diabetes

Question 1

What BGL makes diabtes likely (fasting and random)?

Answer 1

FBGL >7.0
RBGL >11.1

Question 2

States which HbA1c may not be accurate?

Answer 2

post traumatic T2DM (eg pancreatitis)
sepsis
steroids
within 4 months post partum
haemoglobiinopathy or haemolysis
CKD
iron def (art elevated)
post blood or iron transfusion

Question 3

OGTT involves

Answer 3

8 hour fast
75g glucose
Fasting and 2 hour post glucose

Question 4

NOrmal OGTT

Answer 4

FBGL <6.1
2 HOUR <7.8

Question 5

Impaired fasting glucose OGTT

Answer 5

FBGL 6.1-6.9
2 HOUR <7.8
RETEST 12 MONTHS

Question 6

impaired glucose tolerance

Answer 6

FBGL <7.0
2 HOUR >7.8-<11.1
RETEST 12 MONTHS

Question 7

DIABETES ON OGTT

Answer 7

FBGL >7.0
>11.1

Question 8

HbA1c diabetes likely

Answer 8

> 6.5% (48mmol/mol)
confirm on another day

Question 9

HbA1c diabetes possible

Answer 9

6.0-6.4%retest in 12 months and look at preventtion to progression

Question 10

HbA1c diabetes unlikely

Answer 10

<6.0%
retest in 3 years

Question 11

Fasting BGL or random BGL diabetes likely

Answer 11

> 7.0 or >11.1
confirm with repeat test

Question 12

in those with symptoms what are diagnostic results

Answer 12

single FBG >7.0
single HbA1c >6.5%
RBGL >11.1

Question 13

symptoms concerning for diabetes

Answer 13

lethargy, polyuria, polydipsia
frequent fungal or bacterial infections
blurred vision
loss of sensation
poor wound healing
weight loss

Question 14

signs of insulin resistance

Answer 14

acanthosis nigricans
skin tags
central obesity
hairy

no role for testing insulin levels

Question 15

features concerning for T1DM

Answer 15

• ketosis/ketonuria (which may be absent)
  • polyuria, polydipsia
  • acute weight loss (>5% in less than four weeks)
  • <50 years of age
  • personal and family history of autoimmune disease
  • acute onset of symptoms

Question 16

What is latent autoimmune diabetes or type 1.5

Answer 16

beta cell antibodies more commonly occuring in adulthood
presents similarly to T2DM but involves more rapid Beta cell destruction, poorer metabolic response to non-insulin therapy, more rapid progression to insulin use

Question 17

what is monogenic diabetes

Answer 17

single gene mutation
dominantly inherited
- neonatal (rare)
- MODY (mature onset diabetes of the young)

Question 18

examinations to assess diabetic patients

Answer 18

• BMI
• Waist circumference (cm)
• Blood pressure
• Central and peripheral vascular systems
• Absolute CVD risk assessment (this may require calculation and
investigations)

Question 19

prevention of progression includes

Answer 19

<7% weight
150 mins mod intensity exercise a week

Question 20

definition of early onset diabetes

Answer 20

<40

Question 21

lifestyle mx adult diabetes

Answer 21

150 min mod ex a week
2-3 resistance sessions a week (total 60 mins)
dont sit longer than 30 mins
whole grains 3 serves daily
1.5 serves dairy
reduce weight
BMI >40 consider bariatric surgery
stop smoking

Question 22

target HbA1c for T2DM?

Answer 22

<7%

Question 23

HbA1c <8% is ok with which patients?

Answer 23

Hx severe hyoglycaemia
short life exp
advanced micro or macrovascular complications
extensive comorbid conditions
difficult to acheive control
effective doses multiple agents

Question 24

targets for self-monitored glucose levels

Answer 24

4-7 fasting or pre-prandial
5-10 2 hour post prandial

Question 25

first line agent and dosing T2DM

Answer 25

metformin IR 500mg BD
inc slowly over 2-4 weeks up to 2g daily in divided doses
provided GFR >60mL/min

Question 26

max daily dosing metformin if

Answer 26

GFR 30-60 max 1g daily in divided doses

Question 27

metformin MR dosing

Answer 27

500mg OD with evening meal
inc over 2-4 weeks max 2 g daily

if GFR >60

Question 28

in GFR 30-60 what is MR metformin max dose

Answer 28

1g daily

Question 29

practice points for metformin dosing

Answer 29

GIT upset most common side effect - reduce with MR dose with meals
can reduce B12 absorption
contraindicated if GFR<30
withhold during acute illness - rsik lactic acidosis
hold before surgery & contrast
caution with CCF

Question 30

What antihyperglycaemic agent should be considered for those with atherosclerotic CVD

Answer 30

GLP-1 agonists
dulaglutide, liraglutide, semaglutide
OR
SGLT2 inhibitor
dapigaflozin or empagliflozin

Question 31

What antihyperglycaemic agent should be considered for those with CCF?

Answer 31

SGLT2 inhibitor
dapigaflozin or empagliflozin

Question 32

What antihyperglycaemic agent should be considered for those with CKD

Answer 32

SGLT2 inhibitor
dapigaflozin or empagliflozin
OR
GLP-1 agonists
dulaglutide, liraglutide, semaglutide

Question 33

mechanism of sulfonyureas and expected HbA1c response

Answer 33

Sulfonylureas (gliclazide, glipizide, glibenclamide, glimepiride) increase insulin secretion via the pancreatic sulfonylurea receptor. When a sulfonylurea is added to metformin, the expected reduction in glycated haemoglobin (HbA1c) is 5.5 to 7.5 mmol/mol (0.5 to 0.7%)

Question 34

side effects of sulfonyureas

Answer 34

Sulfonylureas can cause weight gain.

Avoid longer-acting sulfonylureas (glibenclamide, glimepiride) in older patients because they increase the risk of severe prolonged hypoglycaemia. Shorter-acting gliclazide and glipizide are converted to inactive metabolites by the liver and are preferred.

Reduce dose in kidney impairment

Question 35

first line options for T2DM

Answer 35

Metformin
Sulfonyureas
INsulin

Question 36

After checking HbAlc after three months, whats second line if targets not met

Answer 36

SGLT2i