Diabetes

Question 1

How is type 2 diabetes managed?

Answer 1

1) Diet & exercise
2) Standard/modified release Metformin (Sulphonylurea if Metformin CI)
3) Metformin + Sulfonylurea/Thiazolidinedione/DPP-4i
4) Try triple oral therapy (Metformin & one of step 3 & either Sitagliptin/Exenatide/Pioglitazone/Liraglutide)
HbA1c not achieved: Add insulin

Question 2

What factors cause an increased in insulin requirement?

Answer 2

DKA/HHS
Sepsis
Steroids
Missed doses
Pancreatitis
Dehydration

Question 3

What factors cause a decrease in insulin requirements?

Answer 3

 Reduced calorific intake
 Reduced renal function (may
reduce drug excretion)
 Alcohol

Question 4

How is type 2 diabetes diagnosed?

Answer 4

Fasting glucose: >7 Impaired: 6.1-6.9

Impaired glucose tolerance: <7

Question 5

How often should HbA1c be measured?

Answer 5

Every 3-6months til unchanging therapy

Every 6months when HbA1c & therapy stable

Question 6

What are the HbA1c targets?

Answer 6

48mmol/mol: Lifestyle or lifestyle + 1 drug (not hypoG associated)
53mmol/mol: Drug associated w/hypoglycaemia

Question 7

Is self-monitoring routinely offered? What are the exceptions?

Answer 7

No
On insulin
Evidence of hypoglycaemic events
Oral meds inc chance of hypoG while driving/ using heavy machinery
Pregnant/trying

Question 8

What are the contraindications of Metformin?

Answer 8

CKD
OH- Abuse
Recent MI
AKI
Dehydration
Sepsis
Withhold: Contrast Xray