Management of Diabetes

Question 1

What is a healthy/normal HbA1c?

Answer 1

41mmol/l or under

Question 2

What is the pre-diabetic range of HbA1c?

Answer 2

42-47mmol/mol

Question 3

What is the diabetic range of HBA1C?

Answer 3

48mmol/l or over

Question 4

If a patient’s HbA1C is 48mmol/l, what is your management plan?

Answer 4

• Lifestyle changes e.g. diet and exercise
• Metformin first line

Question 5

If a patient’s HbA1C is 53mmol/l, what is your management plan?

Answer 5

1. Metformin
2. Gliclazide
   (Council with the risk of hypoglycaemia)

Question 6

If a patient’s HbA1c is 58mmol/mol, what is the management plan?

Answer 6

1. Metformin
2. Gliclazide
3. Specialist referral for indication to intensify treatment

Question 7

How does metformin work?

Answer 7

Reduces insulin resistance and/or enhance the effect of endogenous insulin

Question 8

How do SGLT2 inhibitors work?

Answer 8

Increase glucose loss in urine and hence lower blood glucose

Question 9

Give an example of SGLT2 inhibitor

Answer 9

Dapagliflozin

Question 10

How does gliclazide work?

Answer 10

Acts directly on beta cells in the Pancreas. Stimulates insulin secretion.

Question 11

How do Dipeptidylpeptidase-4 inhibitors (DPP4-i) work?

Answer 11

Prolongs the effect of hormone GLP1 which slows gastric emptying (reducing appetite) and increases insulin production after meals.

Question 12

Give examples of Dipeptidylpeptidase-4 inhibitors

Answer 12

Sitagliptin and Linagliptin

Question 13

What are Glucagon-like peptide-1 receptor agonists?

Answer 13

Similar mechanism to gliptins, they are injectable and are used in patients with BMI over 35.
They promote weight loss and provide cardiovascular benefit.

Question 14

Injectable insulin - what are the 2 types?

Answer 14

Human insulins same genetic sequence as endogenous human insulin

Insulin analogues – modified to meet certain characteristic

Question 15

Short acting insulin, dosing and duration

Answer 15

1. Taken with meals
2. Onset within 15-60 mins and duration is up to 8 hours

Question 16

Intermediate acting insulin. Dosing and duration

Answer 16

Once daily or twice daily
Onset 1-2 hours
Max effect 4-12 hours
Duration 16-35 hours

Question 17

Long acting insulin - dosing and duration

Answer 17

Taken OD
Steady state can be achieved after 2-4 days to produce a constant level insulin

Question 18

Ultra long acting insulin - dosing and duration

Answer 18

taken OD
Achieve steady state after 2-4 days