T2DM

Question 1

insulin deficiency in T2DM

Answer 1

relative

Question 2

what causes insulin deficiency in T2DM

Answer 2

excess adipose - not enough insulin to go around

Question 3

symptoms T2DM

Answer 3

overweight, over 30, polydipsia, polyuria

Question 4

glucose for T2DM

Answer 4

fasting >7 // random or glucose tolerance >11.1 // once if symptomatic, twice if asymptomatic

Question 5

what is glucose tolerance testing

Answer 5

eat 75g glucose –> test 2 hours later

Question 6

what is HbA1c

Answer 6

glycosated Hb over past 2-3 months

Question 7

what does HbA1c give a good measure of

Answer 7

diabetic control over last few months

Question 8

T2DM diagnosis HbA1c

Answer 8

> 6.5% or 48 // if asymptomatic repeat test

Question 9

what are the 2 categories of prediabetes

Answer 9

impaired fasting glucose // impaired glucose tolerance

Question 10

what is impaired fasting glucose in (IFG) pre-diabetes

Answer 10

fasting glucose between 6.1-7

Question 11

what is impaired glucose tolerance (IGT) in pre-diaebtes

Answer 11

fasting glucose <7 AND glucose tolerance test between 7.8-11.1

Question 12

what should patients with IGF be offered

Answer 12

oral glucose test // >11.1 = T2DM // 7.8-11.1 = IGT // <7.8 = IFG

Question 13

what insulin resistance occurs in IFG pre-diabetes

Answer 13

hepatic

Question 14

what insulin resistance occurs in IGT pre-diabetes

Answer 14

muscle

Question 15

what type of pre-diabetes is more likely to result in T2DM + CVD

Answer 15

IGT

Question 16

mx pre-diabetes

Answer 16

weight loss, diet, exercise // metformin if high risk

Question 17

why can a low HbA1c not rule out T2DM

Answer 17

not as sensitive as fasting

Question 18

what other factor can cause a rise in HbA1c

Answer 18

red cell turnover

Question 19

what conditions cause low HbA1c

Answer 19

sickle cell anaemia // GP6D // spherocytosis // haemodialysis

Question 20

what conditions cause high HbA1c

Answer 20

vitB + folic acid def // iron def // splenectomy

Question 21

what conditions would HbA1c not be used for diabetes diagnosis (8)

Answer 21

haemoglobinopathies // haemolytic anaemia // iron deficiency // GDM // children // HIV // CKD // steroid users

Question 22

what initial target weight loss should T2DM aim for

Answer 22

5-10%

Question 23

what is the HbA1c target for those on lifestyle +/- metformin mx for T2DM

Answer 23

48mmol (6.5%)

Question 24

when should a second drug be added in T2DM

Answer 24

if HbA1c >58mmol (7.5%)

Question 25

why does metformin need to be titrated up slowly

Answer 25

to avoid GI upset

Question 26

what type of metformin should be used if GI upset occurs

Answer 26

modified release

Question 27

if metformin is contraindicated, what drug(s) are 1st line in T2DM

Answer 27

CVD risk = SGLT2i // otherwise = DDP4i, pioglitazone, SUR

Question 28

in a patient with CVD, what drug should be added to metformin as 1st line treatment

Answer 28

SGLT2i

Question 29

what dual therapy options are offered second line in T2DM

Answer 29

metformin + DDP4i OR pioglitazone OR SUR OR SGLT2i

Question 30

what 3rd line options are available for T2DM

Answer 30

triple therapy OR start insulin

Question 31

what drug can be used last line in T2DM mx + when is it esp indicated

Answer 31

GLP1 mimetic if BMI >35 // switch out a drug eg use triple therapy

Question 32

T2DM BP targets

Answer 32

clinical <140/90 (ABPM 135/85)

Question 33

1st line anti HTN in T2DM

Answer 33

ACEi or ARB (ARB if black)