Diabetes Flashcards
What did the ACCORD trial tell us?
harm if overcontrol of BG
When is the benefit for aggressive BG targets?
5-10 years
What frailty score can we treat like regular patients?
1-3= fit- not physically active
What target for functionally dependent or frailty score 4-5?
midly frail= 7-8
What is the target for severely frail or dementia?
7-8.5
What is hypoglycemia?
<4 mmol/L or <5 in older
What is hypoglycemia risk factors?
more intensive control
previous episode
meds
dementia
Signs of hypoglycemia
shaking, sweating, hunger, nausea, confusion, weak
who is associated with asymptomatic hypoglycemia?
older, longer duration of diabetes, more episodes
How to fix hypoglycemia?
15-20 g of carb, glucagon if BG <2.8
Who should have continuous glucose monitoring?
older adults with type 1 or if type 2 and insulins
What is time to benefit of statins and ACE?
statin= >2 years
ACE= >3-5 years
How much A1C lowering does nutrition do?
1-2%
How much A1C lowering does exercise do?
0.5-0.7
How much A1C lowering does metformin/SU/GLP do?
1-1.5%
How much A1C lowering does SGLT2 do?
0.5-0.8
What additional agent is better in diabetes if CV risk as well?
GLP best for CV or SGLT2
Cons of SGLT2?
ortho hypo risk, genetic infection and costy
Cons of GLP?
cost, NDV, low appetite, weight LOSS= frailty
Lowest risk insulin?
once daily basal ie basaglar
Pros of metformin?
cheap, effective low risk of hypo
Pros of SGLT
CV and CKD benefit, low risk of hypo, not as good at lowering A1c
Pros of GLP?
CV benefit, weight loss, effective, low risk of hypo
Pros of DPP?
low risk of hypo, well tolerated, moderate A1c effect
