8 Final questions
The Learning Outcomes can be found at the start of this course
Question 1 (1st, 2nd and 3rd Learning Outcome)
List the investigations that are likely to take place during a diabetes annual review and the various team members involved.
Various investigations take place during an annual review. They include reviewing blood glucose control, measuring levels of HbA1c and ketones in the blood and determining the lipid profile. Blood pressure is measured and the BMI is determined along with waist measurement. Lifestyle, including diet history, smoking and exercise is discussed.
Various members of the diabetes team are involved in the annual review, for example the diabetologist, dietitian, and diabetes care technician.
Question 2 (2nd Learning Outcome)
Which tests in the diabetes annual review check for coronary heart disease risk?
The tests that contribute to the checks for risk of coronary heart disease are: blood pressure, blood lipid profile, smoking history, lifestyle, BMI and waist measurement.
Question 3 (4th and 6th Learning Outcome)
Mrs Smith feels her diabetes is well controlled because her home blood glucose test results are all in single figures. When she attends the diabetes clinic with her GP for her annual review, she is shocked to find her HbA1c is well above target. Can you suggest possible reasons for this?
There are several possible reasons why Mrs Smith’s HbA1c level is high. Her meter could be faulty, she may not be using it correctly, she may be using the wrong strips or they could be out of date or damaged. She may be testing infrequently and only when she knows her tests will be satisfactory. She may be only testing at a certain time of day and missing high results at other parts of the day. There could be an abnormality with her haemoglobin which is giving a high HbA1c, or there may be a problem with the laboratory equipment (these last two reasons are very unusual).
Question 4 (4th Learning Outcome)
Explain how the HbA1c result can give a picture of diabetes glycaemic (i.e. the level of glucose in the blood) control.
HbA1c measures the amount of haemoglobin in the blood that has been changed or glycated by the prevailing blood glucose concentration over the previous two to three months. If the blood glucose has been within normal limits for most of the time, the HbA1c is likely to be normal. If the blood glucose has usually been higher than normal, then a greater percentage of haemoglobin will have been in contact with glucose and therefore glycated. The HbA1c will therefore be higher than normal. If the blood glucose has been lower than normal (because the person with diabetes has had a lot of episodes of hypoglycaemia or low blood glucose) then the HbA1c value will be lower than normal. Unfortunately, if the blood glucose has been equally high and low, then a normal HbA1c may be the result. This is why the patient’s own home blood testing record is important.
Question 5 (1st and 4th Learning Outcome)
When would you expect to find ketones in urine?
Ketones may be found in the urine and blood of people with Type 1 diabetes who have insufficient insulin in their blood to control their blood glucose level and prevent the breakdown of body fats into ketones. Ketones can also be found in small quantities in the urine of people who have been fasting for a prolonged period of time.
Question 6 (5th Learning Outcome)
Jane weighs 70 kg and is 1.75 m tall. Nina weighs 70 kg and is 1.52 m tall. Who is at greater risk of CHD, based on their BMI?
The equation to calculate BMI is:
A BMI greater than 25 kg/m2 is a risk factor for CHD, so Nina has a higher risk than Jane.