A 55-year-old woman, with type 2 diabetes, has been successful in controlling her HbA1c through diet alone. She has lost 5 kilograms in the past 6 months by making changes to her diet and exercising regularly. Despite her progress, she is aware that her BMI categorizes her as ‘obese’ and wants to continue losing weight. During her clinic visit, she inquired about foods she should avoid.
What foods should this patient steer clear of?
A 65-year-old man with a history of myocardial infarction, congestive heart failure, and chronic obstructive pulmonary disease presents for a diabetes check-up at his GP’s office. He has been diagnosed with type 2 diabetes mellitus and his HbA1c remains high at 56 mmol/mol despite attempts to modify his lifestyle. The GP decides to initiate drug therapy.
Which of the following medications would be inappropriate for this patient?
A 50-year-old woman is undergoing a routine health assessment. She admits to consuming at least 5 standard alcoholic drinks each weekday evening and even more on the weekend. The risks of this intake are discussed with her and a plan is made to reduce her intake.
Which of the following actions is the most appropriate?
Mrs. Waller, a patient with type 2 diabetes, comes to discuss her latest HbA1c result. It has gone up to 66 mmol/mol since the last check. She is already taking metformin and gliclazide. You advise adding in a third blood glucose lowering drug, and agree on trying canagliflozin, an SGLT2 inhibitor. You counsel her that it will cause a slight increase in urine volume and risk of urinary and genital infections, including rare reports of Fournier’s gangrene, but that it can have beneficial side effects of weight loss and possibly improves cardiovascular outcomes. You also mention that the MHRA have issued an alert about an uncommon but important possible hazard of treatment with SGLT2 inhibitors.
What specific aspect of routine diabetes care is crucial in preventing or detecting this potential side effect?
A 25-year-old woman with type 1 diabetes mellitus is discovered collapsed in the hallway. A nurse is present and has conducted a finger-prick glucose test, which shows a reading of 1.8 mmol/l. Upon examination, you observe that she is unresponsive to verbal cues, with a pulse rate of 84/min. The nurse has already positioned the patient in the recovery position. What is the best course of action for treatment?
You are consulted for a 50-year-old patient with type 2 diabetes who presents with a 24-hour history of polyuria, polydipsia, and vomiting. The patient is currently taking metformin, gliclazide, and empagliflozin. On examination, the patient has a temperature of 37.4°C, blood pressure of 130/80 mmHg, pulse of 100, blood glucose of 13 mmol/L, and blood ketones of 3.3 mmol/L. Urinalysis shows +++ ketones, but is otherwise normal.
What is the most likely diagnosis?
Mrs. Smith is a 65-year-old lady who has been prescribed once-daily insulin for her type 2 diabetes by the secondary care diabetes team a few months ago. During her routine medication review, you observe that she is not utilizing many lancets or blood sugar (BM) testing strips. She confesses to not checking her sugars every day. You inquire if she drives; she frequently uses the car for running errands around town.
What guidance should you provide to Mrs. Smith regarding blood glucose (BM) monitoring and driving?
As the on-call physician, you receive a lab report for a 75-year-old man who has undergone routine blood tests to monitor his Antihypertensive medication.
The blood results are as follows:
Na+ 126 mmol/l
K+ 4.8 mmol/l
eGFR 85 ml/min/1.73m2
Upon calling the patient, he reports no symptoms and confirms that he is taking his regular lisinopril and amlodipine.
What would be the most appropriate course of action to manage this situation?
You receive the blood tests which were requested by the practice nurse in advance of the annual diabetes review of Mrs. Johnson, a 50-year-old patient. Mrs. Johnson was diagnosed with type 2 diabetes about 4 years ago, and after 2 years of attempting to control it with lifestyle measures, she commenced metformin and is now prescribed 1g BD. Her full blood count, renal profile and liver function tests are normal, her total cholesterol is 5.3mmol/L. Her HbA1c is 60mmol/mol.
As per NICE guidelines, what should be done regarding Mrs. Johnson’s blood sugar control?
A 55-year-old man with a history of hypertension has a 10-year cardiovascular disease risk of 20%. It is decided to initiate treatment with atorvastatin 20 mg. Before starting the medication, liver function tests are conducted:
Bilirubin 10 µmol/l (3 – 17 µmol/l)
ALP 96 u/l (30 – 150 u/l)
ALT 40 u/l (10 – 45 u/l)
Gamma-GT 28 u/l (10 – 40 u/l)
After three months, the LFTs are repeated:
Bilirubin 12 µmol/l (3 – 17 µmol/l)
ALP 107 u/l (30 – 150 u/l)
ALT 104 u/l (10 – 45 u/l)
Gamma-GT 76 u/l (10 – 40 u/l)
What is the most appropriate action to take?