diabetes Flashcards
What BGL makes diabtes likely (fasting and random)?
FBGL >7.0
RBGL >11.1
States which HbA1c may not be accurate?
post traumatic T2DM (eg pancreatitis)
sepsis
steroids
within 4 months post partum
haemoglobiinopathy or haemolysis
CKD
iron def (art elevated)
post blood or iron transfusion
OGTT involves
8 hour fast
75g glucose
Fasting and 2 hour post glucose
NOrmal OGTT
FBGL <6.1
2 HOUR <7.8
Impaired fasting glucose OGTT
FBGL 6.1-6.9
2 HOUR <7.8
RETEST 12 MONTHS
impaired glucose tolerance
FBGL <7.0
2 HOUR >7.8-<11.1
RETEST 12 MONTHS
DIABETES ON OGTT
FBGL >7.0
>11.1
HbA1c diabetes likely
> 6.5% (48mmol/mol)
confirm on another day
HbA1c diabetes possible
6.0-6.4%retest in 12 months and look at preventtion to progression
HbA1c diabetes unlikely
<6.0%
retest in 3 years
Fasting BGL or random BGL diabetes likely
> 7.0 or >11.1
confirm with repeat test
in those with symptoms what are diagnostic results
single FBG >7.0
single HbA1c >6.5%
RBGL >11.1
symptoms concerning for diabetes
lethargy, polyuria, polydipsia
frequent fungal or bacterial infections
blurred vision
loss of sensation
poor wound healing
weight loss
signs of insulin resistance
acanthosis nigricans
skin tags
central obesity
hairy
no role for testing insulin levels
features concerning for T1DM
- ketosis/ketonuria (which may be absent)
• polyuria, polydipsia
• acute weight loss (>5% in less than four weeks)
• <50 years of age
• personal and family history of autoimmune disease
• acute onset of symptoms
What is latent autoimmune diabetes or type 1.5
beta cell antibodies more commonly occuring in adulthood
presents similarly to T2DM but involves more rapid Beta cell destruction, poorer metabolic response to non-insulin therapy, more rapid progression to insulin use
what is monogenic diabetes
single gene mutation
dominantly inherited
- neonatal (rare)
- MODY (mature onset diabetes of the young)
examinations to assess diabetic patients
• BMI
• Waist circumference (cm)
• Blood pressure
• Central and peripheral vascular systems
• Absolute CVD risk assessment (this may require calculation and
investigations)
prevention of progression includes
<7% weight
150 mins mod intensity exercise a week
definition of early onset diabetes
<40
lifestyle mx adult diabetes
150 min mod ex a week
2-3 resistance sessions a week (total 60 mins)
dont sit longer than 30 mins
whole grains 3 serves daily
1.5 serves dairy
reduce weight
BMI >40 consider bariatric surgery
stop smoking
target HbA1c for T2DM?
<7%
HbA1c <8% is ok with which patients?
Hx severe hyoglycaemia
short life exp
advanced micro or macrovascular complications
extensive comorbid conditions
difficult to acheive control
effective doses multiple agents
targets for self-monitored glucose levels
4-7 fasting or pre-prandial
5-10 2 hour post prandial
first line agent and dosing T2DM
metformin IR 500mg BD
inc slowly over 2-4 weeks up to 2g daily in divided doses
provided GFR >60mL/min
max daily dosing metformin if
GFR 30-60 max 1g daily in divided doses
metformin MR dosing
500mg OD with evening meal
inc over 2-4 weeks max 2 g daily
if GFR >60
in GFR 30-60 what is MR metformin max dose
1g daily
practice points for metformin dosing
GIT upset most common side effect - reduce with MR dose with meals
can reduce B12 absorption
contraindicated if GFR<30
withhold during acute illness - rsik lactic acidosis
hold before surgery & contrast
caution with CCF
What antihyperglycaemic agent should be considered for those with atherosclerotic CVD
GLP-1 agonists
dulaglutide, liraglutide, semaglutide
OR
SGLT2 inhibitor
dapigaflozin or empagliflozin
What antihyperglycaemic agent should be considered for those with CCF?
SGLT2 inhibitor
dapigaflozin or empagliflozin
What antihyperglycaemic agent should be considered for those with CKD
SGLT2 inhibitor
dapigaflozin or empagliflozin
OR
GLP-1 agonists
dulaglutide, liraglutide, semaglutide
mechanism of sulfonyureas and expected HbA1c response
Sulfonylureas (gliclazide, glipizide, glibenclamide, glimepiride) increase insulin secretion via the pancreatic sulfonylurea receptor. When a sulfonylurea is added to metformin, the expected reduction in glycated haemoglobin (HbA1c) is 5.5 to 7.5 mmol/mol (0.5 to 0.7%)
side effects of sulfonyureas
Sulfonylureas can cause weight gain.
Avoid longer-acting sulfonylureas (glibenclamide, glimepiride) in older patients because they increase the risk of severe prolonged hypoglycaemia. Shorter-acting gliclazide and glipizide are converted to inactive metabolites by the liver and are preferred.
Reduce dose in kidney impairment
first line options for T2DM
Metformin
Sulfonyureas
INsulin
After checking HbAlc after three months, whats second line if targets not met
SGLT2i
