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Finals > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the HbA1c targets based on the management of T2DM ?

A
  1. Lifestyle : 48mmol/mol (6.5%)
  2. Lifestyle + metformin : 48mmol/mol
  3. Any drygs that may cause hypoglycaemia : 53mmol / mol (7.0%)
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2
Q

what is the HbA1c target for a patient already on one drug but HbA1c has risen to 58mmol/mol?

A

53mmol/mol

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3
Q

First line treatment for T2DM?

A

Metformin

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4
Q

First line management of T2DM if metformin causes GI upset

A

Modified release metformin trial

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5
Q

When would an SGLT-2 ‘flozin’ inhibitor be added to metformin as first line treatment ?

A
  • Patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)
  • Patient has established CVD
  • Patient has chronic heart failure
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6
Q

What is given first line for the management of T2DM if metformin is CI AND the pt is at risk of or has CVD / HF

A

SGLT-2 monotherapy (‘Floxin’)

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7
Q

What is given first line for management of T2DM if metformin is CI but the pt is not at high risk of CVD / not in HF?

A
  1. Pioglitazone : UNLESS bladder Ca, ketoacidosis, fracture risk, haematuria, HF
  2. Sulfonylurea : UNLESS ketoacidosis / lorry drivert
  3. DPP-4 inhibitor (e.g. linagliptin) : AVOID weight gain
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8
Q

Mode of action and class of metformin

A

Improves insulin sensitivity
Biguanide

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9
Q

SE of metformin

A

Nausea
Diarrhoea

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10
Q

When is metformin CI ?

A

Creatinine : 150
eGFR <30

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11
Q

Effect of metformin on weight

A

Neutral

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12
Q

Action and example of DDP-4 inhibitor

A
  • Linagliptin
  • Increase leves of incretins which stimulate insulin release and inhibiting the release of glucagon
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13
Q

Effect of DPP-4 inhibitor on weight

A

Neutral

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14
Q

Action of Pioglitazone and class

A
  • Improves insulin sensitivity and suppresses gluconeogenesis
  • Thiazolidinedione
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15
Q

SE of pioglitazone

A

Weight gain
HF
Bone fractures
Bladder cancer

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16
Q

Effect of pioglitazone on weight

A

Increase

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17
Q

Action of sulfonylurea and example

A

Enhances insulin secretion
Gliclazide

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18
Q

two SE pf gliclazide

A

Hypoglycaemia
Cholestasis

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19
Q

Effect of gliclazide on weight

A

Increase

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20
Q

Action and example of SGLT-2 inhibitor

A

Empagliflozin
Reduces renal glucose reabsoprtion = increasing urinary glucose excretion

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21
Q

SE of SGLT-2 inhibitors

A

Euglycaemic ketoacidosis
Increased risk of UTI and genital thrush
Fournier’s gangrene

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22
Q

Effect of SGLT-2 inhibitors on weight

A

weight loss

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23
Q

Example and action of GLP-1 analogue

A
  • Exenatide, semaglutide
  • Increase insulin secretion and inhibit glucagon secretion
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24
Q

3 SE of GLP-1 analogues

A

Nausea
Diarrhoea
Pancreatitis

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25
Q

Effect of GLP-1 analogues on weight

A

Decrease

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26
Q

Example and action of a-glucosidase inhibitor

A

Acarbose
Reduces glucose absorption

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27
Q

3 SE of acarbose

A

Bloating
Flatulence
Diarrhoea

28
Q

First line management of DM if underweight

A

Glicliazide

29
Q

What is the earliest, clinically detectable manifestation of classic diabetic kidney disease

A

Microalbuminuria

30
Q

Screening for diabetic nephropathy

A
  • Annual screening using urinary albumin:creatinine ratio (ACR)
  • Should be an early morning specimen
  • ACR > 2.5 in mend OR >3.5 in women = microalbuminuria
31
Q

Management of diabetic nephropathy

A
  • BP control with ACEI or ARB to aim for <130/80
  • Dietary protein restriction
32
Q

What is the best way to distinguish AKI from CKD

A

Renal USS -> most pts with CKD have bilateral small kidneys

EXCEPCT

  • ADPKD
  • Diabetic nephropathy (early stages -> enlarged kidneys)
  • Amyloidosis
  • HIV- associated nephropathy
33
Q
  • Small well defined deep ulcer on ventral aspect of the heel
  • Pale, dry with cracked skin
A

Arterial ulcer

34
Q

Sick day rules for pt with T1DM on inuslin

A
  • CONTINUE NORMAL INSULIN REGIMEN
  • Check blood glucose more reg (every 1-2 hrs, including through night),
35
Q

T2DM sick day rules if on metformin

A

stop treatment if there is a risk of dehydration, to reduce the risk of lactic acidosis.

