Type 2 Diabetes

Question 1

HbA1c Target for Lifestyle interventions (1)

Answer 1

1. 48 mmol/mol (6.5%)

Question 2

HbA1c Target for Lifestyle interventions + Metformin (1)

Answer 2

1. 48 mmol/mol (6.5%)

Question 3

HbA1c Target for amy drug that causes hypoglycaemia (1)

Answer 3

1. 53 mmol/mol or 7.0%

Question 4

Name 4 conditions or procedures that artificially lower HbA1c (4)

Answer 4

1. Haemodyalisis
2. G6PD Deficiency
3. Hereditary Spherocytosis
4. Sickle Cell

all reduce RBC lifespan so average of HbA1c is less long term and accurate

Question 5

Name 3 conditions that artificially raise HbA1c (3)

Answer 5

1. Iron Deficiency Anaemia
2. Vit B12 / Folate Deficiency Anaemia
3. Splenectomy

they all raise the RBC lifespan affecting the average

Question 6

Sick Day Rules for Type 1 Diabetes: (5)

Answer 6

1. DO NOT STOP INSULIN
2. Regularly check BMs every 1-2 hours including at night
3. Check blood or urinary ketones regularly
4. Maintain normal meals and substitute in sugary / carb drinks if missing meals or low appetite
5. Drink at LEAST 3L or 5 pints of water to fight dehydration

Question 7

Sick Day Rules for Type 2 Diabetes: (8)

Answer 7

1. Stop some antiglycaemics in acute illness
2. Restart when rehydrated and eating for 24-48 hrs
3. Metformin: stop if dehydration - risk of lactic acidosis
4. Sulfonylureas - increased risk of Hypos
5. SGLT2is - stop if ketones or dehydrated - euglycaemic DKA
6. GLP1 - stop in dehydration - AKI risk
7. DO NOT STOP INSULIN if on it

8 Check BMs more regularly

Question 8

FPG range for prediabetes (1)

Answer 8

1. 6.1 - 6.9

Question 9

HbA1c range for prediabetes (1)

Answer 9

42 - 47

Question 10

Normal HbA1c

Answer 10

< or equal to 41

Question 11

How many Units of Insulin per ml in a standard preparations? (1)

Answer 11

1ml = 100 units

Question 12

Diagnostic Criteria (3)

Answer 12

1. FPG: >7.0 + symptoms
2. Random Glucose >11.1 +symptoms
3. if asymptomatic - need two readings

Question 13

Test to tell Type 1 from 2 (1)

Answer 13

1. Anti-GAD antibody

Question 14

Indications for SGLT2s to be added to Metformin in T2DM (4)

Answer 14

1. High risk of CVD/High QRISK
2. Established CVD
3. Chronic Heart Failure
4. Develops any CVD condition during treatment course

Question 15

What do you swap to if Metformin is contraindicated or not tolerated? (2)

Answer 15

IF CVD RISK HIGH, ESTABLISHED OR KNOWN HEART FAILURE
1. SGLT2 Monotherapy - can add sulfonylurea later

IF NOT:
2. DDP4 or Pioglitazone or Sulfonylurea

Question 16

Drug regimen if HbA1c is not controlled (T2DM) on just metformin (5)

Answer 16

HbA1c not down to target on metformin then:

2nd Line:
1. Add ONE of: DDP-4, Pioglitazone, Sulfonylurea

STILL NOT DOWN

3rd Line:
2. Another of DDP-4, Pioglitazone, Sulfonylurea (remaining)
or
3. Start Insulin

4th Line:
4. If tripple therapy isn’t cutting it, maybe swap one for a GLP-1 or start insulin. Together these are specialist

5. IF AT ANY POINT QRISK > 10, swap out for Metformin + SGLT2 and add sulfonylurea as needed

Question 17

Describe the Insulin + Metformin regimen for T2DM control (2)

Answer 17

1. Human NPH Insulin (Intermediate acting) taken at bed or twice daily according to need
2. Continue Metformin and review need for previous antiglycaemics