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GP block > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the symptoms of T2DM?

A

Normally asymptomatic but:

  • Polydipsia, polyuria,
  • Blurred vision
  • Recurrent infections
  • Tiredness
  • Acanthosis nigricans suggests insulin resistance
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2
Q

What is the diagnostic criteria of T2DM?

A
  • Symptomatic = single abnormal HbA1c >48mmol/ml or 6.5%

- Asymptomatic = 2 raised BM tests 2 weeks apart

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3
Q

What is the diagnostic criteria of T1DM?

A

Symptoms - ketosis, rapid weight loss, <50yo, FH

  • Random venous plasma glucose >11 mmol/l
  • Fasting plasma glucose conc >7mmol/l
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4
Q

What is the ongoing management of a patient with T2DM?

A
  • Initial diagnosis need HbA1c every 3 months and then every 6 months after that
  • Annual review w diabetic specialist nurse
  • Diabetic MOT - weight, BP, waist circumference, diabetic foot check
  • Retinal screen every 2 years if low risk
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5
Q

What are the microvascular complications of diabetes?

A
  • Retinopathy
  • Diabetic kidney disease - due to nephropathy, HTN, renal atheroma and ischaemia
  • Neuropathy, autonomic (gastroparesis, unexplained diarrhoea, erectile dysfunc) and peripheral (numbness, burning pain, paraesthesia)
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6
Q

What are the macrovascular complications of diabetes?

A

Atherosclerotic cardiovascular disease

including coronary heart disease, cardiomyopathy, peripheral artery disease, arrhythmias.

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7
Q

What is asked about during the annual diabetic review w the specialist diabetic nurse?

A
  • Check CVS RF - smoking status, BM control, BP, albuminuria, lipids
  • Ask about sx of autonomic neuropathy and peripheral neuropathy
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8
Q

What can affect the accuracy of HbA1c?

A

Measures glucose bonded to Hb so any condition that prolongs the life of an erythrocyte can affect HbA1c:

  • Anaemia - Fe def, B12, folate
  • Splenectomy
  • Renal failure
  • Medications
  • Stress levels and general health
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9
Q

Biguanides:

  • MOA
  • Benefits
  • Example
A

eg. metformin - inhibits gluconeogenesis

Benefits - can limit weight gain and there isn’t a high risk of hypoglycaemia.

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10
Q

Biguanides:

  • SE
  • Contraindications
A

SE - GI upset

Contraindications - if impaired renal function

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11
Q

DPP-4 inhibitors:

  • MOA
  • Benefits
  • Example
A

eg. sitagliptin - increase incretin levels and promotes insulin secretion
Benefits - suppresses appetite, no risk of hypoglycaemia as glucose dependent

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12
Q

DPP-4 inhibitors:

  • SE
  • Contraindications
A

SE - GI upset and risk pancreatitis

Contraindications - pregnancy and hx pancreatitis

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13
Q

Thiazolidinediones:

  • MOA
  • Benefits
  • Example
A

eg. pioglitazone - increase insulin sensitivity and glucose utilisation

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14
Q

Thiazolidinediones:

  • SE
  • Contraindications
A

SE - weight gain, GI upset, fluid retention, hypoglycaemia risk, bladder cancer
Contraindications - don’t use in HF due to fluid retention

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15
Q

Sulfonylurea:

  • MOA
  • Benefits
  • Example
A

eg. gliclazide - increase insulin secretion

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16
Q

Sulfonylurea:

  • SE
  • Contraindications
A

SE - GI upset, hypoglycaemia, weight gain

Contraindications - those at risk of hypoglycaemia, hepatic and renal disease

17
Q

SGLT-2 inhibitors:

  • MOA
  • Benefits
  • Example
A

eg. dapaglifozin - reduce glucose absorption at tubule so increase excretion
Benefit - no risk hypoglycaemia, weight loss

18
Q

SGLT-2 inhibitors:

  • SE
  • Contraindications
A

SE - UTI and genital infection

Contraindications - not to patient at risk DKA

19
Q

GLP-1 mimetics:

  • MOA
  • Benefits
  • Example
A

eg. exenatide - injectable med, increase glucose dep synthesis of insulin
Benefit - no risk hypoglycaemia, weight loss

20
Q

What are some of the RF for hypoglycaemia in T2DM?

A
  • Increasing age and loss of awareness of hypoglycaemia, some of the sx of hypoglycaemia eg. reduced consciousness, slurred speech can be explained as sx of old age
  • Comorbidities
  • Renal impairment
  • Loss of insulin secretion

GP block (14 decks)

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