36
Q

T2DM sick day rules if on sulfonylurea

A

may increase the risk of hypoglycaemia

37
Q

T2DM sick day rules if on SGLT-2 inhibitor

A

check for ketones and stop treatment if acutely unwell and/or at risk of dehydration, due to the risk of euglycaemic DKA

38
Q

T2DM sick day rules of GLP-1 receptor agonist

A

stop treatment if there is a risk of dehydration, to reduce the risk of AKI

39
Q

Dangerous complication of fluid resuscitation in pts with DKA

A

Cerebral oedema -> reduced GCS, urine incontience, abnormal neurogenic respiratory and vomiting

40
Q

When would NICE recommend adding metformin in the management of T1DM ?

41
Q

Important adverse SE of SGLT-2 inhibitors

A
  • Urinary and genital infection (secondary to glycosuria).
  • Fournier’s gangrene has also been reported
  • Normoglycaemic ketoacidosis
  • Increased risk of lower-limb amputation: feet should be closely monitored
42
Q

Two ways of diagnosising T2DM

A
  • Plasma glucose
  • HbA1c
43
Q

If symptomatic, how is DM diagnosed base on plasma glucose ?

A
  • Fasting glucose greater than or equal to 7.0 mmol/l
  • Random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
44
Q

If asymptomatic, how is DM diagnosed based on plasma glucose

A
  • Fasting glucose greater than or equal to 7.0 mmol/l
  • Random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

TWO SEPARATE OCCASIONS

45
Q

when is Hba1c diagnostic of T2DM

A
  • HbA1c of greater than or equal to 48 mmol/mol (6.5%) is diagnostic of diabetes mellitus
  • If asymptomatic, repeat to confirm diagnosis
46
Q

HbA1c level suggestive of pre diabetes

A

42-47 mmol/mol (6.0-6.4%)

47
Q

What can cause a falsely low HbA1c

A

Haemodialysis

48
Q

Metformin rules with surgery

A
  • If taken once or twice daily take as normal
  • If taken 3 times, omit lunch time dose
49
Q

Rules regarding sulfonylureas and morning surgery

A
  • If taken OD in the morning , omit morning dose that dose
  • If taken BD - omit morning dose
50
Q

Rules regarding sulfonylureas and afternoon surgery

A
  • If taken once daily in the morning -
    omit the dose that day
  • If taken twice daily - omit both doses that day
51
Q

Rules regarding DDP-4 and GLP-1 analogues inhibitors and surgery

A

Take as normal

52
Q

Rules regarding SGLT-2 inhibitors and surgery

A

Omit on the day

53
Q

Rules regarding once daily insulins and surgery

A
  • Reduced dose by 20% day prior
  • Reduced dose by 20% on the day
54
Q

Rules regarding BD biphasic or ultra long acting insulins

A
  • No dose change day before
  • Halve the usual morning dose and leave evening unchanged
55
Q

what can be used to distinguish type 1 and type 2 DM

A

C peptide levels
Low in T1DM

56
Q

Explain T1DM

A
  • Chronic autoimmune disorder in which insulin producing beta cells in the islets of langerhans in the pancreas are destroyed by immune system
  • Low insulin = high glucose levels
57
Q

Explain T2DM

A

Chronically high glucose levels leads to a peripheral resistance to insulin

58
Q

Step wise management of T2DM if no CVD risk

A
  1. Metformin
  2. Sulfonylurea, pioglitazone, DPP-4 inhibitor
  3. Triple therapy (metformin + 2 drugs)
59
Q

When is GLP-1 mimetic considered

A
  • When triple therapy fails and pt has a BMI above 35kg/m2
  • Only continue if reduction of at least 11mmol/mol in in HbA1c and weight loss of at least 3% of initial body weight in 6mnths.
60
Q

What is the pathophysiology behind HHS?

A

Hyperglycaemia
Increased serum osmolality
Osmotic diueresis
Severe volume depletion

61
Q

Presentation of HHS

A
  • Clinical dehydration, polyuria, polydipsia
  • N&V
  • Altered consciousness
62
Q

Management of HHS

A
  • FLUID : IV0.9% saline 0.5-1L/hr with potassium monitoring
  • Insulin only given if blood glucose stops falliing whilst giving IV fluid
  • VTE prophylaxis
63
Q

If starting insulin in T2DM what is recommended

A

NICE recommend starting with human NPH insulin (isophane, intermediate-acting) taken at bed-time or twice daily according to need

64
Q

when reviewing a pt on maximum dose metformin, when would anotehr drug be added ?

A

HbA1c = 58mmol/mol

65
Q

BP target and first line meds for HTN

A

140/90

ACEI
ARB in afro-caribbean origin

Finals (92 decks)

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