Diabetes in Primary Care Flashcards
how many people with type 2 diabetes are undiagnosed?
around 1 million
when does retinopathy occur in diabetes?
3-5 years consistent hyperglycaemia in diabetic range
already present in 19% of people at diagnosis
how is diabetes screened for?
2 stage strategy
risk assessment questionnaire gives risk
then fasting blood glucose
who should be recalled annually for a fasting venous/plasma glucose measurement?
impaired glucose tolerance
impaired fasting glycaemia
past history of gestational diabetes
who should be recalled opportunistically for fasting glucose measurement?
non-Caucasian
family history of type 2
obese
women with polycystic ovary syndrome
who would you consider a diagnosis of diabetes in?
thirst and polyuria unexplained weight loss or tiredness pruritic vulvae or balanitis or recurrent UTIs recurrent infections blurred vision discoloured or ulcerated feet acutely unwell - vomiting/abdo pain
how is diabetes diagnosed if classical symptoms are present?
random plasma glucose > 11.1
fasting plasma glucose > 7
venous plasma glucose (2 hr OGTT) > 11.1
how is diabetes diagnosed if asymptomatic?
not based on single venous plasma glucose measurement
need additional tests on another day
how is diabetes managed if ketonuria is present?
if present with
- severe symptoms - vomiting, dehydration then urgent hospitalisation required
- milder symptoms = discuss urgently with diabetes team
general algorithm for DM diagnosis?
random plasma glucose over 6.1 > symptoms of hyperglycaemia
- if present > single plasma glucose measurement (random or fasting)
- if no > 2 separate plasma glucose measurements at least 4 weeks apart (fasting >7 on both tests or fasting >7 and random >11.1)
when is the oral glucose tolerance test used?
if fasting glucose is 6.1 - 6.9
when is referral to secondary care required for diabetes?
new definite type 1 diabetes patient with low or low normal BMI all children if pregnant or planning pregnancy pre-existing renal disease consider if type 2 in under 40s if there's a specific concern
describe the initial management of type 2 diabetes?
register with SCI-DC retinopathy screening give support and information refer for education check baseline measures (BMI, BP, urine etc) identify/address risk factors manage cardio risk manage glycaemic control foot screening and risk assessment
lifestyle advice for new type 2 diagnosis?
weight loss healthy eating smoking cessation exercise alcohol consumption lipids and BP management
recommendations for food and fluids in acutely unwell type 1 diabetics?
100-200 ml (1 glass every hr)
regular carb intake regardless of blood glucose (means you can give insulin which treats the ketosis)
- take in the form of high sugar/nutrient drinks
when do you monitor blood glucose and ketones in an acutely unwell patient?
blood glucose = every 4 hrs
ketones = check regardless on blood glucose in acutely unwell/vomiting and pregnant patients
at what ketone level must action be taken and what is done?
above 0.6 mmol/L
increase insulin dose by 10% if elevated BG or dose of rapid acting insulin
recheck BG and ketones in 1-2 hrs
how is insulin delivery modified in illness?
NEVER OMIT INSULIN
often more is required if BG is high or to correct ketosis
extra insulin can be given 2-4 hourly to address elevated BG in addition to routine insulin
how is ketosis managed if BG is low or normal?
IV fluid and insulin and patient should be admitted to hospital
how do you calculate correct dosage of extra rapid acting insulin?
increase usual dose by 10% if recent BG trend = >10
use short acting isulin for STAT dose
calculate STAT dose as 10-20% of the patients daily dose of insulin
when should a diabetic be admitted to hospital?
inability to swallow or keep fluids down persistant vomiting persistent diarrhoea ketonuria/ketonaemia with or without hyperglycaemia when ketoacidosis is clinically abvious
how would you advice a type 2 diabetic who has been unwell with vomiting and diarrhoea during previous day/night?
oral diabetes tablets should be continued apart from metformin if there is severe infection or dehydration
increase oral fluids and take carbs if possible and maintain insulin delivery
