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MAKING BEST PRACTICE, EVERYDAY PRACTICE

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Sharing best practice in diabetes care – Case study 2

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Sharing best practice in diabetes care – Case study 2 Sharing best practice in diabetes care – Case study 2

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Question 1 of 10
1. Question
1. During this consultation we discussed the treatment goals again and agreed that her current control is suboptimal to prevent complications. We are hoping to achieve an HbA1c of <7%. What treatment alterations would you suggest to optimise glycaemic control?
A. Add a sulphonylurea
B. Add a DPP-4 inhibitor
C. Add basal insulin
Question 2 of 10
2. Question
2. The patient fears using insulin as she has heard frightening stories about hypoglycaemia from other patients using it. What would you advise?
A. Delay starting insulin and do not intensify treatment
B. Inform her that she has no option but to start on a basal-bolus insulin regimen
C. Suggest that she start on basal insulin and then slowly titrate the dose
Question 3 of 10
3. Question
3. Second-generation basal insulins, e.g. glargine U-300, need to be dosed twice a day for optimal effect.
A. True
B. False
Question 4 of 10
4. Question
4. Explain to the patient your reasons for introducing a second-generation basal insulin, in this case insulin glargine U-300:
A. It is convenient as you only have to use it once a day
B. It has a low incidence of hypoglycaemia
C. It is effective at achieving good glycaemic control with little variability
D. All of the above
Question 5 of 10
5. Question
5. Carbohydrate counting is regularly incorporated as part of treatment for patients living with diabetes. Is it essential to count carbohydrates to optimise the treatment dose of basal insulin?
A. Yes
B. No
Question 6 of 10
6. Question
6. Her fasting glucose has improved. What would you do next?
A. Continue with current treatment, including the glargine U-300, at 10 units a day
B. Stop the insulin glargine and switch to mealtime insulin
C. Continue with insulin glargine and increase the dose with two units every three days until fasting glucose is below 7mmol/l
Question 7 of 10
7. Question
7. In addition to optimising her glycaemic control, which of the following would you do?
A. Stop her ARB as her blood pressure is not elevated
B. Intensify her lipid treatment by adding ezetimide and/or increasing atorvastatin
C. Suggest adding eltroxin 100μg daily to her treatment
Question 8 of 10
8. Question
8. Is her slightly elevated liver function test of any importance? What should be the next step?
A. Review liver function again next year
B. Refer to a hepatologist
C. Add supplements to her diet
D. Refer for further assessment using FibroScan or liver elastography
Question 9 of 10
9. Question
9. Is it imperative to intensify her treatment any further to achieve a HbA1c of <7%?
A. Yes, therapy should be intensified to achieve a target of <6.5%
B. No, a target of <8% is adequate
C. Targets do not matter and should not be used to guide treatment
Question 10 of 10
10. Question
10. If her renal function deteriorates over time, which medication would you discontinue first?
A. Insulin glargine U-300
B. Semaglutide
C. Empagliflozin
D. Metformin

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