Diabetes Flashcards
Who is screened for diabetes and how?
AUSDRISK for 40+ or ATSI 18+ (3y or 1y), FBG or HbA1c for score 12+, 40 + overweight, FDR w diabetes, GDM, PCOS, antipsychotics, CVD, ethnicities, IFG.
What children require diabetes screening?
ATSI,Maori/pacific island age 10 if BMI >85th centile, maternal GDM, FDR w T2DM, acanthosis nigracans, psychotropic drugs, HTN/PCOS/dyslpidaemia.
Metformin - SE, monitoring, risks, peri-op plan.
Nausea, abdo pain, diarrhoea. 1g if eGFR < 60, cease < 30. Monitor b12. Stop if N/V/D, bowel prep and morning of surgery/dehydration.
SGLT2 inhibitors - risks, benefits, C/I, SE, peri-op plan.
Genitourinary infections, euglycaemia ketoacidosis, small risk hypos. Help w CVD, CCF, CKD, slight weight. C/I eGFR < 45. WH 2d before bowel prep, 2d before surgery, 1 day for procedure. WH if N/V/D/dehydrated.
What are GLP1-RA/analogues? Benefits, risks, C/I, pre-op plan
Glutides, weight loss, CVD/CKD benefit. SE: N/V, injection site reaction, gallstone, pancreatitis, worsen retinopathy. C/I eGFR < 30 (dula < 15). WH if N/V/D and day of surgery.
Gliptins and sulphonylureas - effects, C/I
G: small hypo risk, small pancreatitis risk, no C/I. S: risk hypo, may increase weight, C/I GFR < 15.
What should be discussed when commencing insulin?
Impacts of diet, fasting, exercise, sick day management plan, hypos. Notify vicroads. SMBG when starting. Store at room temp for 1mo. Rotate injection sites. Single use short 4mm needles, sharp disposal.
How is insulin first dosed and titrated?
Usually long acting glargine 0.2U/Kg at night. Use fasting glucose to titrate - aiming BSL over 2-3 days 6-6.9. Adjust by 2-4 units as needed.
What is involved in a diabetic sick day action plan?
Indications - unwell, BSL >15. SMBG - 2-4hourly monitoring. Meds plan (metformin, SLGT2, GLP1-RA may need WH). Maintain hydration and aim to have normal meals. Seek assisstance if unwell.
Hyperosmolar hyperglycaemia - features, triggers, management, risks.
Thirst, altered consciousness over days. T: infection, CV event, AKI. High serum osmolality and BSL (>20). Endo review, slow IV fluid (50% loss in 12hr). Risk thrombosis, ketosis, death.
Diabetic retinopathy - appearance, screening.
Non-proliferative or proliferative. Exudates (white spot), haemorrhages, cotton wool spots and neovascularisation. Screen 2 yearly unless HbA1c >8, diabetes for 15y, ATSI, NESB, systemic disease - yearly.
How is diabetic retinopathy managed?
If diagnosed, start fenofibrate. Control HTN. Opthal if oedema, proliferative, moderate non-proliferative, near optic disc. Can do phototherapy + AntiVEGF. Improving BSL can worsen retinopathy.
How is diabetic peripheral neuropathy assessed?
Symmetric. Pinprick sensation, vibration w 128Hz fork, 10g monofilament pressure sensation at distal plantar toes and MTP. Ankle reflexes. Proprioception at big toes.
Diabetic peripheral neuropathy - differentials, management.
B12, Hypothyroid, CKD. Vascular (chillblains, PVD w small vessel). Idiopathic. Myeloma. Pain: amitriptyline 25mg 1st line, 2nd: duloxetine, pregab, gabapentin. Consider capsaicin cream.
What are the risk factors for GDM? How is it tested for?
Prev GDM, age, PCOS, high BMI or weight gain, Fhx DM, prev preg loss, ATSI/maori, migrants. HbA1c or FBG in 1st trimester, OGTT in 2nd trimester. FBG >5.5 or 2h >8.0.
How is GDM managed? What are the risks and followup?
Diet, BSL monitoring. Add metformin, insulin. CV malformation, macrosomia, hypoglycaemia, low iron, prematurity. Post partum OGTT 6-12wk post, bloods 3yearly. 30-50% T2DM within 20y.
How is pre-existing diabetes managed in pregnancy?
Aim HbA1c < 6.5%, cease ACEI statins, likely swap to insulin - DW endo for metformin - check B12. Folate 5mg, check GFR and retinopathy prior to pregnancy.
What are the requirements for driving with diabetes? Private vs commercial.
If no meds, no restriction. Private, no insulin - notify authority, 5y review unconditional. Private with insulin - conditional with annual review. Commercial always needs specialist. Conditions: minimal risk hypoglycaemia, awareness of hypoglycaemia. Aim BSL >5 before drive, have monitor and snacks.
How is type 1 diabetes diagnosed?
Sx: weight loss, polyuria/polydipsia, autoimmune history. Glutamic acid decarboxylase + insulinoma antigen 2 (GAD, IA2) antibodies in 90%. C-peptide < 0.2 supportive.
What are the non-pharm management aspects for diabetes?
Diet: low GI, limit saturated fats. Cease smoking. Alcohol < 2std/day. Exercise 150min + 2-3 resistance sessions (No hypos 48hr prior, aim BSL >5, have snacks). Weight loss if BMI >25 (meds if >27, surgery if >40 - bypass/sleeve)
What should be checked in the setting of poor diabetes control?
Understanding of meds, adherence meds + lifestyle. Exclude infection, steroids, antipsychotics. Anaemia/transfusion will lower HbA1c. Check for hypos limiting use.
Acute hypoglycaemia - risk factors, management.
RF: meds, insulin, age, exercise, fasting, GI disease, alcohol (BSL + awareness). If awake, swallow - 15g oral glucose (6 jellybeans), recheck 15min then give long acting. Monitor 4hr. If decreased GCS, ambulance IV 200mL 10% over 15min OR IM/sc 1mg (0.5 in kids) glucagon, (20ml of 50% glucose - necrosis risk). Needs review.
