Type 2 Diabetes

Question 1

For whom is self-monitoring of blood glucose recommended?

Answer 1

For people using insulin or those using other glucose-reducing drugs.

Question 2

What are three benefits of self-monitoring of blood glucose?

Answer 2

• modifying treatment (including diet and exercise)
• identifying and treating hypoglycaemia
• encouraging the patient to become more involved in self-management

Question 3

How should a patient be initiated on Metformin treatment?

Answer 3

500mg daily with food, titrating upwards to 1000mg to allow the patient to develop GI tolerance.

Question 4

What proportion of patients will not tolerate metformin at any dose?

Answer 4

1/50

Question 5

In a patient with renal impairment GFR 50 mL/min, what maintenance dose of metformin is most appropriate?

Answer 5

Metformin 500mg bd (This is equivalent to 1000 mg bd in a patient with normal renal function. )

Question 6

What is an example of a patient group for whom Thiazolidinediones are prescribed as a third-line treatment, instead of insulin?

Answer 6

Patients who cannot easily take insulin, e.c. commercial drivers are often prescribed thiazolidinediones because of the reduced risk of hypoglycaemia.

Question 7

What is a potential issue for a patient taking insulin and a beta blocker?

Answer 7

Beta blockers will blunt the adrenergic response to hypoglycaemia so patients and their families need to be aware of this.

Question 8

What advice would be given to a patient taking insulin or sulfonylureas?

Answer 8

• the need to monitor blood-sugar adequately and be educated about the symptoms of hypoglycaemia.

Question 9

How should insulin therapy be initiated in a type 2 diabetic?

Answer 9

Once-daily long acting insulin. Initiated at a lower dose than normal, then titrated up according to blood sugar levels.

Question 10

What HbA1C treatment target(s) would you recommend for a patient with type 2 diabetes starting insulin?

Answer 10

53 mmol/mol (7.0%)

Question 11

How often should a patient with T2DM just starting insulin therapy self-monitor their blood glucose levels?

Answer 11

Daily morning fasting glucose and if symptomatic.

Question 12

A patient with type 2 diabetes treated with metformin and once daily insulin glargine, 56 units/day has a nocturnal seizure.
There is no previous history of seizure, what do you advise regarding his diabetes treatment?

Answer 12

Reduce the insulin dose by 20 units

Approximately a third reduction in insulin dose is usually effective in reducing the risk of hypoglycaemic seizures and avoiding major hyperglycaemia.