TYPE 2 DIABETIES

Question 1

what is the best diagnostic test for type 2 diabetes

Answer 1

HBA1C

Question 2

what are the contraindications for HBA1C

Answer 2

very young, pregnant. CKD,T1DM anaemia recent trauma

Question 3

what is the second line test for T2DM if HBA1C not suitable

Answer 3

oral glucose tolerance test

Question 4

what is the general rule for testing for type 2 diabetes

Answer 4

symptoms = 1 test
no symptoms = 2 tests

Question 5

what HBA1C result would indicate type 2 diabetes

Answer 5

HBA1C >48

Question 6

what oral glucose tolerance test would indicate diabetes

Answer 6

> 11.1

Question 7

when should you start treatment right away

Answer 7

if HBA1C is more than 58

Question 8

what is the first line advice

Answer 8

lifestyle changes - low gi carb diet, medatrainian diet, 150 minutes of exercise per week 5-10% weight loss

Question 9

what educational programs can you refer patients too

Answer 9

DESMOND or XPERT

Question 10

what results indicate prediabetes

Answer 10

HBA1C more than 42-47
FBG 5.6-6.9

Question 11

treatment of pre-diabetes

Answer 11

referral to diabetes prevention programme and lifestyle advice is no change in 6-8weeks and bmi more than 30 consider metformin

Question 12

what is the first line treatment for T2

Answer 12

METFORMIN 1g daily

Question 13

what is the main risk factor with metformin

Answer 13

can cause acidosis as it prevents the liver from taking up lactic acid

and can cause GI symptoms

Question 14

what is the mechanism of action for metformin

Answer 14

enters the liver via OCT1 goes to mitochondria and inhibits complex 1 this decreases the amount of atp in the cell and activates the amp activated protein kinase which tells the cell that there is no glucose so stop making it and start burning it.

deacreases gluconegensis
decreases glucose foration in the liver
deacreases lipogenolysis
increases insulin receptor sensitivity
increases glucose up take in the musle and fat tissue