Diabetes (general)

Question 1

What is the impact of alcohol on diabetes?

Answer 1

Make the signs of hypoglycaemia less clear and can cause delayed hypoglycaemia.

Specialist sources recommend that patients with diabetes should drink alcohol only in moderation, and when accompanied by food.

Question 2

When are oral glucose tolerance tests used?

Answer 2

Mainly for the diagnosis of impaired glucose tolerance; not recommended or necessary for routine diagnostic use when severe symptoms of hyperglycaemia are present.

OGTT may be required in patients who have less severe symptoms and a blood-glucose concentration that does not establish or exclude diabetes.

Question 3

What is the basis of the HbA1c test?

Answer 3

Glycated haemoglobin (HbA1c) forms when red blood cells are exposed to glucose in the plasma. The HbA1c test reflects average plasma glucose over the previous 2 to 3 months and provides a good indicator of glycaemic control.

Question 4

What can the HbA1c test not be used for?

Answer 4

The diagnosis of suspected diabetes type 1 in children, during pregnancy or in women who are up to two months postpartum.

Should also not be used for those who have:
<2 months diabetic symptoms
High diabetes risk and acutely ill
Medication that could cause hyperglycaemia
Acute pancreatic damage
End-stage chronic kidney disease
HIV

Question 5

How often should the HbA1c be measured in patients with type 1 diabetes?

Answer 5

every 3-6 months, more frequently if blood glucose control is thought to be changing rapidly..

Question 6

How often should the HbA1c be measured in patients with type 2 diabetes?

Answer 6

Every 3-6 months until levels and medicatio are stable then can be reduced to every 6 months.

Question 7

Self-monitoring of blood glucose is appropriate for what patients?

Answer 7

Those with type 2 diabetes who:

• are treated with insulin;
• are treated with oral hypoglycaemic drugs e.g. sulfonylureas, to provide information on hypoglycaemia;
• to monitor changes in blood-glucose concentration resulting from changes in lifestyle or medication, and during inter current illness.
• to ensure safe blood-glucose concentration during activities, including driving.

Question 8

How can pregnant women with pre-existing diabetes be treated? [2]

Answer 8

Women with pre-existing diabetes can be treated with metformin hydrochloride, either alone or in combination with insulin.

Question 9

What can women with gestational diabetes be treated with?

Answer 9

Women with gestational diabetes may be treated, with or without concomitant insulin, with glibenclamide from 11 weeks gestation (after organogenesis) [unlicensed use] or with metformin [unlicensed use].