Diabetes Flashcards
What type of drug is exenatide?
GLP-1 mimetic
They increase insulin secretion and decrease glucagon secretion. They also result in weight loss.
What are the requirements for GLP-1 mimetic therapy??
BMI > 35
1% hba1c drop in 6 months
3% weight loss in 6 months
What type of drug is sitaglipin?
Dipeptidyl peptidase 4 (DPP-4) inhibitor
Oral, no hypoglycaemia and no weight gain.
Diagnostic criteria for diagnosis diabetes?
Symptomatic
- Fasting blood glucose >7.0mmol/L
- Random glucose >11.1 mmol/L (or after 75g OGTT)
- HBA1C >6.5% (48mmol)
Assymptomatic
-same as above but on 2 occasions
What is seen in HHS and how is it managed?
Long history, no acidosis, glucose high eg. >35! Dehydration, osmolatiy >320. No ketones.
Slow rehydration over 2 days
(no insulin unless poor response eg glucose doesn’t fall by 5mmol/l/hour or ketonemia)
Maintain 10-15mmol/l of glucose to prevent cerebral odema.
Treat the cause
How does Latent Autimmune Diabetes of Adulthood (LADA) present?
Slow onset (several months), young-ish, not increased body habitus.
Can treat with oral hypoglycaemics initially before insulin therapy is needed.
Which antibodies are present in LADA?
Glutamic acid decarboxylase AB (GAD)
Islet cell AB (ICA)
Insulinoma-associated AB (IA-2)
Zinc transporter AB (ZnT8h
How does MODY present?
Younger patients with asymptomatic hyperglycaemia without complications like DKA.
But can also be symptomatic eg polyuria, polydipsia
At what HBA1C level do you add a 2nd anti-diabetic drug?
7.5% (58mmol)
When to start drug therapy (metformin) in someone with T2DM on lifestyle interventions?
If HBA1C rises to 6.5% (48)
What is first line anti-hypertensive in any person with diabetes? What BP should be aimed for?
ACEi
<140/80 (<130/80 if end organ damage)
What’s the atorvastatin dose for primary and secondary prevention of cardio risk?
P - 20mg
S- 80mg
Blood glucose targets on waking and before meals in T1DM?
4-7 before meals
5-7 on waking
Whats the joint British diabetes societies diagnostic criteria for of DKA?
PH <7.3
Glucose > 11 or known diabetic
Bicarbonate < 15
Ketones > 3 in blood or urine ketones +++
How do you manage DKA?
Fluids - 0.9% saline (unless BM <15, can use 5% dextrose) usually need 5-7 litres! Regime: 1L/1Hr, 1L/2hr, 1L/2hr, 1L/4hr….
If systolic <90bpm consider 500ml fluid challenge.
Insulin - 0.1unit/kg/hour
Potassium
>5.5 - nil
3-5.5 - 40 KCL (10mmol per hour)
<3.5 - senior review
Watch/monitor for cerebral odeama - esp children and young adults. Neuro-obs needed
What’s the treatment for diabetic neuropathic pain?
1st: amitriptyline, duloxitine, gabapentin,or pregabalin.
Tramadol for rescue therapy.
What are the symptoms of gastroparesis?
BloAting, vomiting and erratic blood sugars (disbetics)
Management with pro-kinetic agents: metoclopramide, dimperidone, or erythromycin.
What is impaired fasting glucose?
Fasting glucose between 6.1-7.
What is impaired glucose tolerance?
Fasting glucose <7, and OGTT between 7.8-11.1
In MODY 3 with HFN-1a gene what is the best treatment?
Sulfonylureas (glicazide)
What test is useful to determine whether diabetes is type 1 or 2, in hard to distinguish cases?
C-Peptide
Lower in patients with type 1 as the pancreas isn’t making enough insulin precursor (broken down into insulin and c-peptide)
How do we stratify diabetic foot risk?
Low - no risk factors other than callus
Mod - deformity, neuropathy or non-critical limb ischemia
Severe - prev ulceration, prev amputation, on renal RT, neuropathy and non critical limb ischemia, neuropathy with callus and/or deformity, non critical limb ischemia and callus and or deformity.
Mod and severe need to regularly be followed up in the local diabetic foot centre.
