Conservative Management

Question 1

Role of the MDT

Answer 1

GP, endocrinologist, surgeons, specialist nurses, dieticians, chiropodists, fellow patients (education groups).

Question 2

Monitoring - 4’c

Answer 2

Control
Complications
Competency
Coping

Question 3

Glycemic control

Answer 3

Record of complications: DKA, HONK, hypos Capillary blood glucose
Fasting: 4.5-6.5mM
2h post-prandial: 4.5-9mM HbA1c
Reflects exposure over last 6-8wks
Aim <45 - 50mM (7.5 - 8%) BP , lipids

Question 4

Complications

Answer 4

Macro:
Pulses
BP
Cardiac auscultation

Micro:
Fundoscopy
ACR + U+Es
Sensory testing plus foot inspection

Question 5

Competency

Answer 5

With insulin injections
Checking injection sites
BM monitoring

Question 6

Coping

Answer 6

Psychosocial: e.g. ED, depression
Occupation
Domestic

Question 7

Lifestyle modification: DELAYS

Answer 7

Diet
Exercise and Education
Lipids
ABP
Aspirin
Yearly/ 6 monthly check-up: 4 Cs
Smoking cessation

Question 8

Dietary changes

Answer 8

Same as that considered healthy for everyone
  ↓ total calorie intake
  ↓ refined CHO, ↑ complex CHO
  ↑ soluble fibre
  ↓ fat (especially saturated)
  ↓Na
  Avoid binge drinking

Question 9

Lipids

Answer 9

Rx of hyperlipidaemia

1O prevention ̄c statins if >40yrs (regardless of lipids)

Question 10

ABP

Answer 10

↓ Na intake and EtOH
  Keep BP <130/80
  ACEis best (β-B: mask hypos, thiazides: ↑ glucose)

Question 11

Aspirin

Answer 11

Primary prevention if >50yrs or <50 ̄c other CVD RFs

Question 12

Education - Type 1

Answer 12

DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis

Question 13

Education - Type 2

Answer 13

Diabetes Education for Self-Management for Ongoing and Newly Diagnosed) programme, to the person and/or their family/carers.
Offer this programme at or around the time of diagnosis, with annual reinforcement and review

Question 14

BP target? Treatment in diabetics?

Answer 14

NICE recommend the following blood pressure targets for type 2 diabetics:
if end-organ damage (e.g. renal disease, retinopathy) < 130/80 mmHg
otherwise < 140/80 mmHg

135/75 for proteinuria or 135/85 for DM1

Hypertension in diabetics - ACE-inhibitors are first-line regardless of age