Making decisions in management

Section 2

In the given scenarios, are the decisions CORRECT or INCORRECT?

Statement Decisions (correct or incorrect?)
1. A 48 year old man has diabetes and is on Metformin alone. His plasma glucose is well controlled. This man is scheduled to undergo a coronary angiogram. Is any change necessary in his diabetes treatment? No change needed
2. A 57 year old woman has coronary heart disease and diabetes. She takes Metformin and Gliclazide for her diabetes but diabetic control is not good. She does not want to start insulin. Would you like to add Pioglitazone or Rosiglitazone to her diabetes treatment in order to reduce the plasma glucose? No. I do not wish to prescribe these drugs
3. A 16 year old boy weighing 50kg has Type 1 diabetes. His fasting plasma glucose is 10mmol/L. Is the following insulin schedule appropriate for initiation of therapy? Inj. Mixtard 30/70, 24 units sc before breakfast / Inj. Actrapid 8 units sc before lunch/ Inj. Mixtard 30/70, 12units sc before dinner Yes. It is appropriate
4. A 48 year old woman, weighing 60kg, with Type 2 diabetes, has to be started on insulin in the outpatient clinic. She is currently on Tab Glibenclamide 10mg before breakfast and Tab Metformin 1000mg twice a day. Her physician prescribes her: Injection Actrapid 4 units sc three times a day before each meal / Tab Metformin 1000mg twice daily / She is also told to stop her Tab Glibenclamide. Do you agree with the physician's advice? No. I do not agree
5. An elderly man with diabetes and sepsis secondary to urinary infection is admitted. His random plasma glucose is 11mmol/L. His doctor stops his usual medication and starts him on thrice daily short-acting insulin according to a test-and-treat strategy. Is that the right thing to do? Yes. It is appropriate to do that
6. A 48 year old man with diabetes is being treated with Injection Mixtard (30/70) 16 units before dinner. He also takes Metformin 500mg TDS. His fasting plasma glucose is 6.3mmol/L but his glycosylated hemoglobin is elevated at 8 percent. In view of the elevated HbA1c, he should now undergo a glucose tolerance test. Yes, a glucose tolerance test is necessary

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