Endocrinology

Question 1

What levels of HbA1C define treatment in DM?

Answer 1

• 48-53 = lifestyle + single therapy
• 53-58 = dual therapy
• > 58 = intense therapy

Question 2

How often should HbA1c be checked?

Answer 2

Every 3-6months until stable and every 6 months after once stability achieved.

Question 3

What are the stages for DM II management?

Answer 3

1. Lifestyle
2. Metformin
3. Metformin + sulphonylurea OR DPP-4i OR piaglitazone OR start insulin if metformin not tolerated
4. Metformin + SU + DPP-4i OR Metformin + PG + SU OR start insulin
5. GLP-1 treatment

Question 4

Annually, what needs to be screened for in diabetics?

Answer 4

Retinopathy
Diabetic foot
Nephropathy - urine sample ACR
CV risks:
- BP consistently below 140/80 
- Statins if QRisk2 over 10%

Question 5

If a patient is diabetic but also has hypertension and is above 55yrs, what do you prescribe?

Answer 5

ACEi - regardless of Ca+ blocker

Question 6

In Type I diabetes, what needs to be checked annually? (8 things)

Answer 6

• Albuminuria - morning sample
• Blood pressure
• Blood glucose
• Thyroid function
• Abdominal adiposity
• Full lipid profile
• Smoking

Question 7

What investigations would you perform to detect Type I diabetes?

Answer 7

• C-peptide and/or specific autoantibody titres if atypical features
• Measure HbA1C every 3-6months
• Inform DVLA if necessary

Question 8

In Type I diabetes, when should the patient self-monitor?

Answer 8

• 4 times a day up to 10 times a day
• Waking up
• Before meals
• If testing after meals, 90minutes