8/12/21: AKT Glace Flashcards
metformin adjustment in renal impariemtn
Renal Impairment: Reduce dose by 50% at eGFR 30-60. Contraindicated at eGFR <30
CrCl: 30-60 → 1g daily, >60 → 2g daily
SGLT2 inhibitors adjustement in renal impairment
Renal Impairment: Contraindicated at eGFR <45 (glycaemic lowering efficacy decreases)
Dapagliflozin 10mg PO Daily
Empagliflozin 10mg PO Daily
Ertugliflozin 5mg PO Daily
Sulonylurea adjustment in renal impairment. examples of sulfs.
Renal Impairment: Contraindicated if Creatinine Clearance <15 (Hypoglycaemia risk increases as eGFR declines)
Gliclazide IR 40mg Daily Gliclazide MR 30mg Daily Glipizide 2.5mg Daily Glibenclamide 2.5mg PO Daily Glimepiride 1mg PO Daily
Dpp4 inhibitors, renal impairment and dosing.
Renal Impairment: Safe with dose reduction in renal impairment but linagliptin can be used at all stages of renal impairment
Aloglitptin 25mg once daily Linagliptin 5mg once daily (safe in all stages of renal impairment) Saxagliptin 5mg once daily Sitagliptin 100mg once daily Vildagliptin 50mg BD
GLP1 Agonists, renal impairment, dosing.
Renal Impairment: Contraindicated in eGFR <30 (dulaglutide contraindicated at eGFR <15)
Dulaglutide 1.5mg Subcutaneously Once Weekly
Exenatide Immediate Release 5 microg BD subcutaneously OR Exenatide Modified Release 2mg subcutaneously weekly
Semaglutide 0.25mg subcutaneously once weekly
Liraglutide 0.6mg subcutaneously once daily for 1 week (not on PBS)
Risk Factors for GDM?
prev GDM migrant ethnicity populations prev big baby prev preg loss bmi >30 pcos old FHx of diabetes
If risk factors, when tested for GDM? If no risk factors, when tested for GDM?
no risk - 24-28 weeks OGTT
>1 risk factor -> first trimester OGTT
follow-up post-partum following diganosis of GDM?
- conduct OGTT 2 hour test - 6-12 weeks post-partum
- if normal - HbA1c every 3 years
- if HbA1c >6 → further investigation and advice before next pregnancy
Definition of DKA
Diabetic BGL >11
ketonuria
acidosis pH <7.3
Risk factors of DKA
infectin or illness discontinuation of insulin inadequate insulin sglt2 - pregs, alcohol, low carb diet, surg (euglycaemic ketoacidosis) new onset t1dm drugs
Clincial features of DKA
evolves rapidly over 24 hours
- Dehydration
- Polyuria + polydipsia, polyphagia
- Weight Loss - due to fluid loss and loss of muscle and fat
- Weakness
- Kussmaul’s Respirations → Hyperventilation of DKA
- Nausea and Vomiting
- Abdominal pain
- signs of volume depletion + fruity odour to breath
Basic management of DKA
fluid replacement - aggressive
insulin therapy
iv glucose to suppress ketones to let acidosis correct itself
SGLT2 managment periop. surgery vs day procedure.
- should be ceased at least 3 days prior to surgery including endoscopy/colonscopy to prevent DKA in the peri-operative period
- however for gastroscopy and other day procedures → can cease the SGLT2 inhibitor for the day of the procedure. note that fasting should be minimised.
peri-operative manageemnt - all diabetic medication other than sglt2 inhibitors
- continue medications until day prior to surgery
- withhold medication on the morning of the surgery → DOES NOT matter if on the morning of afternoon list
insuling management in peri-operative period. long-acting, short-acting vs mixed
- long-acting - continue as normal
- short-acting
- morning - no insulin
- afternoon - half dose before light breakfast
- mixed - take half normal dose