Diabetes Flashcards
What dietary aims should patients with T2DM have?
Reduce cholesterol, BMI and HbA1c Reduce fats, especially polysaturated Reduce salt Reduce alcohol Eat 5 fruit and veg a day
10kg weight loss in prediabetic stage reduces risk of later developing diabetes
When is hba1c not used to diagnose diabetes?
T1DM Patients with renal failure on EPO Anaemia Acute illness - blood sugar levels will rise Antiviral drugs
How is T2DM diagnosed?
One reading hba1c greater than 48 with symptoms
Two readings greater than 48 without symptoms, at least a month apart
If greater than 70, start oral treatment! If not, begin trial of lifestyle interventions
When should low dose aspirin (75mg) be offered in diabetes?
If over 50 and BP is under 145/90
If under 50 and has significant risk factors
How should microbuminuria be tests for in T2DM?
Early morning urinary albumin:creatinine ratio
> 2.5mg/mmol in men
3.5mg/mmol in women
Positive result should be repeated once or twice in the subsequent month
How should microalbuminuria be managed?
Offer ACEI or ARBs
Maintain low blood pressure
In type two, prognostic of IHD
Which t1dm patients should be started on statins?
All patients over 40 with diabetes for more than 10 years, or that have complications
What regular reviews should patients with T2DM have?
Diet control - once a year Cardiovascular risk estimation - annual Renal complications - measure proteinuria, creatinine and eGFR Retinopathy - annual screening Neuropathy - annual foot check
General diabetic checks- twice a year
How does metformin work?
Metformin is a biguanide
Reduces hepatic glucose production
Increases glucose uptake by cells
Delays intestinal glucose absorption
Reduces cholesterol and does not cause weight gain!
What are the side effects of metformin?
Nausea
Diarrhoea
These usually pass within the first few days
Start with low dose and increase over weeks to 2g a day
If not tolerated, try modified release
When is metformin contraindicated?
Renal failure - risk of lactic acidosis - renal function must be determined first!
Iodine containing scan contrast - stop using metformin
How should metformin be taken?
Take with meals
500mg with breakfast for a week
Then 500mg with breakfast and dinner for a week
Then 500mg with breakfast, lunch and dinner
How does gliclazide (sulphonylurea) work?
Increases insulin secretion from pancreatic B cells
What are the side effects of gliclazide?
Nausea and vomiting Diarrhoea Constipation Weight gain Hypoglycaemia - patients must have regular food intake and not be on low carb diets
Rarely causes hepatitis and jaundice
When should gliclazide not be used?
Acute porphyria
Ketoacidosis
Avoid in: Patients who are overweight Patients with irregular diets - increased risk if hypoglycaemics Elderly Renal impairment Hepatic impairment
What hba1c level is needed to start insulin?
Hba1c greater than 58 mmol
How does sitagliptin (DPP4 inhibitor) work?
Incretin hormones, such as GLP1 are secreted from l cells of the small intestine
These hormones increase insulin release from B cells
DPP4 inhibitors inhibit the enzyme, dipeptyl peptidase 4, which breaks incretins down
What are the side effects of sitagliptin?
Can cause hypoglycaemia
May decrease appetite
GI disturbance
Upper respiratory tract infection
Rarely, pancreatitis
What are the contraindications of sitagliptin?
Ketoacidosis
Reduce dose if renal impairment
How does pioglitazone (glitazones) work?
Pioglitazone is an agonist for the PPARG receptor, which up regulates genes that increase insulin sensitivity of cells
What are side effects of pioglitazone?
Weight gain Hypoglycaemia GI disturbances Osteoporosis Fluid retention - oedema - HF?
Bladder cancer
Liver toxicity - assess liver function before!
What are the contraindications of pioglitazone?
Heart failure
Patients with a history of bladder cancer
Patients with Undiagnosed haematuria
Patients at high risk of fracture
How does exenatide work?
Exenatide mimics GLP1 to increase insulin secretion from the pancreas
This is an injectable drug
What are the side effects of exenatide?
Hypoglycaemia
Nausea - delays gastric emptying
Pancreatitis
When should exenatide be used?
For patients with T2dm previously uncontrolled with metformin and a sulphonylurea
Does not increase weight!
Use instead of insulin if:
BMI >35
BMI <35 and insulin not acceptable
When should statin be considered in T2DM?
Considers simvastatin if :
Under 40 and with poor cardiovascular risk profile
Over 40 and cardiovascular risk greater than 20% over 10 years
When and how should self monitoring be used in t2dm?
Offer to newly diagnosed patients on t2dm if on oral hypoglycaemics or insulin
Make plan of how blood glucose levels should be interpreted and what action should be undertaken
If blood glucose testing is not tolerated, use urine glucose testing
