Diabetes: Managment Flashcards
To understand why good glycaemic control is important To be able to describe methods for assessing glycaemic control To be aware of commonly used therapies and their place in the treatment of diabetes To be able to describe common insulin regimes
Diabetes management
How often does a diabetic review occur? [1]
State 6 factors reviewed in a diabetic review [6]
Every person with diabetes should be seen at least twice a year
The Diabetes Annual Review should include:
▪ Review of symptoms
▪ Review clinical issues
▪ Weight / BMI
▪ Glucose levels
▪ Blood pressure
▪ Cholesterol
▪ Creatinine (eGFR) + urine albumin creatinine ratio (ACR)
Diabetes managment
What BP for a diabetic patient would indicate BP treatment? [1]
What BP for a diabetic patient would indicate BP treatment if they have kidney, eye or CV disease ? [1]
BP persistantly over 140 / 90 mmHG
BP persistantly over 130 / 80 mmHG & kidney, eye or CV disease
Diabetic treatment
What drug, dose and administration would you give to DMT2 patients with no CVD, but Qrisk score of greater than 10%? [1]
What drug, dose and administration would you give to DMT2 patients with known CVD? [1]
If not achieving target, which drugs should be prescribed? [2]
Diabetic patients with no CVD, but Qrisk score of greater than 10%:
- Arvostatin, 20mg daily
Diabetic patients with known CVD:
- Arvostatin, 80mg daily
No response:
- Ezetimibe
- PCSK9 inhibitors
Diabetes management
When should you provide statins for DMT1 patients? [2]
Anyone who has has DMT1 for over 10 years
Statins for anyone with complications (eyes / neuro etc)
Diabetes management
Describe the physiological effect for long term diabetic management of having tight glycaemic control [2]
Microvascular complications reduced
Macrovascular complications has no effect
Which conditions are HbA1c may be invalid for when assessing diabetic conditions? [2]
▪ May be invalid in haemoglobinopathy or anaemia (reduced red blood cell survival)
Diabetic management
What substance can be used if HbA1c is invalid to assess glycaemic control? [1]
Fructosamine (Another glycated protein, lasts around 2 weeks)
Diabetic management
How can patients using insulin therapy assess their glycaemic control? [1]
What are pre-prandial and post-prandial glucose level aims? [2]
Self monitoring of blood glucose (SMBG):
Pre-prandial aim: 4-7 mmol/L
Post-prandial aim: 5-9 mmol/L
Name this [1]
Intermittently Scanned Continuous Glucose Monitoring (Freestyle Libre)
▪ Can be used in most people with T1D
▪ Consider in people with T2D if they are on
twice daily or more insulin therapy
▪ AND have recurrent hypos or severe hypos or hypo unawareness
▪ OrLearningdisability/Cognitiveimpairment
Which patient populations are the only group given Continuous Glucose Monitoring? [1]
Suffer from hypoglycaemic unawareness
The NICE guidelines (updated 2022) recommend the following HbA1c treatment targets:
[] mmol/mol for new type 2 diabetics
[] mmol/mol for patients requiring more than one antidiabetic medication
The NICE guidelines (updated 2022) recommend the following HbA1c treatment targets:
48 mmol/mol for new type 2 diabetics
53 mmol/mol for patients requiring more than one antidiabetic medication
Diabetic management
DMT2 Management:
- MoA of Metformin? [3]
Acts by activation of the AMP-activated protein kinase (AMPK)
Increases insulin sensitivity / improving insulin resistance
Decreases hepatic gluconeogenesis
Diabetic management
DMT2 Management:
Advantages [4] and Disadvantages [2] of Metformin?
Advantages:
- Rapid & effective
- No effect on weight
- Insulin sparing
- Useful pregnant population
- Cheap
Disadvantages:
- Can cause lactic acidosis in renal / liver disease patients
- GI effects (nausea, anorexia, diarrhoea), intolerable in 20%.
