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
basic exercise advice for t2dm
- 150mins aerobic
- 2-3 resistance exercises/week
- balance and flexibilty training for older
- break up sedentary sittgin every 30 mins
other cautions with exercise in regards to t2dm
- no vigourous activity in proliferative retinopathy
- if on insulin or sulf - be weary of hypos. can have delayed hypos
- aim 5-13.9 pre exercise
- monitor bsl pre exercise and every 30-45 mins during exercise
- do not exercise if recent severe hypo
- proer footwear, if peripheral neuropathy - check feet for bilsters a daily and after physical activity
- refer to exercise physio
how often at ATSI people tested for t2dm?
annually from 18yo. no need for ausdrisk
testing every 3 years criteria for t2dm?
- AUSDRISK >12
- GDM
- PCOS
- PHx of CVA
- Anti-psychotic medication
When to use AUSDRISK?
every 3 years once patient hits 40yo
alcohol and diabetes - implications
alcohol interferes with insulin
alcohol lowers BGLs, reduces awareness of hypos
esp if with sulfonylureas -> increased risk of hypos
Metformin in renal impairment
Renal Impairment: Reduce dose by 50% at eGFR 30-60. Contraindicated at eGFR <30
CrCl: 30-60 → 1g daily, >60 → 2g daily
sulfonylurea in renal impairment. also try give examples of this drug.
gliclazide, glibenclamide, glipizide, glimepiride
Renal Impairment: Contraindicated if Creatinine Clearance <15 (Hypoglycaemia risk increases as eGFR declines)
SGLT2 in renal impairment. also try give examples of this drug.
Dapagliflozin, empagliflozin
Renal Impairment: Contraindicated at eGFR <45 (glycaemic lowering efficacy decreases)
GLP1 Agonist in renal impairment. also try give examples of this drug.
Dulaglutide, exanatide, semaglutide, liraglutide
Renal Impairment: Contraindicated in eGFR <30 (dulaglutide contraindicated at eGFR <15)
