T2DM

Question 1

What are the HbA1c thresholds for treatment? NAme each stage

Answer 1

42-48- Lifestyle advice
>48 Lifestyle advice and metformin
>58 Add a second drug (Sulphonurea) and potentially another if it is resistant

Question 2

How often should you check HbA1c?

Answer 2

Every 3 months until stable then every 6

Question 3

What is impaired fasting glucose caused by?

Answer 3

Hepatic insulin

Question 4

What is glucose tolerance a test of?

Answer 4

Muscle insulin resistance= test for T2DM

Question 5

What does HbA1c test?

Answer 5

3 months worth of blood sugar

Question 6

What is the target BP in T2DM?

Answer 6

140/90

Question 7

What lifestyle measures are used in T2DM?

Answer 7

Excercise
Weight loss
Dietary advice (glycaemic index tool)

Question 8

How are diabetic feet checed?

Answer 8

Annually by diabetic nurse

Question 9

How do you assess for peripheral neuropathy?

Answer 9

ABPI

Question 10

Describe diabetic foot disease

Answer 10

Absent pulses
Peripheral neuropathy
Ulcers and cellulitis risk
Intermittent claudication in legs
Osteomyelitis risk

Question 11

How do you check for diabetic nephropathy?

Answer 11

Cr 9 (early morning)
Albumin
Us and Es all checked annually

Question 12

What is used to reduce risk of nephropathy?

Answer 12

BP control and statins

Question 13

Describe diabetic peripheral neuropathy

Answer 13

PAINFUL
Glove and stocking distrobution
Glucose damages nerves

Question 14

What is used to treat Neuropathy?

Answer 14

Trycyclics
Pregabalin/Gabapentin/Duloxetine
Rescue- Tramadol

Question 15

What should you always check with retinopathy?

Answer 15

Acuity

Question 16

What is the pathophysiology of retinopathy

Answer 16

Glucose build up causes vessels to be destroyed and reform (micraneurysm and revasculasation and ischeamia)

Question 17

How does DKA present?

Answer 17

Pain
Polyuria
Polydipsia
(Reduced consiousness and vomit)

Question 18

IS DKA more T1 or T2DM?

Answer 18

T1

Question 19

How is DKA managed?

Answer 19

Fluids
Insulin
Potassium (to protect heart- but created cerebral oedema risk)

Question 20

What is the main side effect of Metformin?

Answer 20

GI upset

Question 21

Name 6 different kinds of diabetes medication

Answer 21

Metformin
Sulphonureas is Glicaside
SGLT2 Inhibitors ie Canagliflozin
Gliptins ie Vildagliptin
Pioglitazone
Insulin

Question 22

Which diabetes meds cause weight gain and hypos risk?

Answer 22

Sulphonureas

Insulin

Question 23

Which Diabetes med causes weight loss?

Answer 23

SGLT2 Inhibitors BUT last line used as very expensive

Question 24

What are the side effect of gliptins?

Answer 24

Pancreatitis

Question 25

When is a second medication added to metformin and what can be added?

Answer 25

>58 HbA1c
Sulphonurea
Gliptin
Pioglitazone
SGLT2 Inhibitor

Question 26

What is done if HbA1c remains >58 on 2 medications?

Answer 26

Go to triple therapy:
Sulphonurea and any of the others
OR INSULIN (continue metformin)

Question 27

What is done if patients cannot tolerate Metformin?

Answer 27

If HbA1c >48 = Sulphonurea, Gliptin or Pioglitazone

If HbA1c >58 = Gliptin + Sulphonurea/Pioglitazone

Question 28

What also needs to be treated in diabetes?

Answer 28

Other risk factors
ACEi for hypertension
Lipid modification
Antiplatelet for existing CV disease