Chapter 6 BNF (Diabetes and Hypoglycaemia) Flashcards
When should long term complications be reviewed in diabetes?
Annually
How is neuropathy treated in diabetes?
By treating hypertension
How is nephropathy treated?
ACE inhibitors
What symptoms are associated with nerve damage in diabetes, how are they treated?
Pain: Duloxetine, TCAs Diarrhoea: Codeine Gastroparesis: Erythromycin Erectile dysfunction: sildenifil Postural hypotension: increase salt
When do insulin requirements increase in pregnancy?
2nd/3rd semester
What’s the target HbA1c in pregnancy?
48mmol
What insulin is first choice in pregnancy?
Isophane
Why should insulin dose be reduced post pregnancy?
Risk of postnatal hypoglycaemia
How is type 2 diabetes treated in pregnancy?
Stop all oral hypoglycaemics except metformin fans substitute with insulin
How should gestational be treated for patients with blood glucose below 7mmol/L
Diet and exercise
Add metformin
Add insulin
How should gestational diabetes be treated in patients with blood glucose levels over 7mmol/L?
Insulin
With or without metformin
What is diabetic ketoacidosis?
Severe hyperglycaemia = ketones
What is the treatment for ketoacidosis?
IV soluble insulin Fluids Potassium Continue long acting insulin Add glucose when below 14mmol/L
What factors raise insulin requirements?
Infection
Stress
Puberty
Pregnancy
What factors reduce insulin requirements ?
Addisons
Hypopituitarism
What’s first line insulin regimen in type 1 diabetes?
Multiple injection regimen
What’s first line insulin therapy in type 2 diabetes ?
Isophane with soluble insulin
Biphasic or multiple
What are the sick day rules in diabetes?
Monitor ketones and sugar every 3/4 hours
Don’t stop insulin
Maintain meal pattern (3L of water )
If fever/vomiting/diarrhoea stop metformin and gliflozins
What’s the conversion from beef insulin to human insulin and the conversion from pork insulin to human insulin ?
Beef to human : reduce by 10%
Pork to human : don’t change
How does metformin work?
Reduce hepatic sugar production, reduce gluconeogenesis
What’s the side effects of metformin?
GI disturbance
Lactic acidosis in renal impairment
Taste disturbance
Reduce vit b12
How do sulfonylureas and metglinides work?
Augmenting insulin secretion
Which sulfonylureas are short acting and which are long acting?
Short: Gliclazide, Tolbutamide
Long: Glimepiride, Glimbenclamide
What are the side effects of sulfonylureas?
Hypoglycaemia
Weight gain
Jaundice
Skin rashes
