Diabetes Flashcards
Is the HbA1c target set in stone?
No can individualise
What is HbA1c?
Average BM for last 2-3mths. glycated Hb
An HbA1c of what number = diabetes diagnosis?
48
What should HbA1c target be if controlled by lifestyle or a single agent?
48 (if not achieved indicates need further Rx)
Or 53 if the drug has a hypo risk
If HbA1c exceeds 58 what should you do?
Use dual therapy
What should HbA1c target be on dual therapy?
53
What should you do if HbA1c exceeds 58 on treatment?
Intensify therapy e.g. triple therapy or injectable
How often should you test HbA1c?
3-6monthly, then 6 monthly when stable
If the first drug you prescribe has a risk of hypo, should your HbA1c target change? If so, what should it be?
Yes should be 53 (if no hypo risk is 48)
If they are on triple therapy, what should HbA1c target be?
53
Or personal target
Or if they are elderly or frail, relax the target but max 70
What does individualised HbA1c target and care depend on?
HbA1c + HbA1c target
eGFR (drugs excreted renally)
BMI (some = wt change)
Age
Occupation (e.g. would a hypo be v bad?)
How do type 1 and type 2 presentations differ?
Type 1 is sudden onset, wt loss, ketones in urine dip
Type 2 gradual onset, wt gain and no ketones
What does microalbuminurea mean in diabetes?
Increased risk of renal and cardiac disease- consider ACEi/ARB
How can achieving the recommended physical activity levels help HbA1c?
Can reduce it by 10!
Name the 6 categories if pre-insulin drugs
Metformin
Sulfonylureas (gliclazide etc)
Gliptin (DPP-4 inhib)
Glitazones
GLP-1 agonist
SGLT2 inibitors (-flozin)
What is the action of metformin
Limits glucose release from liver and decreases insulin resistance
Does metformin work immediately?
No takes a while (month)
Does metformin have a risk of hypo?
Low risk
Does metformin cause weight gain?
No
What are the cautions/SEs metformin?
Caution in low eGFR
Risk lactic acidosis in dehydrated
GI SEs
Action of sulfonylureas?
Spank the panc to increase insulin prod
risk in sulfonylureas?
Hypo and wt gain
Name two sulfonylureas
Gliclazide
Glimepiride
Do sulfonylureas work quickly?
Yes
Action of gliptins?
Inhibit DPP-4 which means GLP-1 is not broken down
GLP-1 increases insulin production and decreases glucose
How are gliptins taken?
Once daily oral
Do gliptins have a hypo risk?
Low risk
Do gliptins effect weight?
No
What is the problem with gliptins
Often stop working
Can gliptins be prescribed in kidney disease?
Yes
SEs gliptins?
Headache, URTI, sinus infection
What do glitazones do?
Decrease insulin resistance
Do glitazones work straight away?
Take up to 12 weeks so no
SEs glitazones?
Weight gain
Fluid retention
Fracture risk
Should glitazones be prescribed in HF?
No as fluid retention SE
Liraglutide is an example of what sort of drug?
GLP-1 agonist
What do GLP-1 agonists do?
Mimic GLP-1 to stimulate pancreatic insulin production and decrease glucagon production.
Do GLP-1 agonists effect weight?
Yes wt loss as slows stomach emptying
How are GLP-1 agonists taken?
Injection
Do GLP-1 agonists have a hypo risk?
No
GLP-1 agonists SEs
N&V
What is a requirement in the patient for prescribing GLP-1 agonists?
> 35 in caucasian patients as very expensive
What is the action if flozins/SGLT2 inhibs?
Prevent glucose reabsorption in kidneys- ‘wee out sugar’
flozins/SGLT2 inhibs SEs?
Increased frequency, UTI, thrush (this may have implications for occupation)
Do SGLT2 inhibitors have a hypo risk?
No
Which diabetes drugs have a hypo risk
Sulfonylureas
glinides
Pioglitazones only if in combination with others
Which diabetes drugs risk weight gain?
Sulfonylureas
Pioglitazones
What proportion of diabetics will have an MI or stroke?
75%
What is a good drug option for a patient who is a lorry driver so doesn’t want GI side effects, can’t risk a hypo and doesn’t want to need a wee all the time. They are caucasian with a BMI of 33
Pioglitazone
or
Gliptins
What is more important in reducing MI/stroke- cholesterol, BP or HbA1c?
BP lowest number needed to treat
How can you advise a patient that they can prevent complications of diabetes?
Diet, exercise
Stop smoking and drinking
Control BM well
Attend annual review
What is done at the annual review?
BMI
Waist circumference
Mood screen
Smoking status
Neuropathy (erectile, neuropathic pain, autonomic neuropathy (bladder and bowel), gastroparesis)
What else needs to be done annually?
Retinoapthy screen
foot check
Nephropathy - early morning urine A:CR and serum creatinine eGFR
Cardio risk factors assessed
What are the cardiac risk factors that should be assessed in diabetics?
Age
Albuminaemia
Smoking
BP
Lipid profile
FHx
Waist circumference
What needs to be checked 6 monthly?
HbA1c
How should you manage a diabetic person presenting with a foot ulcer?
Fluclox, see again in 48hrs and refer to community diabetic nurse.
what are glinide’s mode of action similar to?
Sulfonlyureas
Do glinides have a hypo risk?
Yes
How are glinides taken?
Before meals (up to TDS) to reduce post-prandial glucose spike.
Who are glinides good for?
If have unpredictable meal times.
SE glinides?
GI
What is metformin’s drug class?
Biguanide
