Diabetes

Question 1

What is the normal HbA1c target

Answer 1

48 mmol/mol

Question 2

What is the HbA1c target in T2DM on treatment that can cause hypoglycaemia

Answer 2

< 53 mmol/mol

Question 3

At what blood glucose level is someone hypoglycaemic?

Answer 3

< 4mmol/L

“4 is the floor”

Question 4

True or false: Beta blockers can mask the signs of hypoglycaemia

Answer 4

TRUE

Question 5

True or false: binge drinking does not increase the risk of hypoglycaemia

Answer 5

FALSE

Question 6

Blood glucose must be > ____ mmol/L when driving

Answer 6

5 mmol/L

Question 7

How often should blood glucose be checked when driving ?

Answer 7

Before driving and every 2 hours

Question 8

How often should blood glucose be tested in T1DM

Answer 8

At least 4 time a day

More according to sick day rules

Question 9

True or false: Insulin should be stopped according to sick day rules

Answer 9

FALSE - do NOT stop insulin therapy. Dose may need to be altered according to BMs

Question 10

Rapid acting insulins work within ____ minutes

Answer 10

5 - 15 minutes

Fiasp is an extra fast acting insulin that works within 2 minutes

Question 11

Insulin aspart is a _____ acting insulin

Answer 11

Rapid acting

Brand = NovoRAPID

Question 12

Short acting and soluble insulins act within _____ minutes

Answer 12

15 - 30 minutes

Question 13

Isophane/intermediate acting insulins act within ______ hours

Answer 13

2-4 hours

Given OD or BD

Question 14

An example of a soluble insulin:

Answer 14

Actrapid

Question 15

Insulin glargine brands? (3 points)

Answer 15

Lantus
Tujeo
Abasaglar

Question 16

Insulin detemir is an example of a ______ acting insulin

Answer 16

Long acting

Brand name = levemir

Question 17

True or false: T1DM may present as weight loss

Answer 17

TRUE

May also present with lethargy, acetone break, N&V and abdo pain

Question 18

What is the blood pressure target in diabetics:

a) Under 80
b) Over 80
c) With CKD

Answer 18

a) 135/85 mmHg
b) 145/85 mmHg
c) 130/80 mmHg

Question 19

First line insulin regimen?

Answer 19

Basal bolus
Long acting (basal)
Rapid acting at meal times

Question 20

True or false: insulin should be prescribed by brand

Answer 20

TRUE

Question 21

What is classed as “High strength Insulin”

Answer 21

Any product with > 100 units/mL

Question 22

Treatment should be intensified in T2DM if HbA1c rises above ____ mmol/mol despite treatment

Answer 22

58 mmol/mol

This applies to both first and second intensifications!

Question 23

Treatment options at second intensification in T2DM?

Answer 23

Triple therapy OR consider insulin

Question 24

_________ inhibits gluconeogenesis and glycogenolysis

Answer 24

Metformin

Question 25

______ inhibits alpha glucosidases so delays starch and glucose absorption

Answer 25

Acarbose (rarely used)

Question 26

True or false: Pioglitazone do not cause weight gain

Answer 26

FALSE

May also cause HF and is associated with an increased fracture risk

Question 27

_____ is used in T2DM. It is contraindicated in heart failure

Answer 27

Pioglitazone

Question 28

Which antidiabetic drugs may cause weight gain? (2 points)

Answer 28

Sulfonylureas

Pioglitazone

Question 29

Mechanism of DPP4 inhibitors

Answer 29

Prevent inactivation of GLP1 by DPP4.

GLP1 stimulates insulin secretion and suppresses glucagon secretion

Question 30

This class of antidiabetic drugs have evidence of reducing HF and CVD

Answer 30

SGLT2 inhibitors (Gliflozins)

Dapagliflozin is licensed for this

Question 31

True or false: Canagliflozin continued (in patients already on it) if eGFR drops below 30 mL/min

Answer 31

TRUE

It has evidence for preventing deterioration in renal function

Question 32

This class of antidiabetic drugs is associated with a risk of DKA

Answer 32

SGLT-2 inhibitors

Question 33

This class of antidiabetic drug is associated with UTIs

Answer 33

SGLT-2 inhibitors (Gliflozins)

Question 34

______ can help with weight loss

Hint: injectables

Answer 34

GLP-1 agonists

Question 35

True or false: GLP-1 agonists should be discontinued temporarily if pancreatitis develops

Answer 35

FALSE - discontinue permanently

Question 36

How often is HbA1c measured in:

a) T1DM
b) T2DM

Answer 36

a) every 3 -6 months

b) every 3-6 months until stable and then 6 monthly

Question 37

Rotation of the insulin injection site is important to avoid __________

Answer 37

Lipohypertrophy

Question 38

MHRA warning: increased incidence of heart failure when combined with insulin, especially in patients with predisposing factors. Monitor cardiac function closely

Which anti diabetic drug does this apply to?

Answer 38

Pioglitazone

Question 39

How does pioglitazone work?

Answer 39

It’s an insulin sensitiser

It works on PPAR-y

Question 40

Which possible signs of bladder cancer should be reported immediately in patients taking pioglitazone

Answer 40

Haematuria
Dysuria
Urinary urgency

Question 41

True or false:

In insulin dependent diabetics, the risk of hypoglycaemia is increased in those with renal impairment

Answer 41

TRUE

Insulin is renally cleared. Renal impairment therefore = decreased insulin clearance = increased risk of hypos

Question 42

True or false:

NSAIDs, ACE inhibitors and Diuretics antagonise the effects of metformin

Answer 42

TRUE

Drugs that cause kidney damage increase glucose. This antagonises the glucose lowering effect of metformin

Question 43

What would you expect fasting blood glucose levels to be on waking ?

Answer 43

5 - 7 mmol/L

Question 44

What would you expect blood glucose levels to be at least 90 minutes after eating ?

Answer 44

5 - 9 mmol/L