T2DM

Question 1

T2DM - who to screen

1. when to use AUSDRISK (2)
2. when to use fasting glucose (7)

Answer 1

1. AUSD risk
   
   • ATSI >18
   • Age >40
2. ask for fasting BSL every 3 years
   
   • AUSDRISK >=12
   • Age >40 + BMI > 30
   • Premature CV disease
   • Gestational DM
   • PCOS
   • People on anti-psychotic
   • Impaired fasting glucose- every 12 months

Question 2

Physical findings suggest insulin resistance (4)

Answer 2

Skin tag
Acanthosis nigricans
Hirsutism
Central obesity

Question 3

diagnosis of metabolic syndrome (4)

Answer 3

1. waist circumference (men >94 cm, women >80 cm)
2. HTN >130/85
3. Fasting BSL > 5.5
4. dyslipidaemia (HDL <1.0, TG > 1.7)

Question 4

when to suspect T1DM in new Dx DM (5)

Answer 4

1. age < 50
2. BMI < 25
3. rapid onset of symptoms
4. polyuria /polydipsia (occur more in T1DM)
5. ketones in urine

Question 5

immunological marker for T1DM (3)

Answer 5

High GAD Abs (glutamic acid decarboxylase Ab)
High IA 52 Ab (Insulinoma Antigen 2 Ab)
Low C-Peptide (low as low insulin)

Question 6

T2DM - diagnosis (4)

Answer 6

1. fasting BSL >7.0
2. Random BSL >11.0
3. HbA1C > 6.5
4. OGTT
   
   • fasting > 7.0
   • 2 hours
     - < 7.8 –> no DM
     - 7.8 - 11.0 –> impaired glycaemic control
     - > 11.0 –> DM

Question 7

who needs self BSL monitoring

Answer 7

1. new diagnose DM
2. pt on sulfonylureas and insulin (risk of hypoglycaemia)
3. when sick (risk of hyperglycaemia)
4. pregnant
5. change medication

Question 8

Target BSL (fasting, postprandial, HbA1C)

Answer 8

fasting 6-8
postprandial 8-10
HbA1C < 7.0 
      - gestational DM <6.0
      - high risk of hypoglycaemia <8.0

Question 9

Diabetic cycle of care (10)

Answer 9

BMI x2
BP x2
HbA1C x1
lipid profile x1
eGFR x1
Urine ACR x1
eye check  x1 / 2years
foot assessment x2
medication review x1
physical activity/smoking x1

Question 10

vaccination in DM

Answer 10

1. dTPA (boostrix) at age of 50 years
2. influenza vaccine
3. pneumococcal vaccine x2 doses
   a. ATSI
   - <50 years
   - at diagnosis
   - 10 years later or at age of 50 (later)
   - > 50 years
   - at age of 50
   - 5 years later
   b. Others
   - <65 years
   - at diagnosis
   - 10 years later or at age of 50 (later)
   - > 65 years
   - at age of 65
   - 5 years later

Question 11

gestational DM - time and diagnosis

Answer 11

28/40

75g OGTT (oral glucose tolerance test)
Fasting glucose → > 5.1
1 hour glucose → > 10.0
2 hours glucose → > 8.5

Question 12

gestational DM- non-pharmacological Mx (8)

Answer 12

• Self BSL monitoring x4 reading/day
• limit weight gain during pregnancy by limiting calorie intake
• Dietary advice with restriction of CHO
• Increase physical activity 2.5 hours/week
• Folic acid 5mg daily
• Multi-disciplinary team (obstetric and endocrinologist)
• Referral to a dietitian
• Close monitoring of fetal welfare

Question 13

target lipid profile in T2DM

Answer 13

cholesterol < 4.0
TG <2.0
LDL < 2.0
HDL > 1.0