QuestionSBA
QuestionChoice
This patient has had a response to her metformin treatment. Her HbA1c has dropped from 62 mmol/mol to 53 mmol/mol in 3 months on metformin she therefore does not need a further anti-diabetic adding to her treatment regime.
50303
e
Add 10 units Humulin I Insulin to take once in the morning
QuestionChoice
This patient has had a response to her metformin treatment. Her HbA1c has dropped from 62 mmol/mol to 53 mmol/mol in 3 months on metformin she therefore does not need a further anti-diabetic adding to her treatment regime.
50302
d
Add pioglitazone 30mg PO OD
QuestionChoice
This patient has had a response to her metformin treatment. Her HbA1c has dropped from 62 mmol/mol to 53 mmol/mol in 3 months on metformin. She should be encouraged to keep taking metformin and keep any dietary/lifestyle changes she has employed and the HbA1c should be rechecked in 3 months.
50299
a
Make no changes to her medications
QuestionChoice
This patient has had a response to her metformin treatment. Her HbA1c has dropped from 62 mmol/mol to 53 mmol/mol in 3 months on metformin she therefore does not need a further anti-diabetic adding to her treatment regime.
50301
c
Add sitagliptin 100mg PO OD
QuestionChoice
This patient has had a response to her metformin treatment. Her HbA1c has dropped from 62 mmol/mol to 53 mmol/mol in 3 months on metformin she therefore does not need a further anti-diabetic adding to her treatment regime.
50300
b
Add gliclazide 40mg PO OD
QuestionComment
when would you consider adding gliclazide here?
36780
QuestionComment
if HbA1c >58??
37215
User
subscriber
Metabolism Biopsy
User
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Kinase Sclerosis
QuestionComment
i thought the target is 48 mmol/mol with metformin alone, it's only 53 with hypo-causing meds?
38500
QuestionComment
same
38641
User
subscriber
Taylor Swift
QuestionComment
the target is 48, but the threshold for considering adding another drug is 58. So her 53 is suboptimal target, but it is not necessary to add another drug. My guess is she would be given further dietary advice and exercise
39348
User
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Biopsy Cystic
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CT Womb
QuestionComment
I agree with biopsy cystic! Though the target is 48, the threshold for adding another drug is 58!
59442
User
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Axillary Ketone
QuestionComment
'If HbA1c levels are poorly controlled despite treatment with a single drug and rise to 58 mmol/mol (7.5%) or higher, drug treatment should be intensified, alongside reinforcement of advice regarding diet, lifestyle, and adherence to drug treatment.

When two or more antidiabetic drugs are prescribed, a target HbA1c level of 53 mmol/mol (7.0%) is recommended for patients in which it is appropriate.''
61604
User
subscriber
Juice Epidermis
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3643
Moving up the treatment ladder in patients with type 2 diabetes mellitus
Topic
9
Internal Medicine
10114
Case Presentation: A 73 year old woman attends her GP for a diabetes review. 


**PH** Type 2 diabetes mellitus, hypercholesterolaemia

**DH** Metformin 500mg PO BD, simvastatin 20mg PO OD. NKDA

**Investigations**

HbA1c 3 months ago: 62 mmol/mol (< 42 mmol/mol)

HbA1c today: 53 mmol/mol (< 42 mmol/mol)

Question: Select the most appropriate management at this stage.
a