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Endocrine > Diabetes in Primary Care > Flashcards

Diabetes in Primary Care Flashcards

1
Q

How common is undiagnosed diabetes?

A

Estimated almost 1 million people with type 2 diabetes don’t know they have it = about 17%

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2
Q

How useful is retinopathy as a screening tool?

A

Not very = only 19.3% have retinopathy at diagnosis and it only develops after at least 3-5 years of consistent hyperglycaemia in the diabetic range

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3
Q

How is the population screened for diabetes?

A

Systematic population screening isn’t cost effective but = targeted screening of high risk patients is used

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4
Q

What should GPs and other community practitioners implement?

A

A two stage strategy to identify patients at high risk of type 2 diabetes and those with undiagnosed type 2 diabetes

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5
Q

How should risk assessment be carried out?

A

Using validated self-assessment or validated web-based tools then fasting blood glucose if indicated

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6
Q

What patient groups should be recalled annually for a fasting plasma glucose measurement?

A

Patients with impaired glucose tolerance or fasting glycaemia, patients with a past history of gestational diabetes

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7
Q

What patients groups should be screened opportunistically, preferably using fasting plasma glucose measurement?

A

Non-Caucasians, patients with a family history of type 2 diabetes, obese (especially centripedal) patients, women with polycystic ovarian syndrome

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8
Q

What symptoms would make you consider a diagnosis of diabetes?

A

Thirst and polyuria, unexplained weight loss or tiredness, pruritic vulvae, balanitis or recurrent UTIs, recurrent infections, burring of vision, discoloured/ulcerated feet, acutely unwell

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9
Q

What else is needed alongside classical symptoms to diagnose diabetes?

A

Random blood glucose >= 11.1mmol/L or
Fasting blood glucose >= 7.0 mmol/L or
2hr blood glucose after OGTT >= 11.1mmol/L

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10
Q

What is needed to diagnose a patient with no symptoms with diabetes?

A

Diagnosis shouldn’t be based of single blood glucose,

additional testing on another day with a value in the diabetic range is essential

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11
Q

When should a 2hr blood glucose after OGTT sample be used to make a diagnosis of diabetes?

A

If the fasting or random blood glucose levels are not diagnostic

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12
Q

How should a patient with ketonuria and severe symptoms be managed?

A

Urgent hospital admission

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13
Q

How should a patient with ketonuria with milder symptoms and weight loss be managed?

A

Discuss patient urgently with diabetic team

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14
Q

When should an oral glucose tolerance test (OGTT) be done?

A

If the fasting glucose is 6.1-6.9mmol/L

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15
Q

How is a OGTT performed?

A

Initial fasting glucose is measured, 75g anhydrous glucose or equivalent is administered, repeat plasma glucose measurement after 2hrs

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16
Q

What must a patient do before undergoing an OGTT?

A

They must have had no food or drink for 8-12hrs beforehand

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17
Q

How are patients with definite or likely type 1 diabetes referred to the specialist consultation service?

A

Via urgent telephone referral

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18
Q

When should referral to specialist consultation service be considered?

A

Patient with low or low-normal BMI
All children
Patients who are pregnant/considering pregnancy
Pre-existing chronic renal impairment
If patient <40 at diagnosis of type 2 diabetes
Whenever there is a specific clinical concern

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19
Q

How are most patients with type 2 diabetes followed up?

A

Mostly by GP in practice = often nurse led clinics, GP clinical lead for diabetes is present in most practices

20
Q

Who must new diabetics be registered with?

A

The SCI-DC

21
Q

How quickly should retinopathy screening begin after a patient is diagnosed?

A

Automatic appointment is made within three months for retinal photography after registering with SCI-DC

22
Q

What education services can patients be referred to?

A

TDEP sessions

23
Q

What baseline measures should be taken in all newly diagnosed diabetics?

A

BMI, BP, urinalysis (for protein etc), bloods, lipids

24
Q

What is involved in the initial management of a new diabetic?

A

Provide initial support and info about type 2 diabetes
Identify and address other risk factors
Management of CV risk and glycaemic control
Foot screening and risk assessment

25
Q

How long should lifestyle measures be trialled for?

A

3 months

26
Q

What are some lifestyle changes that can be made?

A

Weight loss TAWMS if BMI > 30

Healthy eating, exercise, alcohol consumption (reduce), smoking cessation, lipids and BP management

27
Q

What are some barriers to lifestyle changes?

A

Locus of control/self-efficacy, shame, stigma, lack of knowledge, depression, lack of resources, cost

28
Q

Is depression a big issue for diabetics?

A

Yes = depression is more common in diabetics than the general population

29
Q

What are the glycaemic targets for a healthy individual?

A

HbA1c < 58m/m
BP < 140/80mmHg
Statin indicated

30
Q

What are the glycaemic targets for a patient with intermediate health?

A

HbA1c < 64m/m
BP < 140/80mmHg
Statins indicated

31
Q

What are the glycaemic targets for a patient with poor health?

A

HbA1c < 69m/m

BP < 140/90mmHg

32
Q

Should insulin be stopped in diabetic ketoacidosis?

A

NEVER stop insulin in suspected DKA = check ketones

33
Q

How often should fluids be given in an acutely unwell type 1 diabetic?

A

100-200ml every hour

34
Q

Why are carbohydrates given to acutely unwell type 1 diabetics regardless of blood glucose levels?

A

To facilitate insulin administration

If unable to take solids then take 200ml of liquid carbohydrates

35
Q

What are some liquid forms of carbohydrates that can be given to an acutely unwell type 2 diabetic?

A

Pure fruit juice, Ribena, milk, flat coca cola, sugary lemonade

36
Q

How should blood glucose and ketones be monitored in an acutely unwell type 1 diabetic?

A

Blood glucose monitoring every 4 hours

Check ketones in acutely unwell patient or during pregnancy

37
Q

What should be done for type 1 diabetic with blood ketone level > 0.6mmol/L?

A

Consider extra insulin by increasing routine insulin dose by 10% if blood glucose levels are elevated

38
Q

How does insulin requirement change during illness in a type 1 diabetic?

A

More insulin is often required = check blood glucose and ketones within 2hrs

39
Q

What should the STAT dose of insulin be in an acutely unwell type 1 diabetic?

A

10-20% of patients daily insulin dose

40
Q

When should type 1 diabetic patients be admitted to hospital when unwell?

A

Dysphagia, inability to keep fluids down, persistent vomiting or diarrhoea, strongly positive ketonuria/ketonaemia, when DKA is clinically obvious

41
Q

What are the diabetic sick day rules?

A

Found on sick day cards = cards tell patients to stop taking medication with a tick next to it until they are well again

42
Q

What normally happens to the blood glucose levels in an unwell type 2 diabetic?

A

Usually rises = short term hyperglycaemia can be tolerated

43
Q

When can unwell type 2 diabetics be manged at home?

A

If no evidence of severe dehydration and the patient is able to increase oral fluids appropriately

44
Q

How does illness change how a type 2 diabetic takes their medication?

A

Oral medication should be continued in most cases

Metformin should be temporarily stopped if there is severe infection or dehydration

45
Q

When should unwell type 2 diabetics be admitted to hospital?

A

Severe dehydration, intractable vomiting

Endocrine (42 decks)

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