Diabetes Flashcards
Explain function and side effects of metformin.
- Increase insulin sensitivity
SE:
- Nausea
- Diarrhoea
- Abdominal pain
- Avoid giving if GFR <36ml/min cos risk of lactic acidosis
* CI: Liver and kidney disease patients
Explain function and side effects of DDP4 inhibitors (sitagliptin).
- Allow continued stimulation of secretion of insulin by prveenting breakdown of incretin.
- SE:*
1. None. Does not delay gastric emptying –> no effect on weight loss.
Explain the function and side effects and contraindications of glitazones.
- Increase insulin sensitivity
SE:
- Fractures (CI : osteoporosis)
- Raised LFT (check LFT regularly, stop if LFT x3)
- Hypoglycaemia
- Fluid retention (CI: stop if theres weight gain or oedema)
CI:
- Past or present congestive cardiac failure
- Osteoporosis
- Oedema
Explain the function and side effects of sulphonylurea.
- Increase secretion of insulin by beta cells
SE:
- Hypoglycaemia (MONITOR BLOOD GLUCOSE CLOSELY)
- Weight gain
Explain the function and side effects of SGLTI (gliflozin).
- Blocks reabsorption of glucose in kidneys, promoting excretion of glucose in urine
- SE:*
- Fungal infection, genital thrush due to incerased glucose in urine
Explain the function and side effects of glucagon like peptide (GLP) analogues e.g. Exenatide and Liraglutide.
Explain the requirements before giving this drug.
Explain when GLP-1 memetic should be continued.
- Act as incretin memetic (to stimulate insulin secretion)
SE:
- Nausea, vomiting, weight loss due to delayed gastric emptying –> feeling full
Requirements:
- patient must have BMI >35 + psychological or medical problem associated with obesity
- patient with BMI <35 must have a good reason to receive it e.g. insulin therapy would have sig occupational implications / weight loss would benefit other sig obesity-related comorbidities
When should it be continued?
- Should have beneficial metabolic response (reduction of HbA1c by at least 11mmol/mol)
- Weight loss of at least 3% of initial body weight in 6mths
Name the ideal diet for obese diabetic patient.
Low carbohydrate, ketogenic diet (LCKD)
- shows better improvements in HbA1c, weight, HDL than low-glycaemic index, reduced-calorie diet
Name and explain the 2 methods for monitoring blood glucose levels.
- Finger prick if on insulin
- Before meal tells you effect of long acting insulin doses
- After meal tells you effect of short acting insulin doses
-
Glycated Hb (HBA1C)
* shows mean glucose level over 8 weeks (half life of RBC)
Why is it important to ask patients about their hypoglycaemic attacks?
Hypoglycaemia is dangerous and can cause death.
Hypoglycaemic awareness may diminish (dont perceive it) if
- Control is too tight (awareness drops after every episode of hypoglaycaemic attack)
- Decrease with time for T1DM due to decreased glucagon secretion (in T1DM, glucagon secretion is also impaired due to loss of communication between beta and alpha cells)
- Gotta lossen control to regain hypoglycaemic awareness
What is “DESMOND” programme for diabetes? What is it used for?
- Used to help type 2 diabetic patient lose weight
D - Diet
E - Exercise
SM - Self management
O - On going
ND - Newly diagnosed
Diet, exercise and self management for ongoing and newly diagnosed diabetes
What are some signs to take note of in diabetic patients?
- Loss of leg hair - sign of peripheral vascular disease
- Polyuria, Polydipsia, weight loss - do urine dipstick test for suspected ketoacidosis
- Palpation of 3 arteries in foot, dorsa tabelis, anterior tibial artery, posterior tibial artery (for peripheral arterial disease)
How to differentiate between Type 1 and Type 2 diabetes.
Type 1:
- Younger patients (before puberty)
- No obesity
- Blood test shows autoantibodies against islet cells e.g. ICA, GBA (anti islet cells ab anti glutamic acid decarboxylase ab)
- Poor response to oral hypoglygaemic drugs
Type 2:
- Older patients
- Obese patients
- Good repsonse to oral hypoglycaemic drugs
Name the possible complications for hyerglycaemia.
- Microvascular problems
- Retinopathy
- Neuropathy
- Nephropathy
- Macrovascular problems
- MI
- Stroke
- Limb ischaemia
Name the 4 types of diabetic neuropathies.
-
Symmetric sensory polyneuropathy - loss of sensation in longest nerve
* Treatment: Paracetamol (first line) + avoid weight bearing -
Mononeuritis multiplex - painful CN3 and 6
* Treatment: supresss immune system with corticosteroids - Amyotrophy - wasting of quadriceps and pelvifemoral muscles
- Autonomic neuropathy - postural hypotension, gastroparesis, erectile dysfunction
- Treatment: Gastric pacing for gastroparesis - stimulate contraction of intestine
- Treatment: Fludrocortisone (powerful mineralocorticoid) or Midodrine (alpha agonist) for postural hypotension. Both SE: hypertension
State 2 reasons why diabetic patient tend to get foot infection or injury.
- Ischaemia - reduced blood flow to foot –> lower immune system (check foot pulses)
- Neuropathy - loss of sensation of foot –> increased mechanical stress and repeated joint injury –> pes cavus, charcot joint
