GP conditions

Question 1

Lifestyles advice for diabetes

Answer 1

• diet
• Low BP
• Low cholesterol (suggest statin)
• control weight
• stop smoking
• regular exercise

Question 2

When in diabetes would you aim to maintain BP at 125/75 instead of 140/90

Why is BP control key

Answer 2

Evidence of renal disease

• ↑ creatinine
• Microalbuminaemia
• Dipstick protein

BP control is essential to ↓ microvascular complications (stroke, heart disease, renovascular disease)

Question 3

What is microalbuminaemia & proteinuria

Answer 3

Albumin:creatinine ratio

Proteinuria: >30mg/mmol
Microalbuminaemia: >3mg/mol

Microalbuminaemia gives an early warning of impending renal problems & is a independant risk factor for cardiovascular disease.

If present, irrespective of BP start:
- Candestartan

Question 4

During annual fundoscopy, when would u refer to ophthalmologist?

Answer 4

• Pre-proliferative retinopathy or any changes with the macula.
  Cotton wool spots (infarcts)
  Haemorrhages
  Venous bleeding
• Changes with the macula
  ↓ Visual acuity

Question 5

If diet does not control TII DM, what medication would you prescribe for an overweight patient

Mechanism
SE
Contraindicatins

Answer 5

Metformin

↑ body sensitivity to insulin, stops production of sugar (gluconeogenesis)

Metallic taste
GI disturbance
Weight loss Lactic acidosis

LOW BMI, ↓ KF

Question 6

If diet does not control TII DM, what medication would you prescribe for an thin patient

Mechanism
SE
Contraindicatins

Answer 6

Sulfonylurea: gliclazide

↑ secretion of insulin at meal times

Hypos
weight gain

patient at risk of hypos
R or L impairment

Question 7

What other medications could you add in for a triple therapy

Answer 7

Pioglitazone

↑ fat uptake, ↑ sensitivity

Oedema, hypos, broken bones. weight gain, hepatic toxic
- Monitor LFT

CI: HF, Hx bladder ca

DPP4 sitagliptin