A 68-year-old man is admitted for an elective total knee replacement (TKR).
His past medical history includes type 2 diabetes mellitus (T2DM), which is well controlled with metformin 500mg BD and gliclazide 80 mg OD.
The surgery is scheduled for the morning, but he is not placed on a variable rate insulin infusion (VRII).
What adjustments should be made to his antidiabetic medication regimen on the day of surgery?
A 57-year-old male patient with a history of type 2 diabetes mellitus and hypertension is admitted to a surgical ward for a routine cholecystectomy. He is currently taking metformin 500mg BD, gliclazide 120 mg BD, ramipril 5mg, and atorvastatin 20 mg. The nurse on the morning drug round asks the doctor if they should administer the morning dose of gliclazide, as the surgery is scheduled for 9 am. What should the doctor advise the nurse?
A 55-year-old woman has been diagnosed with acute cholecystitis and is set to undergo a cholecystectomy in 4 days. She is currently managing her type 1 diabetes with a daily dose of 20 units of long acting insulin in the morning. What is the appropriate once-daily dose of insulin for her to take the day before her surgery?
A 65-year-old man has scheduled an elective inguinal hernia surgery and is a diabetic taking metformin once daily. His blood glucose levels have been well controlled. He is wondering what he should do with his medication before the surgery.
What advice would be appropriate for him?
A 65-year-old man is scheduled for elective surgery to repair an umbilical hernia. He has a medical history of osteoarthritis and type two diabetes mellitus. He takes paracetamol 1 gram four times daily and metformin 500 mg once daily at breakfast. The surgery is expected to last for an hour and is scheduled for 11am. What is the appropriate management of his metformin on the day of surgery?
A 26-year-old primigravida visits her General Practitioner at 25 weeks of gestation after her midwife detected glucose in a routine urinalysis. The patient’s results are as follows:
– Blood pressure: 129/89 mmHg
– Fundal height: 25.5 cm
– Fasting plasma glucose: 6.8 mmol/L
What treatment option should be provided to this patient?
Which one of the following statements regarding gestational diabetes is accurate?
A 35-year-old woman who is currently 33 weeks pregnant has been monitoring her capillary blood glucose (CBG) at home since being diagnosed with gestational diabetes mellitus (GDM) 3 weeks ago. She has received appropriate dietary and exercise advice, as well as review by a dietitian. Additionally, she has been taking metformin and has been on the maximum dose for the past week. Fetal growth scans have been normal, with no signs of macrosomia or polyhydramnios. Today, she presents her CBG diary, which indicates a mean pre-meal CBG of 6.0 mmol/L and a mean 1-hour postprandial CBG of 8.4 mmol/L. What is the most suitable management plan?
A 27-year-old African American woman who is 28 weeks pregnant undergoes an oral glucose tolerance test (OGTT) due to her ethnicity and a history of being overweight. An ultrasound reveals that the fetus is measuring larger than expected for its gestational age. The results of the OGTT are as follows:
Time (hours) Blood glucose (mmol/l)
0 9.5
2 15.0
What would be the most suitable course of action?
A 28-year-old woman presents to her GP with complaints of weight gain, hair loss, constipation, feeling cold all the time, and absence of menstrual periods. She also had difficulty breastfeeding after giving birth. Her medical history is unremarkable except for a previous episode of hypovolaemic shock due to significant blood loss during delivery, which required a prolonged hospital stay. What is the most probable diagnosis for her symptoms?