Type 2 Diabetes Flashcards
what is an appropriate BP target for a patient with uncomplicated type 2 diabetes
140/80mmHg
what is an appropriate BP target in a patient with type 2 diabetes and a history of MI and angioplasty
130/80mmHg
what is the first line choice for antihypertensives in T2DM
ACE inhibitor
what is the target LDL cholesterol for all patients with T2DM
2.0mmol/l
what proportion of patients with type 2 diabetes will succumb to cardiovascular complication
75%
which is the most important risk factor to control to reduce cardiovascular risk in a pt with T2DM
Cholesterol
a 65 year old male attend diabetes clinic. He reports lower limb pain in the calf after walking approx 50 yards and is relieved by rest.
His co-morbidities include HTN and dyslipidaemia.
He smokes 10 cigarettes a day.
What is the likely diagnosis
intermittent claudication
which study showed long term benefit of reduced ischaemic heart disease from early intensive glycemic control in pts with T2DM
UKPDS
in a pt with newly diagnosed T2DM, following lifestyle intervention, what is the first line anti-diabetic treatment
Metformin
which of these treatments is associated with hypoglycaemia as a potential side effect: Gliclazide Pioglitazone Metformin Sitagliptin GLP-1 receptor angonist
Gliclazide (a sulfonylurea)
A 21y/o with T2DM presents with a BMI of 36.
She has hyper pigmentation of the skin in the axilla bilaterally what is the most likely diagnosis
Acanthosis nigrans
strongly suggestive of insulin resistance
which anti diabetic agent is associated with potential weight gains as an adverse effect
pioglitazone
what causes weight gain with pioglitazone
saltwater retention
which anti diabetic agent is theoretically associated with the risk of lactic acidosis
metformin
more likely to occur in pts with renal impairment
at what level of eGFR should one stop metformin
30ml/min/1.73m2
which study suggested an adverse outcome from intensive glucose monitoring in pts with longstanding T2DM
ACCORD
how would you classify chronic kidney disease in a lady who is 60yrs with Hx of T2DM for 20yrs Hb1ac = 7.9% BP= 170/95 albumin:creatinine ratio of 40mg/mol eGFR= 40ml/min/1.73m2
3b
the main management of this patient would be controlling her blood pressure
what biochemistry finding would cause you to discontinue ACE inhibitor treatment in T2DM
Serum creatinine 215
what clinical sign would be suggestive of cardiac autonomic neuropathy
absent beat to beat variation in pulse rate with deep respiration
a pt is complaining of erectile dysfunction
investigation show normal gonadotrophin levels
you are considering treatment with a PD5 inhibitor
he has a history of IHD
which medication is a contraindication to PD5 inhibitor treatment
isosorbide mononitrate
a 55y male who has been recently diagnosed with T2DM.
Hx: HTN and dyslipidaemia
today:
BP= 160/90
Ab1ac = 7.4%
eGFR >90ml/min/1.73m2
persistently raised alb:creat (10-15mg/mol)
what is his risk of progression to macroalbuminuria over the next 10 years
30%
in this patient irbesartan would be the most effective agent to attenuate this risk (angiotensin-II receptor antagonist)
the use of ACE inhibitor has gained widespread acceptance as the first line treatment of hen in pts with early or advance diabetic nephropathy.
This class of agents help to lower BP and attenuate proteinuria
how are these benefits achieved
improved renal perfusion
which electrolyte disturbance is a potential concern when dosing ACE inhibitors
hyperkalaemia
what level of HbA1c is the aim to reduce the microvascular complications of diabetes
53mol/mmpl (7.0%)
