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PY7020 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnosis of Diabetic ketoacidosis

A

Ketoanemia > 3.0mmol/L
CBG > 11.0mmol/L or known diabetes mellitus
HCO3 < 15.0mmol/L
Venous pH < 7.3

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2
Q

Symptoms of diabetic ketoacidosis

A

Polyuria
Polydipsia (increased thirst)
Blurred vision
Weakness
Headache
Orthostatic hypotension
Tachycardia
GI symptoms
Fruity breath from acetone production

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3
Q

Hyperglycaemic hyperosmolar state

A

Marked hyperglycaemia > 30.0 mmol/L
Severe dehydration (Hypovolemia)
Osmolality usually 320mosmol/kg or more

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4
Q

DKA management

A
  • Rehydration
  • IV insulin 0.1ml/hr/kg
  • Continue long acting insulin
  • Correct electrolyte abnormalities
  • VTE prophylaxis
  • Avoid hypoglycaemia
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5
Q

HHS management

A

Calculate osmolality (2Na + Glucose + Urea)
- IV 0.9% NaCl
- Switch to 0.45%NaCl if osmolality not declining
- Commence IV insulin (0.05ml/kg/hr) if CBG not falling with IV fluids alone
- Prophylactic anticoagulation is required in most patients

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6
Q

Metformin mechanism

A

Increases insulin sensitivity and uptake by skeletal muscles. Suppresses hepatic glucose production. Renal excretion.

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7
Q

Metformin pros and cons

A

Pros:
- Helps weight loss
- Doesn’t cause hypoglycaemia

Cons:
- GI upset
- Lactic acidosis

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8
Q

Cautions with metformin

A

Not to be used in severe renal impairment and use with caution in moderate impairment.
Hold in AKI - risk of lactic acidosis
Caution in hepatic impairment - risk of lactate accumulation

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9
Q

Sulphonyl ureas mechanism

A

Stimulates pancreatic insulin secretion by blocking K+ channels in pancreatic beta cells

Gliclazide

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10
Q

Pros and cons of sulphonylureas

A

Pros:
- Good reduction in HbA1c

Cons:
- Weight gain
- Insulin resistance
- GI upset
- Hypersensitivity reactions

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11
Q

Cautions with sulphonyureas

A

Can cause hypoglycaemia
Increased risk in elderly, pituitary and adrenal insufficiency

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12
Q

Dipeptidyl peptidase 4 inhibitor mechanism of action

A

Delays inactivation of GLP-1.
GLP-1 increases insulin secretion after a meal and reduces glucagon release.
GLIPTINS

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13
Q

Pros and cons of DPP4 inhibitors

A

Pros:
- Low hypoglycaemic risk
- No effect on weight
- Well tolerated

Cons:
- URTI
- Headache
- Nausea
- Heart failure
- Hypersensitivity and skin reactions

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14
Q

Cautions with DPP4i

A

Increased risk of urticaria, pancreatitis, angioedema

Can be used in CKD with dose titration

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15
Q

Sodium glucose transporter protein 2 mechanism of action

A

Inhibits renal reabsorption of glucose. Insulin independent mechanism.
FLOZIN

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16
Q

Pros and cons of SGLT2 inhibitors

A

Pros:
- Low risk of hypoglycaemia
- Weight loss
- Can improve blood pressure

Cons:
- Increased UTIs especially in women
- Diabetic ketoacidosis

17
Q

Cautions with SGLT2 inhibitors

A

Avoid in CKD
Avoid with diuretics

18
Q

Thiazolidinediones mechanism of action

A

Potentiates insulin action and enhances its effects on skeletal muscles, adipose tissue and liver with increased glucose uptake and reduced hepatic gluconeogenesis.
PIOGLITAZONE

19
Q

Pros and cons of thiazolidinediones

A

Pros:
- Low risk of hypoglycaemia
- Reduced insulin resistance

Cons:
- Weight gain
- Peripheral oedema

20
Q

Cautions with pioglitazone

A

CI in heart failure and fracture risk
Caution in hepatic impairment

21
Q

Glucagon like peptide mechanism

A

Increases insulin secretion after meals from beta cells and suppresses alpha cells from releasing glucagon.
Reduces gastric emptying and improves satiety.
Exenatide, Liraglutide

22
Q

Pros and cons of GLP-1 agonists

A

Pros:
- Weight loss
- Low hypoglycaemia risk

Cons:
- GI upset

23
Q

Cautions with GLP-1 agonists

A

Injectables not suitable for all patients
Possible association with gallstones

24
Q

1st line (monotherapy) for DM

A

Start metformin when HbA1c rises above 48mmol/L (6.5%) on lifestyle intervention.
- If GI adverse effects, switch to MR metformin

25
Q

2nd line (dual therapy) for DM

A

Start dual therapy when HbA1c rises to 58mmol/L
- Metformin + DPP4i
- Metformin + Pioglitazone
- Metformin + Sulphonylurea
- Metformin + SGLT2 inhibitor

26
Q

3rd line (triple therapy) for DM

A

Start if HbA1c remains 58mmol/L
- Metformin + DPP4i + sulphonylurea
- Metformin + Pioglitazone + sulphonylurea
- Metformin + Pioglitazone + SGLT2i
- Metformin + Sulphonylurea + SGLT2i

If this treatment fails, start insulin treatment and aim for HbA1c to reach 53mmol/L

PY7020 (23 decks)

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