Diabetes long

Question 1

When is the OGTT diagnostic of diabetes

Answer 1

11. 1 mmol or higher = diabetes

7. 8 - 11 = impaired fasting glucose

Question 2

Diagnosis of diabetes in asymptomatic people

Answer 2

2x lab tests of 2 different days

Question 3

Fasting glucose values for diagnosis

Answer 3

6.1-6.9 = impaired fasting glucose

7 mmol or higher = diabetes

Question 4

What proportion of patients with diabetes have over diabetic nephropathy

Answer 4

20-30%

Question 5

Definition of microalbuminuria

Answer 5

2.5-25/35 albumin/creatining ratio

Question 6

What are the biggest RF for diabetic retinopathy

Answer 6

hyperglycaemia and hypertension

Question 7

How often should you screen for diabetic retinopathy

Answer 7

1-2 years

Question 8

How to treat diabetic retinopathy

Answer 8

Retinopathy -laser photocoagulation

Biggest benefit is in patients with new vessels on the optic disc or vitreous haemorrhage

Question 9

What is involved in daily foot care

Answer 9

inspection, washing and careful drying, moisturiser for dry skin, nail care, practical footwear

Question 10

What can be used for management of symptomatic painful peripheral neuropathy

Answer 10

Amitriptyline, pregabalin

Question 11

Evidence of ACE/ARBs in diabetes

Answer 11

ACE I have evidence in both T1DM and T2DM

ARB only have evidence in T2DM

Question 12

What is the HbA1C target in a patient with reduced hypoglycaemia awareness

Answer 12

8.0%

Question 13

What is the general HbA1C target

Answer 13

7.0%

Question 14

What is the HbA1C target for patients with major comorbidities

Answer 14

8.0%

Question 15

What second line oral hypoglycaemia agent for patients with clinical cardiovascular disease

Answer 15

SGLT2 or GLP1

Question 16

What second line oral hypoglycaemic agent for patients with CKD

Answer 16

SGLT2

Question 17

What second line oral hypoglycaemia agent for patients with predominant HF

Answer 17

SGLT2

Question 18

What OHGs are good for weight loss

Answer 18

SGLT2 or GLP1

Question 19

What OHGs causes weight gain

Answer 19

Sulphonylureas

Question 20

What glycaemic control should elective surgery be postponed

Answer 20

HbA1C >9.0%

Question 21

What are BGL aims during the perioperative period

Answer 21

5-10 mmol/l

Question 22

How to maintain euglycaemia post op

Answer 22

Insulin-glucose infusion

Question 23

How to manage perioperative diabetes for major surgery in insulin dependent patients

Answer 23

Aim morning list
FFMN
Omit usual morning insulin and AHG
Commence insulin-glucose infusion at induction, and continue for 24 hours or until normal eating resumes
Measure BSL hourly during the intra-operative period

If PM list: modified dose of insulin with early breakfast, admit early for pre operative ward for BGL monitoring, commence insulin-glucose infusion prior to induction of anaesthesia

Question 24

How to manage insulin treated patients undergoing minor stuergy on a morning operative list

Answer 24

Aim to delay insulin to be with meal after procedure

Question 25

When should insulin-glucose infusion be commenced for insulin dependent patient undergoing minor surgery

Answer 25

BGL > 10mmol/l

Question 26

When to start metformin post major surgery

Answer 26

> 24 hours

Question 27

When should SGLT2 be withdrawn prior surgery

Answer 27

at least 72 hours