Diabetes Flashcards
What is diabetes ketoacidosis?
When there is a severe lack of insulin in the the body so the body is unable to use glucose for energy. Thus as a result the body uses fats for energy which release ketones.
Who is more at risk of DKA?
People with type 1 diabetes
What are the signs and symptoms of DKA?
- high blood sugar levels
- being very thirsty
- needing to pee more often
- feeling tired and sleepy
- confusion
- blurred vision
- stomach pain
- feeling or being sick
- sweet or fruity-smelling breath (like nail polish remover or pear drop sweets)
- passing out.
What are the signs and symptoms of Type 1 diabetes?
The 4Ts which are the four most common signs:
Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.
Thirsty - Being really thirsty and not being able to quench the thirst.
Tired - Feeling more tired than usual.
Thinner - Losing weight or looking thinner than usual.
What are the treatment for DKA?
- Being given insulin through a vein
- Being given fluids through a vein to rehydrate your body
- Being given nutrients through a vein to replace any you’ve lost
What can DKA lead to?
DKA is a medical emergency because it leads to dehydration and electrolyte imbalances. The mechanisms responsible for fluid depletion in DKA include osmotic diuresis due to hyperglycaemia, vomiting, and inability to take in fluid owing to a diminished level of consciousness. Electrolyte shifts and depletion are in part related to the osmotic diuresis.
What are the risks with SEVERE HYPOglycaemia?
- Convulsions
- Inability to swallow
- Loss of consciousness
- Coma.
What is the finger-prick blood glucose levels that indicates significant HYPERglycaemia?
finger-prick blood glucose level greater than 11 mmol/L
What are the clinical features of HYPERglycaemia?
Increased thirst and urinary frequency.
Weight loss.
Inability to tolerate fluids.
Persistent vomiting and/or diarrhoea.
Abdominal pain.
Visual disturbance.
Lethargy and/or confusion.
Fruity smell of acetone on the breath.
Acidotic breathing — deep sighing (Kussmaul) respiration.
Dehydration, which can be classified as:
-Mild — only just clinically detectable.
-Moderate — dry skin and mucus membranes, and reduced skin turgor.
-Severe — sunken eyes and prolonged capillary refill time.
Shock (resulting from severe dehydration). The person is severely ill with:
Tachycardia, poor peripheral perfusion, and (as a late sign) hypotension (indicating decreased cardiac output).
Lethargy, drowsiness, or decreased level of consciousness (indicating decreased cerebral perfusion).
Reduced urine output (indicating decreased renal perfusion
What are the precipitating factors of DKA?
- Infection (for example pneumonia or a urinary tract infection).
- Physiological stress (such as trauma or surgery).
- Non-adherence to insulin treatment regimen or intentional insulin omission in order to lose weight (diabulimia).
- Other medical conditions (such as hypothyroidism or pancreatitis).
- Drug treatment (such as corticosteroids, diuretics, and sympathomimetic drugs [for example salbutamol]).
Where are ketones made?
They are produced by the liver when there is a lack of glucose [starvation ketones] and as an alternative energy source when there is a relative insulin deficiency
How to test for DKA and what is considered a high ketone in the urine and blood
For an adult test for urine or blood ketones even if plasma glucose levels are near normal.
In a child or young person with suspected DKA, test for blood ketones. If this is not possible, arrange immediate admission to a hospital with acute paediatric facilities.
Ketones are high if above 2+ in the urine or above 3 mmol/L in the blood.
A blood test will show ketone levels in real time but a urine test will show what they were a few hours ago.
What are the anti-diabetic medications to stop when someone is sick?
- Metformin – dehydration can make it more likely that you will develop a serious side effect
called lactic acidosis - Sulfonylureas – if you are unable to eat or drink, it will be more likely that you develop low
blood glucose (hypos)
Examples: names ending with ‘ide’ such as gliclazide, glibencamide, glipizide
If you are eating and drinking normally and blood sugars are high continue to
take Sulfonylureas - GLP-1 analogues –dehydration can make it more likely that you will develop a serious side
effect.
Examples: names ending with ‘tide’ such as exenatide, dulaglutide, liraglutide,
lixisenatide and semaglutide - SGLT2 inhibitors – dehydration can make it more likely that you will develop a serious side
effect called ketoacidosis.
Examples: names ending with ‘flozin’ such as canagliflozin, dapagliflozin,
empagliflozin and ertugliflozin
Restart when patient is well again (normally after 24 to 48 hours of eating and drinking normally). When
patient restart medicines, they should take them as normal
What are the background Insulin (given once or twice daily)?
Insulatard Humulin I Insuman Basal Lantus Abasaglar Semglee Levemir
What are the twice daily Mixed Insulin?
Novomix 30
Humalog Mix 25
Humalog Mix 50
Humulin M
What are the Ultra-long acting Insulin?
Toujeo
Tresiba
What is the treatment option for low blood glucose of less than 4mmol/L?
Treat with eating or drinking 15-20g of fast acting carbohydrate.
Examples of fast acting carbohydrate include: • 5 Dextrose tablets • 5 jelly babies • Half a can of sugary drink (non-diet) • Fruit juice 200mls (non-diet) • Ice cream 1 large scoop • 5 spoonfuls sugar in warm water
After treating the hypo, try to eat 15-20g of slower acting carbohydrate.
Examples of slower acting carbohydrate include:
• Sandwich
• Piece of fruit
• Bowl of cereal
• Glass of milk 200mls
What drugs are in the drug group SGLT-2?
- Canagliflozin
Recommended starting dose is 100 mg once daily, increased to 300 mg once daily if needed, dose to be taken preferably before breakfast. - Dapagliflozin
Recommended dose is 10 mg once daily. - Empagliflozin
Recommended starting dose is 10 mg once daily, increased to 25 mg once daily if needed and tolerated. - Ertuglifozin
Recommended starting dose is 5 mg once daily, increased to 15 mg once daily if needed and tolerated, dose to be taken in the morning.
What are the contraindication of SGLT-2?
- Diabetic Ketoacidosis
- Moderate-to-severe renal impairment — avoid initiation if eGFR is less than 60 mL/min/1.73 m2; avoid continuation if eGFR is less than 45 mL/min/1.73 m2.
- For canagliflozin: eGFR 45-60 should be initiated at 100mg and maintained at this dose.
Do not initiate canagliflozin
How long can Levemir Flexpen be used for once it has been taken out of the fridge for use?
6 weeks
What is the risk of pioglitazone with elderly people?
Increase risk of bladder cancer, use with caution.
How should glibenclamide be used with the elderly?
Use with caution
What are the positive effects of metformin?
Weight loss, less risk of hypoglycaemia, additional long term CVD benefits
When is Sulfonylurea used?
It is 2nd line treatment
What is the issue with Acarbose?
It has a poorer effect of anti-hyperglycaemia effect than other antidiabetic drugs
What is the target HBA1c for patients with Type 2 Diabetes taking a drug associated with Hypoglycaemia?
53mmol/mol
What is the target HBA1c for patients with Type 2 diabetes that are being managed by lifestyle and diet only OR lifestyle, diet and on a medication NOT associated with hypoglycaemia?
4mmol/mol
What group is glibenclamide in?
Sulfonylurea
