Diabetes

Question 1

List 6 main symptoms of DM

Answer 1

• Polyuria, Polydipsia
• Blurred vision, Weight loss
• Weakness/ Fatigue (T1: Vomit)

Question 2

Compare HbA1c in Prediabetes and Diabetes

Answer 2

Pre: 42-47 (6-6.4%)

Diabetes: 48+ (6.5%)

Question 3

Outline general management of Type 1 DM

Other than lifestyle advice, and advice to wear Diabetic ID

Answer 3

Same day referral to Paediatric Diabetes MDT / Diabetes Specialist for diagnosis confirmation and immediate care

Insulin therapy. Target HbA1c: 48mmol/mol (65%)

Routine Blood Glucose Self-monitoring (Annual review of Technique, Timing, Result Interpretation)

Question 4

Is Continuous Blood Glucose self-monitoring usually recommend in Type 1 DM pts

Answer 4

No

Question 5

In Type 1 DM pts, what should targets be for regular blood glucose self monitoring?

Answer 5

4-7mM before meals and on waking

5-9mM 90mins after eating

Question 6

When managing Type 2 DM, the HbA1c target is 48 (or 53 if the drug can cause hypoglycaemia)

When do you recommend self monitoring of glucose?

Answer 6

On Insulin therapy

Evidence of hypoglycaemic episodes OR On a drug that can cause hypoglycaemia

Pregnant/ planning to get pregnant

Question 7

List the structured education programs used in Managing adults with T1 and T2 DM

Answer 7

T1 DM: DAFNE

T2 DM: Desmond

Question 8

Other than offering DESMOND, outline the Management guidelines of T2 DM in adults

(1st ,2nd, 3rd line)

Answer 8

1: Standard/ Modified release Metformin, gradually increasing dose (Monitor renal function) or DPP-4 Inhibitor/ Pioglitazone/ Sulfonylureas/ SGLT-2 Inhibitor
2: Metformin + Other anti-diabetic agent OR Gliptin + Pioglitazone/ Sulfonylurea OR Pioglitazone + Sulfonylurea
3: Triple therapy

Question 9

List Micro and Microvascular DM Complications

Answer 9

Microvascular;

• Retinopathy (+ Diabetic eye disease)
• Nephropathy
• Neuropathy (+ Diabetic foot)

Macrovascular;
- MI/ Stroke/ Peripheral circulation problem

Question 10

Outline Diabetic Monitoring

Diabetic eye screening not done through general ophthalmology, but need referral

Answer 10

HbA1c every 3-6mths

Annual diabetic screening + Urine sample (Complications)

Look for signs of new autoimmune problems

Question 11

List factors affecting HbA1c accuracy

Answer 11

Hb variations, Sickle cells, Thalassaemia

CKD, Conditions affecting RBC lifespan

Fe deficiency, Myeloid Leukaemia

Question 12

Outline the ideal BP in DM pts

Answer 12

• Not on BP Meds: 140/80

On meds;

• <80: 140/80
• 80+: 150/90
• CKD etc: Systolic 130, Diastolic 90