Diabetes long Flashcards
When is the OGTT diagnostic of diabetes
- 1 mmol or higher = diabetes
7. 8 - 11 = impaired fasting glucose
Diagnosis of diabetes in asymptomatic people
2x lab tests of 2 different days
Fasting glucose values for diagnosis
6.1-6.9 = impaired fasting glucose
7 mmol or higher = diabetes
What proportion of patients with diabetes have over diabetic nephropathy
20-30%
Definition of microalbuminuria
2.5-25/35 albumin/creatining ratio
What are the biggest RF for diabetic retinopathy
hyperglycaemia and hypertension
How often should you screen for diabetic retinopathy
1-2 years
How to treat diabetic retinopathy
Retinopathy -laser photocoagulation
Biggest benefit is in patients with new vessels on the optic disc or vitreous haemorrhage
What is involved in daily foot care
inspection, washing and careful drying, moisturiser for dry skin, nail care, practical footwear
What can be used for management of symptomatic painful peripheral neuropathy
Amitriptyline, pregabalin
Evidence of ACE/ARBs in diabetes
ACE I have evidence in both T1DM and T2DM
ARB only have evidence in T2DM
What is the HbA1C target in a patient with reduced hypoglycaemia awareness
8.0%
What is the general HbA1C target
7.0%
What is the HbA1C target for patients with major comorbidities
8.0%
What second line oral hypoglycaemia agent for patients with clinical cardiovascular disease
SGLT2 or GLP1
What second line oral hypoglycaemic agent for patients with CKD
SGLT2
What second line oral hypoglycaemia agent for patients with predominant HF
SGLT2
What OHGs are good for weight loss
SGLT2 or GLP1
What OHGs causes weight gain
Sulphonylureas
What glycaemic control should elective surgery be postponed
HbA1C >9.0%
What are BGL aims during the perioperative period
5-10 mmol/l
How to maintain euglycaemia post op
Insulin-glucose infusion
How to manage perioperative diabetes for major surgery in insulin dependent patients
Aim morning list
FFMN
Omit usual morning insulin and AHG
Commence insulin-glucose infusion at induction, and continue for 24 hours or until normal eating resumes
Measure BSL hourly during the intra-operative period
If PM list: modified dose of insulin with early breakfast, admit early for pre operative ward for BGL monitoring, commence insulin-glucose infusion prior to induction of anaesthesia
How to manage insulin treated patients undergoing minor stuergy on a morning operative list
Aim to delay insulin to be with meal after procedure
When should insulin-glucose infusion be commenced for insulin dependent patient undergoing minor surgery
BGL > 10mmol/l
When to start metformin post major surgery
> 24 hours
When should SGLT2 be withdrawn prior surgery
at least 72 hours
