3/12/21 Flashcards

1
Q

Non-Pharmacological Advice in T2DM

A
  • *Diet** - Dietary review
  • Diet with caloric deficit

BMI - 5-10% weight loss in those who are overweight/obese with T2DM

  • *Physical Activity**
  • 150mins of physical aerobic activity/week
  • 2-3 sessions of resistance exercise
  • Decrease daily sedentary behaviour

Cigarette Consumption → zero cigarettes/day

Alcohol Consumption → ≤2 standard drinks/day

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2
Q

Referrals to be made in young people with t2dm

A

optom, pod, exercise physiologist, diabetes ed, dietician and ENDOCRINOLOGIST IN A YOUNG PERSON

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3
Q

Medications for Weight Loss Management

A

orlistat, liraglutide, naltrexone + bupropion, phenteramine

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4
Q

Surgical options for Weight loss

A

sleeve gastrectomy, roux en Y bypass, biliopancreatic diversion

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5
Q

when to consider weight loss surgery in twcm

A

BMI >40

BMI 35-39 poor glycaemic control

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6
Q

poor glycaemic control…why?

A
  1. concurrent infection
  2. poor compliance to medication
  3. insulin not stored correctly
  4. misdiagnoses of LADA or MODY
  5. Obesity
  6. Inadequate insulin dose regimen
  7. medication - steroids, antipsychotics
  8. smoking
  9. sedentary lifestyle, lack of exercise
  10. poor diet
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7
Q

Assess nicotine dependence - 3 points

A
  • Minutes after waking for first cigarette → if smoking <30mins from waking
  • Number of cigarettes/day → if smoking >10 cigarettes/day
  • Cravings or Withdrawal Symptoms in previous quit attempts
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8
Q

5 As of Smoking Cessation

A
Ask
Assess
Advise
Assist
Arrange
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9
Q

Pharm options for smoking cessation

A
  1. NRT - patch + inhaler/gum/lozenge
  2. varenicline (no good in pregs or young people)
  3. bupropion (contraindicated in seizures, MAOi, pregs)
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10
Q

Dosing of NRT

A

other than if >30mins to first cig + <10 cigs per day -> 21mg/24hour patch + gum 2mg (4mg if >10 cigs/day)

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11
Q

DOsing of varenicline

A

0.5 for 3 days, 0.5BD for 4 days then 1mg BD

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12
Q

Non-Pharmacological for smoking cessation

A
quit day, quit plan
manage smoking triggers
address barriers to quit
motivational interviewing
frequent and regular follow-up
- Join Quitline/Support Group
- Mobilise Social Supports
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13
Q

Characteristics of HHS

A
  • Severe Hyperglycaemia
  • Hyperosmolarity - >320
  • Severe Dehydration
  • Change in Mental State - drowsiness to comatose
  • Little or No Ketacidosis
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14
Q

Office Tests for HHS

A
  • Urine Dipstick

- Finger Prick BSL + Ketones

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15
Q

Management points for HHS

A
  • Slowly and Safely replace fluid and electrolyte losses and normalise the osmolality
  • Slowly and safely normalise blood glucose concentrations → reduce glucose at 4-6mmol/L hour
  • Treat the underlying cause
    NEED SPECIALIST CARE AND MAJOR HOSPITAL CARE
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16
Q

Causes of SUDDEN ONSET Unilateral Painless Visual Loss

A
  • Retinal Detachment
  • Vitreous Haemorrhage
  • Central or Branch Retinal Artery Occlusion
  • Central or Branch Retinal Vein Occlusion
  • Temporal Arteritis
  • Optis Neuritis
  • CVA