3/12/21 Flashcards
Non-Pharmacological Advice in T2DM
- *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
Referrals to be made in young people with t2dm
optom, pod, exercise physiologist, diabetes ed, dietician and ENDOCRINOLOGIST IN A YOUNG PERSON
Medications for Weight Loss Management
orlistat, liraglutide, naltrexone + bupropion, phenteramine
Surgical options for Weight loss
sleeve gastrectomy, roux en Y bypass, biliopancreatic diversion
when to consider weight loss surgery in twcm
BMI >40
BMI 35-39 poor glycaemic control
poor glycaemic control…why?
- concurrent infection
- poor compliance to medication
- insulin not stored correctly
- misdiagnoses of LADA or MODY
- Obesity
- Inadequate insulin dose regimen
- medication - steroids, antipsychotics
- smoking
- sedentary lifestyle, lack of exercise
- poor diet
Assess nicotine dependence - 3 points
- 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
5 As of Smoking Cessation
Ask Assess Advise Assist Arrange
Pharm options for smoking cessation
- NRT - patch + inhaler/gum/lozenge
- varenicline (no good in pregs or young people)
- bupropion (contraindicated in seizures, MAOi, pregs)
Dosing of NRT
other than if >30mins to first cig + <10 cigs per day -> 21mg/24hour patch + gum 2mg (4mg if >10 cigs/day)
DOsing of varenicline
0.5 for 3 days, 0.5BD for 4 days then 1mg BD
Non-Pharmacological for smoking cessation
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
Characteristics of HHS
- Severe Hyperglycaemia
- Hyperosmolarity - >320
- Severe Dehydration
- Change in Mental State - drowsiness to comatose
- Little or No Ketacidosis
Office Tests for HHS
- Urine Dipstick
- Finger Prick BSL + Ketones
Management points for HHS
- 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