Diabetic Diagnosis and Complications

Question 1

What is the diagnostic fasting glucose level?

Answer 1

7.0mmol/l and above

Question 2

What is diagnostic 2-hr oral glucose tolerance test glucose level?

Answer 2

11.1mmol/l and above

Question 3

What is a diagnostic random blood glucose level?

Answer 3

11mmol/l and above

Question 4

What is a diagnostic HbA1C? (Not used as diagnostic indicator in tayside).

Answer 4

48mmol/mol

Question 5

What is used to help diagnosis of autonomic neuropathy in diabetes?

Answer 5

Nerve conduction studies/electromyography
HR variability
Ultrasound (bladder and urinary tract)
Gastric emptying studies

Question 6

What is used in diabetic nephropathy screening?

Answer 6

Urinary albumin to creatinine ratio (ACR).

Question 7

Who is screened for diabetic nephropathy and how frequently?

Answer 7

All patients 12 and over at diagnosis and annually.

Question 8

What is R1 retinopathy (mild background)?

Answer 8

May have:
Dot/blot/flame haemorrhages
Microaneurysms
Hard exudates
Cotton wool spots

Question 9

What is R2 retinopathy (observable background)?

Answer 9

4 or more blot haemorrhages in one hemi-field only.

Question 10

What is R3 retinopathy (referable background)?

Answer 10

4 or more blot haemorrhages in both hemi-fields
Venous beading
IRMA (intra-retinal microvascular abnormalities)

Question 11

What is R4 retinopathy (proliferative)?

Answer 11

Active new vessels

Vitreous haemorrhage

Question 12

What is M1 maculopathy (observable)?

Answer 12

Hard exudates between 1 and 2 disc diameters of the fovea.

Question 13

What is M2 maculopathy (referable)?

Answer 13

Any blot haemorrhages or hard exudates within <1 disc diameter from the fovea.

Question 14

What imaging is available to look for maculopathy?

Answer 14

Optical coherance tomography.

Question 15

What should you do if someone has a high fasting blood glucose but no symptoms of diabetes?

Answer 15

Do a second reading 4 weeks after the first one.

Question 16

When should you refer a type 2 diabetic to secondary care?

Answer 16

Definite or likely T1DM
Low or low normal BMI
All children
Patients who are pregnant or planning pregancy
Pre-existing chronic renal impairment
If under age of 40
Specific clinical concern

Question 17

In newly diagnosed type 2 diabetes, what should you consider before starting medications?

Answer 17

3 months of lifestyle changes and risk factor modifications.

Question 18

What is the target for pre-meal glucose in type 1 diabetics?

Answer 18

3.9-7.2mmol/l (4-7 roughly)

Question 19

What is the target for post-meal glucose in type 1 diabetics?

Answer 19

<10mmol/l 1-2 hours after eating

Question 20

What is the target for HbA1c?

Answer 20

58mmol/l or below.