Diabetes in Primary Care Flashcards
what should high risk (of getting diabetes) individuals get
annual fasting venous plasma glucose measurement
who is at the highest risk of getting diabetes
impaired glucose tolerance
impaired fasting glycaemia
past history of gestational diabetes
who should get opportunistic fasting glucose measurement
non-caucasian
FHx of T2DM
obese, esp central adiposity
women with POS
when should you consider diabetes
thirst and polyuria
unexplained weight loss or tiredness
pruritus vulvae, balanitis or recurrent UTIs
recurrent infections
blurring of vision (usually an osmotic effect and not permanent)
discoloured or ulcerated feet
Acutely unwell- vomiting/abdominal pain (children)
what are the criteria for diagnosis in a symptomatic patient
- Classical symptoms (e.g. polyuria, polydipsia, unexplained weight loss)plus one of thefollowing:
random plasma venous glucose concentration≥11.1 mmol/L or
fasting venous plasma glucose concentration ≥7.0 mmol/Lor
venous plasma glucose concentration ≥11.1 mmol/L (2 hour sample in OGTT)
when is a oral glucose tolerance test done
when fasting glucose is between 6.1-6.9 mmol/L
what happens if patient is not symptomatic
one elevated venous plasma glucose is not diagnostic - need other testing on another day
when should you consider referal to diabetes specialists
Definite or likely Type 1 diabetes (urgent telephone referral to on-call Paediatric or Adult Diabetes Team)
Patients with low or low normal BMI
All children
Patients who are pregnant or planning a pregnancy
Pre-existing Chronic Renal Impairment.
Seriously consider if patient under age of 40 at diagnosis of Type 2 diabetes (especially if strong family history of diabetes)
Wherever there is a specific clinical concern about an individual patient.
what is the initial management of T2DM
register with SCI-DC retinopathy screening support info refer for education check baseline measures identify other risk factors (smoking, CVD risk) manage CVD risk glycaemic control (3 month trial of diet and lifestyle) foot screening
what are the barriers to change in T2DM
Locus of control /self efficacy Shame Stigma Lack of knowledge Depression Lack of resources Cost
what do you need to monitor in unwell T1DM
never omit insulin as risk of DKA (more insulin often needed in illness)
100-200mls of fluid every hour
regular intake of carbs to facilitate insulin administration
if unable to eat, take carbs as fluids
4 hourly BM
ketone monitoring
when should T1DM be admitted to hospital
Inability to swallow or keep fluids down.
Persistant vomiting.
Persistant diarrhoea.
Strongly positive ketonuria/ketonaemia with or without hyperglycaemia
When ketoacidosis is clinically obvious i.e. dehydration, abdominal pain, intractable vomiting, rapid or laboured respirations.
what happens to blood glucose in stress or illness
usually rises
what is recommended in T2DM intercurrent illness
Can be managed at home if no evidence of severe dehydration and the individual is able to increase oral fluids appropriately
Oral diabetes medication should normally be continued
Metformin should be temporarily stopped if there is severe infection or dehydration. Admission to hospital is advised if the individual is severely dehydrated or intractable vomiting
what medications should T2DM stop on sick days (D and V, fevers, sweats, shaking)
ACE inhibitors ARBs duiretics metformin NSAIDs
