7/12/21 Flashcards
Clinical Features of Hypoglycaemic Episodes
- Adrenergic - pale skin, sweating, shaking, palpitations, feeling anxious
- Neuroglycopenic → hunger, difficulty concentrating, confusion and inappropriate behaviour, loss of consciousness, seizures
Precipitants or Risk Factors for Hypoglycaemic episodes?
Precipitants
- change in diet + alcohol consumption
- change in medication
Risk Factors
- insulin or long-acting sulfonylurea
- increasing age + duration of diabetes
- kidney or liver impairment or GIT disease
Management if BSL <4
- 15g of quick acting carbohydrate → wait 15mins then repeat BSL check → if not rising, eat another quick-acting carbohydrate.
- Also add a longer acting carb if patients meal is >15mins away
- Test BSL every 1-2 hours for next 4 hours
Management of severe hypoglycaemia - change in consciousness + coma
- Glucagon 1mg IM, S/C
- if IV → glucose 50% - 20ml IV
- Test BSL after 15mins → ensure >4mmol/L
Driving post hypoglycaemic episode
After hypoglycaemic episode → not to drive for at least 6 weeks while diabetes re-stabilisation is undertaken. Notify relevant driving authority.
Management points for diabetes in pregnancy?
aim HbA1c <6.5
cease Acei and ARb in women iwht CKD
cease statin
continue metformin and sulfonylurea until pregs is achieved
change all other hypoglycaemics to insulin
folate 5mg for 1 month prior to conceptions
ADVISE EXAMINATION OF RETINA PRIOR TO CONCEPTION AND DURING TRIMESTER
Cuases of abnormally low Hba1c?
- Anaemia → haemolytic anaemia, acute or chronic blood loss
- Blood Transfusion or Iron Transfusions
Causes of abnormally high HbA1c?
- Iron Deficiency anaemia
- Splenectomy
- Alcoholism
Management of Fe Deficiency Anaemia?
- elemental iron 100-210mg (child 3-6 mg elemental iron/kg/day up to 210mg) orally, daily.
- continue therapy until Fe stores have been replenished and the serum ferritin has normalised → takes 3-6 months.
- CANNOT stop after a few weeks and adverse effects cause lack of compliance so need to monitor this
Counselling points of Fe Deficiency Anaemia? (Adverse effects, when to take, concurrent dos and donts)
- Adverse effects → nausea, bloating, constipation, diarrhoea - COMMON
- Administer in divided doses
- Take 1 hour before food to enhance absorption however if this worsens adverse effects → take with food
- Absorption is also reduced by Ca2+ supplements, PPI, H2 Receptor Antagonists, Antacids and Tea
- Can cause black stools
- Need to give Vit C concurrently to optimise Fe absorption
Continue fe supplementation for how long?
3-6 months
Who cannot have an unconditional license in context of diabetes?
end organ damage
recent severe hypoglycaemic epsisode
or on insulin - review every 2 years
who can have an unconditional license in context of diabetes?
diabetic not on insulin. still needs gp review every 5 years
considerations of commercial license in the context of diabetes?
all medicated diabetics - need specialist review yearly
CV targets for patients with T2DM? cholesterol, htn
BP <140/90
- if microalbuminuria <130/80
- be weary of triple whammy → ACEi + NSAIDs + diuretic
Cholesterol
- TC <4
- HDL >1
- LDL <2 (1.8 if CVD)
- TG <2
