Diabetes

Question 1

In hypoglycaemia, how many grams of carbohydrates should be given?

Answer 1

10-20g

(0.3g/kg) for for children and young people)

Question 2

What are the options for treating hypoglycaemia if able to swallow? What should not be used?

Answer 2

3-6 glucose tablets

90-180ml of fizzy drink or squash

50-100ml lucozade energy

2-4 spoonfuls of sugar

Sweets E.g 4 large jelly babies

1-2 tubes of dextrogel

Avoid: chocolate and biscuits due to lower sugar content and higher fat content delays stomach emptying

Question 3

What should be used to treat hypoglycaemia if the patient is unable to swallow?

Answer 3

IM glucagon:

<8years (or <25kg) : 500mcg
Everyone else: 1mg

Question 4

What glucose level indicates hypoglycaemia?

Answer 4

<3.5 mmol/L

Question 5

What angle should insulin be injected?

Answer 5

90 degrees

Question 6

How long after injecting should the needle be left in the skin?

Answer 6

5-10 seconds

Question 7

What sites can be used to inject insulin?

Answer 7

Abdomen (fastest absorption)
Outer thigh
Buttocks
Arm (not usually recommended)

Question 8

What is the target fasting glucose level?

Answer 8

5-7mmol/L

Question 9

What is the target glucose level before meals and other times of the day?

Answer 9

4-7mmol/L

Question 10

What is the glucose target for adults testing at least 90mins after meals?

Answer 10

5-9mmol/L

Question 11

Is extra insulin required when drinking alcohol?

Answer 11

No

Question 12

What ketone level indicates DKA?

Answer 12

2+ on urine dipstick

Above 3 mmol/L in blood

Question 13

What plasma glucose level may indicate ketoacidosis?

Answer 13

Over 11mmol/L

Question 14

What are the clinical features of DKA?

Answer 14

Increased thirst and urgent urination (polyuria/polydipsia)
Weight loss
Persistent vomiting and diarrhoea
Abdominal pain
Visual disturbance
Lethargy and confusion
Fruity smell on breath
Acidotic breathing - deep sighing
Tachycardia
Hypotension
Decreased consciousness

Question 15

What are the symptoms of hypoglycaemia?

Answer 15

Hunger
Anxiety or irritability
Sweating
Palpitations
Tremor
Weakness/ lethargy
Impaired vision
Confusion and disorientation
Convulsions
Coma

Question 16

What HbA1c and glucose levels indicate T2DM?

Answer 16

HbA1c over 48mmol/L
Fasting glucose over 7mmol/L
Random glucose over 11mmol/L

Question 17

When should HbA1c not be used to diagnose T2DM?

Answer 17

Under 18
Pregnant or 2 month’s postpartum
Symptoms for <2 months
Taking medications (long-term corticosteroids)
Acute pancreatic damage (e.g surgery)
End stage renal disease
HIV +

Question 18

What are the risk factors for T2DM?

Answer 18

Obesity
Family hisory
Asian, African and Afro-Caribbean (2-4 x more likely)
Hx of gestational diabetes
Diet (low fibre, high glycemic index)
Drugs (statins, corticosteroids, thiazide + beta blocker)
PCOS
Metabolic syndrome (raised BP, fatty liver, tendency for thrombosis)

Question 19

What is the referral programme for adults with T2DM?

Answer 19

DESMOND

Question 20

How frequently should HbA1c be measured in T2?

Answer 20

Every 3-6 months until anti diabetic regime is stable, then every 6 months

Question 21

What is the HbA1c target for T2DM with drug treatment associated with hypoglycaemia (e.g sulfonurea)?

Answer 21

53mmol/L

Question 22

What is the HbA1c target for T2DM with drug treatment not associated with hypoglycaemia (e.g metformin)?

Answer 22

48mmol/L

Question 23

What HbA1c level suggests T2DM is not adequately controlled by a single drug?

Answer 23

58mmol

Question 24

How soon before travelling must a glucose test be performed for insulin-treated drivers? And how frequently while driving?

Answer 24

Maximum of 2 hours before and every 2 hours during

(Maximum of 2 hours between pre-driving glucose check and the 1st glucose check performed whilst driving)

Question 25

What advice is there for drivers having had more than 1 severe hypoglycaemic episode while awake in the last 12 months?

Answer 25

Must not drive and inform the DVLA (If not lorry driver then May resume driving after a clinical report from GP or diabetes specialist)

Question 26

At what glucose level should you not drive?

Answer 26

<5mmol/L (eat a snack and recheck level - can drive 45 mins after level has returned to normal) 4mmol/L (do not drive)

Question 27

What glucose monitoring can be used for group 1 and group 2 drivers?

Answer 27

Group 1: fingerprick or continuous monitoring systems (flash glucose and real-time) Group 2: finger prick only!

Question 28

Do group 2 drivers need to stop driving and tell the DVLA if they have an episode of hypoglycaemia when asleep?

Answer 28

Yes (Not group 1 - only if more than 1 in 12 months while awake)

Question 29

What is the renal cut off for metformin?

Answer 29

Avoid if eGFR is less than 30ml/min

Question 30

What are the monitoring requirements for metformin?

Answer 30

Renal function before starting and at least annually (twice a year if additional risk factors for renal impairment)

Question 31

What are the signs of lactic acidosis?

Answer 31

Dyspnoea, muscle cramps, abdominal pain, hypothermia, asthenia

Question 32

What are the common side effects of metformin?

Answer 32

B12 deficiency, abdominal pain, GI disorders, nausea and vomiting, altered taste, decreased appetite, diarrhoea

Question 33

What are the severe side effects of metformin (rare or very rare)?

Answer 33

Hepatitis, lactic acidosis (discontinue)

Question 34

What are the unlicensed uses for metformin?

Answer 34

PCOS T2DM in children aged 8-9

Question 35

Why class of drug are gliclazide, glimepiride, glipizide and tolbutamide? Can they cause hypoglycaemia?

Answer 35

Sulfonureas - yes

Question 36

Which DPP-4 inhibitor is best for renal impairment?

Answer 36

Linagliptin - no dose reduction required

Question 37

Which classes of anti diabetic drugs should be avoided in pancreatitis?

Answer 37

DPP-4 inhibitors (the ‘gliptins) GLP-1 inhibitors

Question 38

What are the MHRA warnings for pioglitazone?

Answer 38

Bladder cancer Cardiovascular safety - contraindicated in heart failure

Question 39

When can a GLP-1 inhibitor be considered?

Answer 39

BMI >35 (and other medical conditions associated with obesity or insulin having significant implications on occupation, or weight loss would benefit other co-morbidities)