetic patients?

Answer 44

5-7 mmol/L on waking and 4-7 mmol/L before meals at other times of the day

Question 45

Use of metformin in T1DM?

Answer 45

consider adding if BMI is greater than 25

Question 46

What is maturity onset diabetes of the young?

Answer 46

development of type 2 diabetes on patients less than 25, inherited in an autsomal dominant way

Question 47

what is diabetic nephropathy characterised by?

Answer 47

proteinuria, progressive decline in GFR and high BP

Question 48

pain management in diabetic neuropathy?

Answer 48

usually starts with tricyclic antidepressant or gabapentinoid. If initial treatment not tolerated can try SNRI

Question 49

DKA resolution is defined by?

Answer 49

pH >7.3 and blood ketones < 0.6 mmol/L and bicarbonate > 15.0mmol/L

Question 50

How do sulfonylureas work?

Answer 50

they increase pancreatic insulin secretion