All things Diabetes Flashcards
What features would raise suspicion of diabetes mellitus?
Thirst
Toileting
Tiredness
Thin
+ blurred vision, infections in T2DM
What history features point towards T1DM over T2DM?
Younger
Family history of autoimmune disease
Ketosis (fruity breath, DKA)
What blood glucose levels would indicate diabetes mellitus?
Random >11.1 mmol/L
Fasting: >7mmol/L
What Hb1AC values suggest…
prediabetes
diabetes
prediabetes: 42-47
diabetes: >=48
How can Hb1AC be used for diagnosis of diabetes mellitus?
>=48 can diagnose T2DM
NOT DIAGNOSTIC IN T1DM, YOUNG, PREGNANT, HAEMOGLOBINOPATHIES
What do you need to diagnose Diabetes mellitus?
Either
1 high blood glucose + symptoms
2 high blood glucose on two separate occasions
In what circumstances would a C-peptide or autoantibody titre be useful in diabetes mellitus?
Confirm T1DM if atypical or monogenic presentation
C-peptide titres would be low
Anti-GAD/islet antibodies would be present
What is the treatment for T1DM?
Insulin therapy
What is the treatment pathway for type 2 diabetes mellitus?
- Metformin
- Metformin + option*
- Metformin + 2 options
- Metformin + sulfonylurea + GLP-1 mimetic if BMI >35 and above 3 drugs not working
Options: Sulfonylureas (glicazide)/SGLT-2 inhibitor (flozins)/pioglitazone
At what point would you escalate drug management of T2DM>
Hb1AC >=58
Regarding GLP-1 as part of last line therapy of T2DM, what criteria needs to be met to continue on it
Reduction in Hb1AC by 11 AND at least 3% body weight
What cardiovascular management should be considered in diabetes mellitus?
ACEi (-prils) or ARBs (-sartans) for HTN
low dose statin if Q-risk score >10%
What would you suspect in a patient with diabetic symptoms without ketosis who was under 25 with a diabetic family history?
Maturity onset Diabetes of the Young
Responsive to sulfonylurea monotherapy
What are the side effects of metformin?
Gastrointestinal upset
Lactic Acidosis is rare but fatal
Regarding metformin’s action, which common drugs do you need to watch for?
Alcohol: hypoglycaemia, lactic acidosis
B-blockers: Can mas hypoglycaemia
Ketotifen (anti-allergic): can reduce platelet count
Topiramate: Increase metformin action
Which T2DM drugs cause hypoglycaemia?
Sulfonylureas (glicazide, glibenclamide)
Low risk in GLP-1 mimetics
Which diabetic drugs induce weight loss?
SGLT-2 inhibitors (-gliflozins)
GLP-1 mimetic (exenatide, liraglutide)
Which diabetic drugs induce weight gain?
Thiazolinediones (pioglitazone)
Sulfonylurea (glicazide)
Which diabetic drugs do not affect weight?
Metformin
DPP4-inhibitors (glitpins)
Which diabetic drugs is most associated with glucosuria?
SGLT-2 inhibitors (gliflozins)
Which diabetic drug is most associated with fluid retetion?
Thiazolidinediones (pioglitazone)
Gliptins are part of x class of drug
Flozins are y kind of drugs
X: DPP-4 inhibitors
Y: SGLT-2 inhibitors
What is the first line HTN therapy for a diabetic?
ACE inhibitor (ramipril, lisinopril)
Regarding insulin therapy, what should
Be given foodwise if there’s a hypo
Be given to patients on commencing therapy
Be changed when sick
be calculated for a rough corrective dose when sick
10-20mg short acting carb (glass sugary drink, 3 glucose tabs)
Glucagon kit for emergency hypos
DONT CHANGE ANYTHING
1/6 daily dose (up to 15 units)
What is the mechanism of action of
Biguanides (metformin)
Sulfonylurea (gliciazide)
SGLT2 inhibitors (flozin)
DPP4 inhibitors (gliptins)
GLP-1 mimetics (exenatide, liraglutide)
Thiazolinedione (pioglitazone)
Met: Decrease gluconeogenesis, increase peripheral glucose usage
SU: increased insulin excretion
SGLT2: Blocks reabsorption by kidneys, promotes urine excretion
DPP4: Inhibits DPP4 mediated destruction of incretin
GLP-1: Increases insulin and reduces glucagon secretion, slows gastric emptying
Thiazolinedione: Increases glucose uptake into muscle and adipose tissue
what T2DM medication is associated with
Bladder cancer
fractures
Liver impairment
Fluid retetion
Thiazolinediones
Contraindicated in heart failure
What are the Hb1AC targets when on therapy?
Lifestyle +/- metformin: 48
Risen past 48 or on hypoglycaemic: 53
In diabetic therapy, when must an SGLT-2i be added?
Established or risk >10% CHD
Heart failure
If metformin was contraindicated in a patient, what therapy would you give?
CHD/HF: SGLT-2
No CHD/HF: DPP4 (Gliptin)/ SU (gliciazide)/ Thiazolinedione (pioglitazone)
When is GLP-1 therapy considered
Inadequate cover by triple therapy and either
BMI >35 + psychological/medical problems associated with obesity
BMI <35 but insulin would be an occupational hazard
How does Ramadan affect T2DM management
Sunrise (Suhoor): 1/3 metformin dose, long acting carb meal
Sunset (Iftar): majority metformin, gliciazide dose
How does diabetes mellitus affect haivng a licence for
Group 1 vehicles (cars, motorbikes)
Group 2 (HGV)
Group 1
Insulin dependent or hypoglycaemics (SU, liraglutide): no more than 1 hypo needing assistance
Group 2
No severe episodes in 12 months
Full hypo awareness + bidaily monitoring data for past 3 months
