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Gphc Exam > Diabetes > Flashcards

Diabetes Flashcards

1
Q

In hypoglycaemia, how many grams of carbohydrates should be given?

A

10-20g

(0.3g/kg) for for children and young people)

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2
Q

What are the options for treating hypoglycaemia if able to swallow? What should not be used?

A

3-6 glucose tablets

90-180ml of fizzy drink or squash

50-100ml lucozade energy

2-4 spoonfuls of sugar

Sweets E.g 4 large jelly babies

1-2 tubes of dextrogel

Avoid: chocolate and biscuits due to lower sugar content and higher fat content delays stomach emptying

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3
Q

What should be used to treat hypoglycaemia if the patient is unable to swallow?

A

IM glucagon:

<8years (or <25kg) : 500mcg
Everyone else: 1mg

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4
Q

What glucose level indicates hypoglycaemia?

A

<3.5 mmol/L

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5
Q

What angle should insulin be injected?

A

90 degrees

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6
Q

How long after injecting should the needle be left in the skin?

A

5-10 seconds

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7
Q

What sites can be used to inject insulin?

A

Abdomen (fastest absorption)
Outer thigh
Buttocks
Arm (not usually recommended)

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8
Q

What is the target fasting glucose level?

A

5-7mmol/L

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9
Q

What is the target glucose level before meals and other times of the day?

A

4-7mmol/L

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10
Q

What is the glucose target for adults testing at least 90mins after meals?

A

5-9mmol/L

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11
Q

Is extra insulin required when drinking alcohol?

A

No

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12
Q

What ketone level indicates DKA?

A

2+ on urine dipstick

Above 3 mmol/L in blood

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13
Q

What plasma glucose level may indicate ketoacidosis?

A

Over 11mmol/L

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14
Q

What are the clinical features of DKA?

A

Increased thirst and urgent urination (polyuria/polydipsia)
Weight loss
Persistent vomiting and diarrhoea
Abdominal pain
Visual disturbance
Lethargy and confusion
Fruity smell on breath
Acidotic breathing - deep sighing
Tachycardia
Hypotension
Decreased consciousness

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15
Q

What are the symptoms of hypoglycaemia?

A

Hunger
Anxiety or irritability
Sweating
Palpitations
Tremor
Weakness/ lethargy
Impaired vision
Confusion and disorientation
Convulsions
Coma

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16
Q

What HbA1c and glucose levels indicate T2DM?

A

HbA1c over 48mmol/L
Fasting glucose over 7mmol/L
Random glucose over 11mmol/L

17
Q

When should HbA1c not be used to diagnose T2DM?

A

Under 18
Pregnant or 2 month’s postpartum
Symptoms for <2 months
Taking medications (long-term corticosteroids)
Acute pancreatic damage (e.g surgery)
End stage renal disease
HIV +

18
Q

What are the risk factors for T2DM?

A

Obesity
Family hisory
Asian, African and Afro-Caribbean (2-4 x more likely)
Hx of gestational diabetes
Diet (low fibre, high glycemic index)
Drugs (statins, corticosteroids, thiazide + beta blocker)
PCOS
Metabolic syndrome (raised BP, fatty liver, tendency for thrombosis)

19
Q

What is the referral programme for adults with T2DM?

A

DESMOND

20
Q

How frequently should HbA1c be measured in T2?

A

Every 3-6 months until anti diabetic regime is stable, then every 6 months

21
Q

What is the HbA1c target for T2DM with drug treatment associated with hypoglycaemia (e.g sulfonurea)?

A

53mmol/L

22
Q

What is the HbA1c target for T2DM with drug treatment not associated with hypoglycaemia (e.g metformin)?

A

48mmol/L

23
Q

What HbA1c level suggests T2DM is not adequately controlled by a single drug?

A

58mmol

24
Q

How soon before travelling must a glucose test be performed for insulin-treated drivers? And how frequently while driving?

A

Maximum of 2 hours before and every 2 hours during

(Maximum of 2 hours between pre-driving glucose check and the 1st glucose check performed whilst driving)

25
Q

What advice is there for drivers having had more than 1 severe hypoglycaemic episode while awake in the last 12 months?

A

Must not drive and inform the DVLA

(If not lorry driver then May resume driving after a clinical report from GP or diabetes specialist)

26
Q

At what glucose level should you not drive?

A

<5mmol/L (eat a snack and recheck level - can drive 45 mins after level has returned to normal)
4mmol/L (do not drive)

27
Q

What glucose monitoring can be used for group 1 and group 2 drivers?

A

Group 1: fingerprick or continuous monitoring systems (flash glucose and real-time)

Group 2: finger prick only!

28
Q

Do group 2 drivers need to stop driving and tell the DVLA if they have an episode of hypoglycaemia when asleep?

A

Yes

(Not group 1 - only if more than 1 in 12 months while awake)

29
Q

What is the renal cut off for metformin?

A

Avoid if eGFR is less than 30ml/min

30
Q

What are the monitoring requirements for metformin?

A

Renal function before starting and at least annually (twice a year if additional risk factors for renal impairment)

31
Q

What are the signs of lactic acidosis?

A

Dyspnoea, muscle cramps, abdominal pain, hypothermia, asthenia

32
Q

What are the common side effects of metformin?

A

B12 deficiency, abdominal pain, GI disorders, nausea and vomiting, altered taste, decreased appetite, diarrhoea

33
Q

What are the severe side effects of metformin (rare or very rare)?

A

Hepatitis, lactic acidosis (discontinue)

34
Q

What are the unlicensed uses for metformin?

A

PCOS
T2DM in children aged 8-9

35
Q

Why class of drug are gliclazide, glimepiride, glipizide and tolbutamide? Can they cause hypoglycaemia?

A

Sulfonureas - yes

36
Q

Which DPP-4 inhibitor is best for renal impairment?

A

Linagliptin - no dose reduction required

37
Q

Which classes of anti diabetic drugs should be avoided in pancreatitis?

A

DPP-4 inhibitors (the ‘gliptins)
GLP-1 inhibitors

38
Q

What are the MHRA warnings for pioglitazone?

A

Bladder cancer
Cardiovascular safety - contraindicated in heart failure

39
Q

When can a GLP-1 inhibitor be considered?

A

BMI >35
(and other medical conditions associated with obesity or insulin having significant implications on occupation, or weight loss would benefit other co-morbidities)

Gphc Exam (10 decks)

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