Diabetes Flashcards
In hypoglycaemia, how many grams of carbohydrates should be given?
10-20g
(0.3g/kg) for for children and young people)
What are the options for treating hypoglycaemia if able to swallow? What should not be used?
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
What should be used to treat hypoglycaemia if the patient is unable to swallow?
IM glucagon:
<8years (or <25kg) : 500mcg
Everyone else: 1mg
What glucose level indicates hypoglycaemia?
<3.5 mmol/L
What angle should insulin be injected?
90 degrees
How long after injecting should the needle be left in the skin?
5-10 seconds
What sites can be used to inject insulin?
Abdomen (fastest absorption)
Outer thigh
Buttocks
Arm (not usually recommended)
What is the target fasting glucose level?
5-7mmol/L
What is the target glucose level before meals and other times of the day?
4-7mmol/L
What is the glucose target for adults testing at least 90mins after meals?
5-9mmol/L
Is extra insulin required when drinking alcohol?
No
What ketone level indicates DKA?
2+ on urine dipstick
Above 3 mmol/L in blood
What plasma glucose level may indicate ketoacidosis?
Over 11mmol/L
What are the clinical features of DKA?
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
What are the symptoms of hypoglycaemia?
Hunger
Anxiety or irritability
Sweating
Palpitations
Tremor
Weakness/ lethargy
Impaired vision
Confusion and disorientation
Convulsions
Coma
What HbA1c and glucose levels indicate T2DM?
HbA1c over 48mmol/L
Fasting glucose over 7mmol/L
Random glucose over 11mmol/L
When should HbA1c not be used to diagnose T2DM?
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 +
What are the risk factors for T2DM?
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)
What is the referral programme for adults with T2DM?
DESMOND
How frequently should HbA1c be measured in T2?
Every 3-6 months until anti diabetic regime is stable, then every 6 months
What is the HbA1c target for T2DM with drug treatment associated with hypoglycaemia (e.g sulfonurea)?
53mmol/L
What is the HbA1c target for T2DM with drug treatment not associated with hypoglycaemia (e.g metformin)?
48mmol/L
What HbA1c level suggests T2DM is not adequately controlled by a single drug?
58mmol
How soon before travelling must a glucose test be performed for insulin-treated drivers? And how frequently while driving?
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)
What advice is there for drivers having had more than 1 severe hypoglycaemic episode while awake in the last 12 months?
Must not drive and inform the DVLA
(If not lorry driver then May resume driving after a clinical report from GP or diabetes specialist)
At what glucose level should you not drive?
<5mmol/L (eat a snack and recheck level - can drive 45 mins after level has returned to normal)
4mmol/L (do not drive)
What glucose monitoring can be used for group 1 and group 2 drivers?
Group 1: fingerprick or continuous monitoring systems (flash glucose and real-time)
Group 2: finger prick only!
Do group 2 drivers need to stop driving and tell the DVLA if they have an episode of hypoglycaemia when asleep?
Yes
(Not group 1 - only if more than 1 in 12 months while awake)
What is the renal cut off for metformin?
Avoid if eGFR is less than 30ml/min
What are the monitoring requirements for metformin?
Renal function before starting and at least annually (twice a year if additional risk factors for renal impairment)
What are the signs of lactic acidosis?
Dyspnoea, muscle cramps, abdominal pain, hypothermia, asthenia
What are the common side effects of metformin?
B12 deficiency, abdominal pain, GI disorders, nausea and vomiting, altered taste, decreased appetite, diarrhoea
What are the severe side effects of metformin (rare or very rare)?
Hepatitis, lactic acidosis (discontinue)
What are the unlicensed uses for metformin?
PCOS
T2DM in children aged 8-9
Why class of drug are gliclazide, glimepiride, glipizide and tolbutamide? Can they cause hypoglycaemia?
Sulfonureas - yes
Which DPP-4 inhibitor is best for renal impairment?
Linagliptin - no dose reduction required
Which classes of anti diabetic drugs should be avoided in pancreatitis?
DPP-4 inhibitors (the ‘gliptins)
GLP-1 inhibitors
What are the MHRA warnings for pioglitazone?
Bladder cancer
Cardiovascular safety - contraindicated in heart failure
When can a GLP-1 inhibitor be considered?
BMI >35
(and other medical conditions associated with obesity or insulin having significant implications on occupation, or weight loss would benefit other co-morbidities)
