3/12/21

Question 1

Non-Pharmacological Advice in T2DM

Answer 1

• *Diet** - Dietary review
• Diet with caloric deficit

BMI - 5-10% weight loss in those who are overweight/obese with T2DM

• *Physical Activity**
• 150mins of physical aerobic activity/week
• 2-3 sessions of resistance exercise
• Decrease daily sedentary behaviour

Cigarette Consumption → zero cigarettes/day

Alcohol Consumption → ≤2 standard drinks/day

Question 2

Referrals to be made in young people with t2dm

Answer 2

optom, pod, exercise physiologist, diabetes ed, dietician and ENDOCRINOLOGIST IN A YOUNG PERSON

Question 3

Medications for Weight Loss Management

Answer 3

orlistat, liraglutide, naltrexone + bupropion, phenteramine

Question 4

Surgical options for Weight loss

Answer 4

sleeve gastrectomy, roux en Y bypass, biliopancreatic diversion

Question 5

when to consider weight loss surgery in twcm

Answer 5

BMI >40

BMI 35-39 poor glycaemic control

Question 6

poor glycaemic control…why?

Answer 6

1. concurrent infection
2. poor compliance to medication
3. insulin not stored correctly
4. misdiagnoses of LADA or MODY
5. Obesity
6. Inadequate insulin dose regimen
7. medication - steroids, antipsychotics
8. smoking
9. sedentary lifestyle, lack of exercise
10. poor diet

Question 7

Assess nicotine dependence - 3 points

Answer 7

• Minutes after waking for first cigarette → if smoking <30mins from waking
• Number of cigarettes/day → if smoking >10 cigarettes/day
• Cravings or Withdrawal Symptoms in previous quit attempts

Question 8

5 As of Smoking Cessation

Answer 8

Ask
Assess
Advise
Assist
Arrange

Question 9

Pharm options for smoking cessation

Answer 9

1. NRT - patch + inhaler/gum/lozenge
2. varenicline (no good in pregs or young people)
3. bupropion (contraindicated in seizures, MAOi, pregs)

Question 10

Dosing of NRT

Answer 10

other than if >30mins to first cig + <10 cigs per day -> 21mg/24hour patch + gum 2mg (4mg if >10 cigs/day)

Question 11

DOsing of varenicline

Answer 11

0.5 for 3 days, 0.5BD for 4 days then 1mg BD

Question 12

Non-Pharmacological for smoking cessation

Answer 12

quit day, quit plan
manage smoking triggers
address barriers to quit
motivational interviewing
frequent and regular follow-up
- Join Quitline/Support Group
- Mobilise Social Supports

Question 13

Characteristics of HHS

Answer 13

• Severe Hyperglycaemia
• Hyperosmolarity - >320
• Severe Dehydration
• Change in Mental State - drowsiness to comatose
• Little or No Ketacidosis

Question 14

Office Tests for HHS

Answer 14

• Urine Dipstick

- Finger Prick BSL + Ketones

Question 15

Management points for HHS

Answer 15

• Slowly and Safely replace fluid and electrolyte losses and normalise the osmolality
• Slowly and safely normalise blood glucose concentrations → reduce glucose at 4-6mmol/L hour
• Treat the underlying cause
  NEED SPECIALIST CARE AND MAJOR HOSPITAL CARE

Question 16

Causes of SUDDEN ONSET Unilateral Painless Visual Loss

Answer 16

• Retinal Detachment
• Vitreous Haemorrhage
• Central or Branch Retinal Artery Occlusion
• Central or Branch Retinal Vein Occlusion
• Temporal Arteritis
• Optis Neuritis
• CVA