Diabetes Flashcards
Why might someone be at risk for developing DKA (3)
- Medications (insulin)
- Illness
- New diagnosis
General treatment for DKA
Insulin Fluids Potassium Bicarb D5w
When you diagnose someone with diabetes what questions should you ask (about symptoms)?
Diet Weight loss Polyuria Polydipsia Symptoms of retinopathy Symptoms of Neuropathy Fatigue
What should you assess for on physical exam when you diagnose someone with diabetes
Retinopathy
Neuropathy
CVD
Best test to diagnose Diabetes
A1C
Non prescription treatments for diabetes (3)
- Wt. loss
- Low glycemic index diet
- Smoking cessation
- Psyllium fiber (Lowers A1C by 0.6)
List 2 first line medications for Type 2 Diabetes and when you would use one over the other
- Biguanide (metformin)
2. SGLT-2 inhibitor (Jardiance)-Can use first line in renal or cardiac disease
List three second line medications in Type 2
DPP-4 (Januvia)
GLP-1 (ozempic)
Sulfonylureas (gliclazide)
List a third line medication in type 2 diabetes
Insulin
Start with basal Qhs then Add bolus once per day
List two side effexts/risks of SGLT2 inhibitors
Jardiance
Euglycemic DKA
Yeast vaginitis/blanitis
AKI
Contraindicated in Type 1
How to initiate insulin
10 units NPH hs to start
Just as good as lantis
Rules for driving
Check sugars q 2h if you have unawareness
Check sugars Q 4h if you don’t have unawareness
Take 6 lifesavers if you have a low and wait 40 minutes
When can you diagnose Diabetes
2 tests in level or one test and symptoms
A1C >6.5
FPG >7
2hr PG 75 OGTT >11.1
When to diagnose prediabetes and waht that means
A1C 6-6.5
FPG 6.1-6.9
75g OGTT 7.8-11
25-50% change of developing diabetes in the next 5 years
List 3 things that can impact your A1C
Pregnancy
Hemoglobinopathy
Anemia
Renal Disease
List one benefit, one risk and two side effects of Biguanide
Metformin
- Good for CVD
- Lactic Acidosis
- GI SE
- Lowers B12
List one benefit and 1 effects of DPP4
Januvia
- Less side effects/good for elderly
- No injections
- Pancreatitis
No CVD impact
List two benefits, one risk, and one contraindication of GLP1 agonists
Ozempic
- CVD benefit
- Wt. loss
- Retinopathy
- GI effects
- Thyroid Cancer
List three benefits, three risks and one contraindication for SGLT2 inhibitors
Jardiance
- CVD benefit
- Improved CHF
- CKD
- Vaginitis/balanitis
- AKI
- DKA
- If they are taking Labetalol
Whats your target A1C
Usually <7
Can be <8.5 in elderly or recurrent hypoglycemia
6.5 in healthy young people
Why might someones A1C not be falling when they are on Insuling
Adherence Infection /inflammation Injection Technique Lipodystrophy Insulin ruined (temperature, expired)
List 10 risk factors for type two diabetes
Age >40 Gestational Diabetes Delivery of macrosomic infant Family history Prediabetes Certain medications (atypical antipsychotics, steroids, HAART, statins, antirejection) Obesity/Metabolic syndrome PCOS Aboriginal, African, Asian, Hispanic, or Sough Asian Descent Cushings HAART NASH CF
What tools can you use to check someone’s risk of diabetes
CANRISK
FINDRISC
Who should you screen for diabetes
A1C q 3 years after the age of 40
Can be more often and earlier if high risk
What should you do at a yearly check up for you diabetes patients (list 5)
1. Check BP: HTN 130/80 ACE or ARB (If CVD, microvascular complications) 2. Lipid profile yearly Start a statin at age 40 or if microvascular or CVD complications 3. ACR yearly 4. Optometry yearly 5. Monofilament testing yearly 6. Weight
Risks for hypoglycemia
Old Insulin Food insecurity Neuropathy Cognitive impairment
What madications should you stop if you are sick
SGLT2 and sulonyuria ACE Diuretics Metformin ARB NSAIDS
Symptoms of hypoglycemia
Palpitations
Swating
Anxiety
Hunger Nausea
Confusion Weakness Headache Dizziness LOC
Sequele of diabetes that you have to report to transport canada
Retinopathy Neuropathy Stroke MI Hypoglycemia
