Diagnosis and monitoring

Question 1

Diagnosis

Answer 1

HbA1c blood test:
- 48 mmol/mol or above (6.5%)
Oral glucose tolerance test:
- Diagnosis of impaired glucose tolerance
- Not recommended/necessary for patients with severe hyperglycaemia symptoms

Question 2

Type 2 diabetes

Answer 2

Monitor:
- Insulin or sulphonylurea
- During intercurrent illness, lifestyle or medication changes
- Driving

Question 3

Blood glucose target

Answer 3

pre-meal = 4-7 mmol/L
post-meal = <9 mmol/L

Question 4

HbA1c

Answer 4

Showers glycaemic control over a longer period of time (2-3 months)
Measured every 3-6 months
Diabetic = 48-59 mmol/mol (6.5%-7.5%
Diabetic patient at high risk of arterial disease <6.5%

Question 5

Hypertension

Answer 5

140/80 mmHG (without complications)
130/80 mmHG (with complications)

Question 6

Diabetes + hypertension

Answer 6

1st line = ACEi
1st line in afro-carribbean = ACEi + diuretic or CCB

Question 7

Cholesterol targets

Answer 7

<4 mmol/L

Question 8

Primary prevention in diabetes

Answer 8

Type 1 diabetes
Type 2 with a CVD 10 year/QRISK2 of 10%

Question 9

Hypoglycaemia

Answer 9

<4 mmol/L

Question 10

Hypoglycaemia symptoms

Answer 10

Hunger
Pale skin
Tingling lips
Sweating, chills, clammy
Dizziness
Shakiness
Palpitations
Blurred vision
Confusion
Slurred speech
Difficulty concentration
Drowsiness and coma
Irritability

Question 11

Blunted hypoglycaemia

Answer 11

• Too tight glycaemic control = lowers levels needed to trigger hypoglycaemia symptoms
• Loss of warning signs, particularly in insulin treated patients
• Avoid frequent hypo episodes to restore warning signs
• Beta blockers masks symptoms of hypoglycaemia and delay recovery