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Primary care > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Threshold values for diabetes diagnosis

A

Fasting blood glucose >7 mmol/L

Random/post-load glucose >11.1 mmol/L

HbA1c >48mmol/mol (6.5%)

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2
Q

How many measurements of HbA1c are needed to diagnose diabetes?

A

Symptomatic -> 1 hyperglycaemic measurement

Asymptomatic –> 2 hyperglycaemic measurements 2-3 months apart

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3
Q

When can HbA1c not be used for diagnosis of diabetes?

A

Pregnant/post-partum

Acute illness

Recent onset (<3mo) diabetes

Type 1 diabetes

Renal failure

HIV

Pancreatic disease/surgery

Antipsychotics or steroids <2mo

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4
Q

HbA1c targets in T2DM

A

First-line: <48mmol/mol (6.5%)

Second-line and beyond: <53 mmol/mol (7.5%)

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5
Q

Microvascular complications of diabetes

A

Retinopathy, glaucoma, cataracts - annual screening

Nephropathy - blood pressure, fluid retention, microalbuminuria

Neuropathy - sensory and autonomic

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6
Q

Symptoms of diabetes

A

Tiredness

Blurred vision (intermittent)

Polydipsia, polyuria

Autonomic neuropathy symptoms

Infections (Esp UTIs)

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7
Q

Features of autonomic neuropathy in diabetes

A

Gastroparesis

Diarrhoea/constipation

ED

Postural hypotension

Bladder dysfunction

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8
Q

Macrovascular complications of diabetes

A

Infections (immunosuppression)

PVD - ulcers/poor healing

IHD

CVA

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9
Q

Management of macrovascular complications of T2DM

A

BP control and lipid regulation

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10
Q

Frequency of HbA1c monitoring in T2DM

A

3-6 monthly until stable

6-monthly when stable

Annual retinal, renal, BP, lipid screening

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11
Q

Antihypertensive treatments in T2DM

A

ACE-I as first-line

Don’t switch on diagnosis unless evidence of poor control

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12
Q

Normal lipid profile

A

Total cholesterol <5

HDL >1

LDL <3

Triglycerides <2.3

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13
Q

Indications for statins in diabetes

A

>40yo

QRISK >10.0%

20mg atorvastatin

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14
Q

Indications for increasing statin dose in diabetes

A

total cholesterol >4

LDL >2

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15
Q

Screening for diabetics

A

Annually:

Retinal/cataract screen

Foot care

Nephropathy: early am alb:creatinine ratio

CVD: BP and lipids

Erectile dysfunction

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16
Q

Dietary adice for diabetes

A

Encourage low-glycaemic-index foods (complex carbs)

Reduce energy intake - 5-10% weight loss target

Increase fruit and veg, wholegrains, fish (Mediterranean)

Reduce fat

Reduce salt (BP control)

17
Q

Lifestyle advice for diabetes

A

Smoking

Alcohol

Weight loss

Exercise

18
Q

DVLA criteria for group 1 license, non-insulin

A

No need to notify if:

<=1 severe hypo in past 12mo AND >=3mo since last episode

Under regular review

19
Q

DVLA criteria for group 1 license, insulin-treatment

A

Must notify DVLA

<=1 severe hypo in past 12mo and >=3mo since last episode

Adequate awareness of hypoglycaemia (warning signs)

20
Q

DVLA criteria for group 2 license, insulin-treated

A

Must notify DVLA

No severe hypos in past 12 months

Regular glucose monitring with reader with >=3mo memory

Full awareness of hypoglycaemia

21
Q

DVLA criteria for group 2 license, non-insulin therapy

A

Must notify

No severe hypos in past 12months

Regular monitoring (eery 2 hours while driving)

Full awareness of hypoglycaemia

22
Q

Options for drug management of T2DM

A

Metformin (biguanide)

Sulphonylureas (Gliclazide)

DPP-4 inhibitors (gliPtins)

GLP-1 mimetics (e.g. exenatide)

Pioglitazone

SGLT-2 inhibitors (Gliflozins)

23
Q

Metformin doses

A

500mg - 2.4 g/day over 2-3 doses

24
Q

Contra-indications for metformin

A

Increased risk of lactic acidosis:

Impaired renal f(x) - check eGFR

CCF

Liver disease

Chronic alcoholism

Acute illness (e.g. sepsis, shock)

25
Q

Contraindications to glitazones

A

PMHx/risk of bladder cancer (incl. uninvestigated frank haematuria)

Fracutres

Heart failure or risk of

26
Q

When to consider insulin treatment

A

Third-line (when considering triple drug therapy)

27
Q

Criteria for use of GLP-1 mimetic

A

Tolerance to self-injecting

BMI >35 and weight-related co-morbidity

BMI <35 AND insulin has occupational implications or weight loss would improve physical/psychological wellbeing

28
Q

Risk factors for T2DM

A

Age >65

Obesity

FHx of T2DM

South Asian/Afro-Caribbean

Gestational diabetes or baby >4kg

29
Q

Pre-diabetes diagnostic criteria

A

fbg >6.1

HbA1c 42-47 mmol/mol

Follow up annually with aggressive treatment of CVD risk factors

30
Q

Diabetes therapy in renal failure

A

Linagliptin (DPP-4 inhibitor) - excreted via gall bladder

31
Q

Main SE of metformin

A

GI upset (diarrhoea)

32
Q

Main SEs for sulphonyureas (e.g. gliclazide)

A

Weight gain

High risk of hypos (take before meals)

Not in renal impairment

33
Q

Weight-neutral antihyperglycaemic

A

DPP-4 inhibitors (gliptins)

34
Q

Pioglitazone SEs

A

Safe in renal impairment

Low hypo risk

Weight gain

HF

Bladder cancer

35
Q

GLP-1 mimetic SEs

A

Pancreatitis

Injection needed

High cost

36
Q

Gliptin SEs

A

DPP4 inhibitors

Heart failure

Pancreatitis

37
Q

Weight loss antiglycaemics

A

Metformin

GLP-1 mimetics

gliflozins

Primary care (8 decks)

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