Diabetes Flashcards
What is type 1 diabetes?
- Cause: autoimmune destruction of pancreatic beta islet cells
- Treatment: insulin
What is type 2 diabetes?
- Cause: unhealthy lifestyle (poor diet, high BO + cholesterol)
- Treatment: anti-diabetics + insulin
What are the symptoms of diabetes?
- Hyperglycaemia
- Polyuria
- Polydipsia
- Poor wound healing
- Fatigue
- Weight loss
- Blurry vision
What are the microvascular diabetic complications?
Diabetic retinopathy
- Treat HPT
Diabetic nephropathy
- Treat HPT
- Low dose ACEi/ARB
Peripheral neuropathy
- Neuropathic pain: analgesic, TCA + anti-epileptic
- Erectile dysfunction: sildenafil
Diabetic foot
What are the macrovascular complications?
- Stroke
- Heart attack
- Atherosclerosis
When would you offer low dose statin (primary)?
- 40+
- Type 1 >10 years
- Type 2 >20 years
- Target organ damage
- Significant elevated risk factor
What are the risk factors of diabetic ketoacidosis?
- Stress
- Severe dehydration
- Not eating
- Surgery
- Intercurrent illness
What are the symptoms of diabetic ketoacidosis?
- Inc ketones
- Blood glucose >11mmol/L
- Extreme thirst
- Polyuria
- Fruity breath
- Rapid weight loss
What is the management of diabetic ketoacidosis?
Fluids?
Shock:
- Yes: restore circulating volume
- No: rehydrate + maintain
Potassium
- Don’t give anuric
Soluble insulin
- Continue LA insulin
- Add glucose when <14mmol/L
- Continue:
- Blood ketones <3mmol/L
- Blood pH >7.3: eat and drink
- Stop: 1H post SC fast acting insulin + meal
What is the treatment for type 2 diabetes?
- First line: Metformin (GI disturbance: MR)
- CV status: HF, CVD, QRISK >10%: Metformin AND SGLT
- Additional therapy: SU, PIO, DPP
- Switch a drug for GLP-1 agonist or Tirzepatide (dual glucose dependent insulin tropic polypeptide + GLP-1 agonist)
Triple therapy: insulin therapy
- Continue Metformin
- Review/stop other drugs
If CVD develops during treatment: add/replace a drug w SGLT
Type 2 diabetes + CKD: treatment
ACEi/ARB + SGLT
Sick day rules: antidiabetic drugs
Temporarily stop -> AKI
- Metformin: INC risk of lactic acidosis
- SGLT inhibitor: volume depletion = dehydration is a significant risk factor
Surgery (major procedure) + antidiabetic drugs
- Sliding scale insulin
- Stop antidiabetic (except GLP-1 agonist)
Surgery (minor procedure) + antidiabetic drugs
Omit antidiabetic dose
- SGLTi: diabetic ketoacidosis
- Sulphonylureas: hypoglycaemia in fasted state
- Metformin: renal impairment = lactic acidosis
Pioglitazone, DPPi, GLP-1 agonist: continue as normal
Pregnancy + diabetes: pregnancy planning
- HbA1c level: <48mmol/mol (6.5%)
- 5mg folic acid daily before conception until week 12
Pregnancy + diabetes: STOP
- Oral antidiabetic drugs except metformin
- ACEi/ARB, statin - STOP
Pregnancy + diabetes: treatment
First line: NPH, continue LA analogues (glargine, determir)
SC infusion: multiple injections AND don’t achieve blood glucose control without causing significant disabling hypo
What is the treatment for gestational diabetes?
stop after birth
<7mmol/L
- First line: diet + exercise
- Metformin
- Alt: insulin (AND metformin if not effective alone)
> 7mmol/L (6-6.9 w hydamnios, macrosomia)
- First line: insulin +/- metformin
What medication is given when breastfeeding?
- Insulin
- Metformin
What are the signs and symptoms of hypoglycaemia?
- Slurred speech
- Blood glucose <4mmol/L
- Sweat + chills
- Blurred vision
- Tingling lips
- Palpitations
- Pale, clammy skin
- Drowsy + confused
Which medication masks symptoms of hypoglycaemia?
Beta blockers
What is the treatment for hypoglycemia?
> 4mmol/L small carbohydrate snack or next meal
<4mmol/L
15-20g fast acting sugar
- Repeat after 15min, max 3 times
- 150-200ml pure fruit juice (avoid orange juice in low potassium diet in CKD)
Long acting carb
- Two biscuits, one sliced bread
Do not omit insulin if due
How is diabetes diagnosed?
HBA1c blood test - Glycaemic control in last 2-3M
- Diabetes: >6.4% (48mmol/mol)
- Prediabetes: 5.7-6.4%
- Normal: <5.7%
For: type 2 diabetes
When would you not use HBA1c for a diagnostic tool?
- Type 1 diabetes
- Pregnancy, <2M postpartum
- Diabetes symptoms <2M
- Acutely ill
- Medication causes hyperglycaemia
- HIV infection, end stage CKD
- Acute pancreatitis damage
When would you use oral glucose tolerance test to diagnose diabetes?
- Pre-diabetes
- Gestational diabetes
- Not suitable if severe hyperglycaemia symptoms
How often do you monitor blood glucose levels?
Type 1 diabetes: 4x day
- Before meals + before bed
Not routinely for type 2:
- Insulin or oral hypoglycaemic
- Intercurrent illness
- Medication changes
- Driving
What are the correct levels when testing for blood glucose?
- Waking (fasting) – 5-7
- Pre-prandial – 4-7
- Post-prandial (90min) – 5-9
- Driving – at least 5
What are the correct levels when monitoring HBA1c in diabetic patients?
Type 1 diabetes: 6.5% (48mmol/mol)
Type 2 diabetes:
- Diet controlled, monotherapy: 6.5% (48mmol/mol)
- Hypoglycaemic monotherapy + combination therapy: 7.0% (53mmol/mol)
- Intensify monotherapy if HbA1c: >7.5% (58mmol/mol)
What are the targets in diabetic patients with hypertension?
- Type 1: 140/90
- Type 2 under 80: <140/90
- Type 2 over 80: <150/90
What are the targets in diabetic patients with high cholesterol?
- Normal patients <5mmol/L
- High risk patient <4mmol/L
Diabetes + driving
Notify DVLA:
- Insulin
Hypoglycaemia
- 2+ severe episodes <12M
- Impaired awareness
- Disabling hypo while driving
Group 2 vehicle
Diabetic complication – retinopathy
How often do you monitor blood glucose levels when driving?
Monitor 2H before + every 2H for long journey: insulin + group 2 vehicle
- <5mmol/L: eat carb snack
- <4mmol/L: do not drive
Hypoglycaemia: stop vehicle in safe place + switch engine off, treatment, wait 45 minutes
