Diabetes_Type 2

Question 1

Diagnosis of Type 2 DM (symptomatic pt’s)

Answer 1

FBG >7.0 or random BSL >11.1 or HbA1c> 6.5% in symptomatic patients is diagnostic for diabetes

OR

One of the above and a classic sx of diabetes

Question 2

Diagnosis of Type 2 DM
(asymptomatic pt’s)

NOTE: A second laboratory result is required for confirmation of the diagnosis of diabetes in asymptomatic patients.

Answer 2

FBG>7.0 or random BSL >11.1 confirmed by a FBG >7.0 on a separate day.

Oral Glucose Tolerance Test
FBG>7.0 or two hours post glucose ingestion BSL >11.1

HbA1c >6.5 on two separate occasions

Question 3

Impaired GTT

• Definition
• When to prescreen

(RACGP GP handbook)

Answer 3

FBG between 6.1 to 7.0
2 hr glucose between >7.7 to >11.1

Retest on 12 monthly basis

Question 4

What are the clinical sx suggestive of diabetes?

Answer 4

polyuria, polydypsia, lethargy
weight loss 
poor wound healing 
blurred vision 
frequent fungal or bacteria infection 
loss of sensation (e.g. vibration, touch)

(ref: 3.2 page 14 GP Mx of T2DM RACGP)

Question 5

What is the predominant risk factor for developing T2DM?

Answer 5

Age over 40 years (RACGP Check Diabetes) or >18 yrs if ATSI

Question 6

Who should be screened for T2DM?

How often?

Answer 6

Individuals aged >40 years
- screen every three years

Those at increased risk
- screen 12 monthly

Question 7

Who are at increased risk of T2DM?

ref: RACGP GP Mx of T2DM, page 12

Answer 7

previous CVD event 
GDM history
obesity (BMI >30) 
PCOS
Antipsychotic drugs 
People >35 yrs from pacific islands, indian subcontinent or china

Question 8

Impaired fasting glucose affects what proportion of the Australian population?

(ref: RACGP GP Mx of T2DM)

Answer 8

1 in 6

Question 9

What % of ATSI deaths are attributable to diabetes?

ref: RACGP GP Mx of T2DM, page 13

Answer 9

20%

Question 10

What are the clinical signs of insulin resistance?

ref: RACGP GP Mx of T2DM, page 14

Answer 10

Acanthosis Nigricans - hyperpigmentation and velvety change under the neck and axillae

Central Adiposity

Skin Tags

Hirsituism (facial and body hair especially in woman can indicate insulin resistance)

Question 11

Aim of BGL’s and HBA1c for diabetes management?

Answer 11

FBG 6-8
2 hours post prandial 6-10

<7% (except in patients that are very elderly, with end organ damage already, at increased risk of hypoglycemia, weight gain)

Question 12

When is HBA1c not a reasonable measure? i.e. When may it be abnormally high? abnormally low?

(ref: RACGP GP Mx of T2DM, page 51)

Answer 12

Abnormally high 
Haemolytic anemia (e.g. spherocytosis,), haemoglobinopathies 
Recovery from acute blood loss
Chronic Blood Loss
CKD 

Abnormally high 
Fe deficiency anemia 
Splenectomy 
Alcoholism 
Steroid therapy, stress, surgery or illness in the last three months

Question 13

What effect does alcohol have on diabetes?

Answer 13

Increased risk of hypoglycemia

Question 14

Insulin and Sulphonylurea can cause a delay in hypoglycemia after exercise for upto how many hours after exercise?

(ref: RACGP GP Mx of T2DM, page 31)

Answer 14

24hours (can occur 6-12 hours after)

Question 15

What is the goal of exercise?

ref: RACGP GP Mx of T2DM, page 30

Answer 15

150mins/wk
(or 30 mins per day)

At 55-70% of max heart rate (200- (0.7 x [age in years]).

Question 16

Which waist circumference puts patients into the high risk category for diabetes?

Answer 16

> 88 cm for woman

>102 cm for men

Question 17

What are secondary causes of diabetes?

Answer 17

Pancreatitis

Drugs: steroids, thiazides, Estrogen

Haemochromatosis

Trauma

Endocrine: Cushings, PCOS, acromegaly, pheochromocytoma

Gestational DM

Medical or surgical stress

(Murtagh’s)

Question 18

Complications of diabetes?

Answer 18

Kidney's
Neurological 
Infection
Vascular
Eyes 
Skin 

(Murtagh’s)

Question 19

What are the goals of treatment for diabetes type 2:

1. HBA1c
2. BP
3. Lipids
4. Which other medication would you start?

Answer 19

1. <7.0%
2. BP 130<80
   if proteinuria BP <125/75
3. Lipids: TC <4.0, LDL <2.0 (other HDL >1.0, TG <1.5)
4. Start Aspirin 75-100mg/daily

Question 20

What’s the rule of 15 for hypoglycaemia?

Answer 20

The rule of 15 recommends 15 g of quick-acting carbohydrate such as half a glass/can of fruit juice or non-diet soft drink or 6–7 jelly beans initially, repeat the blood glucose check 15 minutes later and then again within 2–4 hours. If the next meal is more than 15 minutes away, a longer acting carbohydrate such as a sandwich should be taken.

(RACGP Check 2015)

Question 21

Goals for
1/ fasting
2/ postprandial BSL

Answer 21

1/ fasting 4 to 8 mmol/L (individualised—in some patients at greater risk of hypoglycaemia, 6 to 8 mmol/L may be appropriate)
2/ <10 mmol/L
(Ref: etg)

Question 22

Screening for T2DM

Answer 22

1/ use AUSDRISK score for >40 year olds
2/ if AUSDRISK >12 - screen for diabetes,
those at high risk = every 3 years
3/ those with impaired fasting glucose = 12 monthly

(RACGP T2DM Guidelines)

Question 23

When should insulin be initiated?

Answer 23

HbA1c is > 75mmol/mol (9.0%) on oral therapy (Ref: ADS_Position statement on new type2 DM…)

Question 24

What is the Risk of developing T2Dm within the next 5 yrs: 
1/ Less than or equal to 5
2/ 6-8 
3/ 9-11 
4/12-15
5/16-19
6/ greater than or equal to 20

Answer 24

1/ 1 in 100 
2/ 1 in 50 
3/ 1 in 30 
4/ 1 in 14 
5/ 1 in 7 
6/ 1 in 3

Question 25

BSL <4.0, what is the rule of 15?

Answer 25

``` Provide 15 g of quick-acting carbohydrate that is easy to consume ½ can of soft drink ½ juice 3 teaspoons of honey 6-7 jellbeans 3 glucose tablets ``` Wait 15 minutes and repeat blood glucose check. If BSL not rising → eat quick acting carbohydrate If the patient’s next meal is more than 15 minutes away, provide some longer acting carbohydrate Sandwich, 1 glass of milk or soy milk 1 piece of fruit 2–3 pieces of dried apricots, gs or other dried fruit 1 tub of natural low-fat yoghurt 6 small dry biscuits and cheese). Test glucose again during the next 2–4 hours. (RACGP article)