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PM Important > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnostic glucose and HbA1c levels:

A
  • fasting glucose >= 7mmol/L
  • random glucose >=11.1mmol/L
  • HbA1c >= 6.5% (48 mmol/mol)
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2
Q

Impaired fasting glucose:

A

> =6.1 and <7.0mmol/L

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3
Q

Impaired glucose tolerance:

A

<7.0mmol/L and 2 hour value >=7.8mmol/L and <11.1mmol/L

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4
Q

Metformin ADR

A
  • GI upset
  • lactic acidosis
  • not if GFR <30ml/min
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5
Q

DPP-4 inhibitors

A
  • gliptins (e.g. vildagliptin, sitagliptin)
  • increased incretin levels and reduced glucagon
  • oral
  • good for obesity (no weight gain)
  • risk of pancreatitis
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6
Q

SGLT-2 inhibitors

A
  • gliflozins
  • oral
  • ADR: UTI, weight loss
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7
Q

GLP-1 agonists

A
  • tides
  • subcut
  • exanatide subcut injection 60 mins before morning and evening meals
  • liraglutide od
  • can be combined with metformin and sulfonylurea if BMI >=35
  • ADR: weight loss, pancreatitis, nausea and vomiting
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8
Q

Sulfonylureas

A
  • gliclazide, glimepiride
  • oral
  • ADR: hypoglycaemia, weight gain, hyponatraemia
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9
Q

Thiozolidinediones

A
  • oral
  • ADR: weight gain, fluid retention
  • pioglitazone
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10
Q

What can result in a lower than expected HbA1c?

A
  • sickle cell anaemia
  • hereditary spherocytosis
  • GP6D deficiency
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11
Q

What is the algorithm for T1DM meds?

A

see notes

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12
Q

What can result in a higher than expected HbA1c?

A
  • B12/folic acid deficiency
  • iron deficiency anaemia
  • splenectomy
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13
Q

What are the different HbA1c targets? (and how often checked)

A
  • lifestyle (+metformin): 48mmol/mol
  • lifestyle + drug that can cause hypoglycaemia: 53mmol/mol
  • already on one drug but has risen to 58mmol/mol: 53mmol/mol
  • checked every 3-6 months until stable and then every 6 months
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14
Q

What determines statin therapy in diabetes?

A
  • QRISK >10% in 10 years: 20mg atorvastatin

- secondary prevention: 80mg atorvastatin

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15
Q

What are the HbA1c targets for T1DM?

A
  • 48mmol/mol

- checked every 3-6 months

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16
Q

Describe glucose self-monitoring in T1DM:

A
  • 4 times per day
  • before each meal and before bed
  • more frequent during pregnancy, exercise, increased hypo episodes, illness, breast feeding
17
Q

What is diabetic foot disease secondary to? Complications? Most common bacteria?

A
  • neuropathy: loss of sensation, Charcot’s arthropathy, dry skin
  • peripheral arterial disease: intermittent claudication, reduced arterial foot pulses, reduced ABPI
  • complications: gangrene, osteomyelitis, cellulitis, calluses, ulceration, Charcot’s arthropathy
  • pseudomonas aeruginosa
18
Q

DKA symptoms:

A
  • abdominal pain
  • polyuria, polydipsia, dehydration
  • Kussmaul respiration
  • acetone smelling breath
19
Q

Management of DKA:

A
  • fluid replacement priority
  • start with isotonic saline
  • insulin infusion IV 0.1/U/kg/hr
  • when glucose <15mmol/L, 5% dextrose
  • correct hypokalaemia
  • continue long acting insulin, stop short acting
20
Q

Complications of DKA:

A
  • gastric stasis
  • thromboembolism
  • arrhythmias
  • cerebral oedema
  • ARDS
  • AKI
21
Q

Diabetic neuropathy treatment:

A
  • 1st line: amytriptylline, duloxetine, pregabalin, gabapentin
  • pain: tramadol
  • topical capsaicin
  • pain clinic
  • gastroparesis: erythromycin, metoclopramide, domperidone
22
Q

Presentation of HOHS

A
  • don’t necessarily look dehydrated because of hypertonicity
  • lethargy, nausea and vomiting, fatigue
  • neurological: headaches, papilloedema, weakness
  • hyperviscous blood - MI, thromboses
  • hypotension, tachycardia
23
Q

Diagnosis of HOHS

A
  • hypovolaemic
  • hyperglycaemic
  • increased serum osmolarity
24
Q

Treatment of HOHS

A
  • IV 0.9% NaCl solution - gradual glucose and osmolarity decline (vigorous initial replacement)
  • no insulin to begin with - cardiovascular collapse
  • only insulin if significant ketonaemia
  • replace potassium if required
25
Q

What drug decreases hypoglycaemic awareness?

A

beta blockers

26
Q

Side effects insulin?

A
  • lipodystrophy (rotate injection sites to avoid)

- hypoglycaemia

27
Q

Presentation and types of MODY

A
  • development of T2DM <25yo
  • autosomal dominant
  • MODY 3: most common, HNF-1 alpha defect, increased risk HCC
  • MODY 2: glucokinase gene defect
  • MODY5: HNF-1 beta defect, increased liver and renal cysts
  • sensitive to sulfonylureas
  • insulin not usually required
28
Q

What is prediabetes?

A

impaired glucose tolerance and fasting glucose

29
Q

Diabetic nephropathy

A
  • screen annually using urinary albumin:creatinine
  • early morning specimen
  • ACR >2.5 : microalbuminuria
  • manage: dietary protein restriction, BP aim <130/80mmHg, ACEi or ARB, statins

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