Diabetes

Question 1

Adult T1DM target fasting (on waking) BMs

Answer 1

5-7mmol/l

Question 2

Adult T1DM target pre-prandial BMs

Answer 2

4-7mmol/L

Question 3

Adult T1DM target post-prandial BMs

Answer 3

5-9mmol/L

Question 4

Target HbA1c in diabetes

Answer 4

<48mmol/mol

Question 5

Adult T2DM target pre-prandial BMs

Answer 5

4-7mmol/L

Question 6

Adult T2DM target post-prandial BMs

Answer 6

<8.5mmol/L

Question 7

Adult T2DM target bedtime BMs

Answer 7

6-10mmol/L

Question 8

Target blood pressure in T1DM

Answer 8

<135/85mmHg

Albuminuria or >2 features of metabolic syndrome <130/80mmHg

Question 9

Target blood pressure in T2DM

Answer 9

<140/80mmHg

Kidney, eye or cerebrovascular damage <130/80mmHg

Question 10

Examples of factors which increase insulin requirements

Answer 10

Infection, accident, trauma, obesity, drug therapy, puberty and pregnancy

Question 11

Examples of factors which decrease insulin requirements

Answer 11

Renal, hepatic impairment, endocrine disorders or coeliac disease

Question 12

What types of insulin are Novorapid (insulin apart) and Humalog (insulin lispro)

Answer 12

Rapid-acting insulins
Onset of action = 10-20mins
Duration is 3-5 hours

Question 13

What types of insulins are Humulin S, act rapid and Insuman?

Answer 13

Short-acting insulins
Onset of action is 30mins -1 hour, should be injected before meals
Duration of action = 6-8 hours

Question 14

What type of insulins are Humulin I, insulatard?

Answer 14

Intermediate acting examples
Usually administered OD or BD
Onset of action is 1.5hours
Duration of action is 8-14 hours

Question 15

Causes of DKA

Answer 15

Undiagnosed diabetes, interruption to insulin therapy, acute illness, trauma, infection,

Question 16

Clinical features of DKA

Answer 16

Polyuria, polydipsia, polyphasic, lethargy, nausea and vomiting, SOB & Kussmaul breathing, abdominal pain, confusion, coma
Dehydration, tachycardia, hypotension, hyperventilation, drowsiness

Question 17

DKA - acute management

Answer 17

Rehydrate - 0.9% saline
Replace electrolytes lost
Commence high rate IV insulin 0.1 unit/kg/hour
Once BMs <14 prescribe glucose containing fluids

Question 18

What do NICE advise as the gold standard insulin regimen in T1DM?

Answer 18

Offer multiple daily injections basal-bolus insulin regimens

Question 19

HONK precipitating factors

Answer 19

Undiagnosed T2DM
Glucose drinks
thiazides/steroids 
Illness
Non-compliance with anti-diabetic medications

Question 20

How do sulphonylureas work?

Answer 20

Increased pancreatic beta cell sensitivity to glucose

Long term use increases tissue sensitivity to insulin

Question 21

Pioglitazone counselling

Answer 21

Weight gain

Haematuria, dysuria and urinary urgency - signs of bladder cancer

Question 22

Pioglitazone MHRA alert

Answer 22

European review found increased incidence of heart failure when pioglitazone was used in combination with insulin
Observe for signs and symptoms of HF, weight gain and oedema
Pioglitazone should be discontinued in any deterioration in cardiac status occurs

Question 23

What class of medications is sitagliptin?

Answer 23

DPP-4 inhibitor

Question 24

NICE algorithm for treatment of T2DM

Answer 24

1st line - metformin
2nd line - metformin and SU
3rd line - metformin, SU and intermediate insulin

Question 25

When should patients with T1DM be offered a statin?

Answer 25

Offer atorvastatin 20mg ON to adults with T1DM who are older than 40 years OR have had diabetes fore more than 10 years, have established nephropathy or have other CVD risk factors

Question 26

When should patients with T2DM be offered a statin?

Answer 26

Estimate risk using QRISK2 - offer if risk >10%

Question 27

What general advice would you provide a patient regarding the storage of insulin?

Answer 27

Before opening - store in fridge at 2-8'C During use store below 25'C for up to 4 weeks Protect vial/cartridge from light On holiday store in a cool bag. Never lean in airplane hold as can freeze

Question 28

How many units should insulin be adjusted by at a time?

Answer 28

Usually insulin doses are adjusted by 2 units each time or 10%

Question 29

Why does DKA occur?

Answer 29

DKA results from absolute deficiency of insulin. Lack of insulin means the body cannot use glucose for energy, and the body starts to breakdown fats as energy source. Ketones are the by-product of this process. Ketones have a low pKa therefore turn the blood acidic