QuestionSBA
QuestionChoice
his patient's HbA1c level is being adequately controlled by his current antidiabetic medication. His HbA1c has dropped from 59 mmol/mol to 51 mmol/mol. There is no clinical indication to start insulin treatment.
50453
e
Start humulin I long acting insulin
QuestionChoice
his patient's HbA1c level is being adequately controlled by his current antidiabetic medication. His HbA1c has dropped from 59 mmol/mol to 51 mmol/mol. There is no clinical indication to start gliclazide 40mg PO OD.
50452
d
Add gliclazide 40mg PO OD
QuestionChoice
This patient's HbA1c level is being adequately controlled by his current antidiabetic medication. His HbA1c has dropped from 59 mmol/mol to 51 mmol/mol with 3 months of treatment. He should continue on this medication for another 3 months, if his HbA1c drops below 48 mmol/mol then his metformin dose may be reduced.
50449
a
Make no changes to his anti diabetic medications
QuestionChoice
This patient's HbA1c level is being adequately controlled by his current antidiabetic medication. His HbA1c has dropped from 59 mmol/mol to 51 mmol/mol with 3 months of treatment. Stopping metformin now would be premature as his HbA1c is still above 48 mmol/mol.
50451
c
Stop his metformin
QuestionChoice
This patient's HbA1c level is being adequately controlled by his current antidiabetic medication. His HbA1c has dropped from 59 mmol/mol to 51 mmol/mol with 3 months of treatment. 
50450
b
Increase his metformin dose to 1g PO BD
QuestionComment
Isn't the target 48 if on metformin only? Why can't we increase the metformin?
17626
QuestionComment
literally
40364
User
subscriber
Lateral Kinase
QuestionComment
He is above target, so you should titrate the metformin dose
59432
User
subscriber
Neutrophillia
User
subscriber
Migraine Serotonin
QuestionComment
48 = Add metformin
53 = Target
58 = Add another drug e.g. sulfonylurea
40362
User
subscriber
Respect
QuestionComment
'Increased if necessary...2 g total daily dose may alternatively be given as 1 g twice daily with meals only if control not achieved with once daily dose regimen. If control still not achieved then change to standard release tablets.'

I suppose control is technically being achieved. Perhaps the take away here, is that if the clinician is struggling to overcome increased HbA1c, he should titrate up; if it's working don't interfere.

Just to be clear, I got it wrong too
60848
User
subscriber
Retake Prophylaxis 
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
3673
When to change anti-diabetic medications based on HbA1c levels in patients with type 2 diabetes mellitus
Topic
9
Internal Medicine
10144
Case Presentation:  A 66-year-old gentleman attends the diabetes clinic for a review of his type 2 diabetes mellitus. 


**PMH** Type 2 diabetes mellitus, hypercholesterolaemia, hypertension, depression

**DH** Metformin 500mg PO BD, simvastatin 20mg PO OD, lisinopril 10mg PO OD, mirtazapine 15mg PO BD

**Investigations**

HbA1c 3 months ago: 59 mmol/mol (< 42 mmol/mol)

HbA1c today: 51 mmol/mol (< 42 mmol/mol)

Question: Select the most appropriate decision option based on this data
a