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STG 2017 > DIABETES MELLITUS > Flashcards

DIABETES MELLITUS Flashcards

1
Q

Fasting glucose profile for diabetes diagnosis

A

Normal: < 5.6mmol/l
Impaired fasting glucose : 5.6-6.9
Diabetes: >7

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2
Q

2 hour post prandial glucose profile for diabetes diagnosis

A

Normal: <7.8
Impaired glucose tolerance: 7.8-11.1
Diabetes: >11.1

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3
Q

HbA1c profile for diagnosis of diabetes

A

Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%

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4
Q

HbA1c profile for diagnosis of diabetes

A

Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%

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5
Q

Types of diabetes

A

Type 1
Type 2
Gestational
Secondary diabetes

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6
Q

Causes of type 1 diabetes

A

Autoimmune disorder
Idiopathic

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7
Q

Causes of type 1 diabetes

A

Environmental factors
Genetic factors causing defect in insulin action or secretion

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8
Q

Causes of secondary diabetes

A

Medication: corticosteroids
Pancreatic disease
Endocrine disorders: cushing’s syndrome, acromegaly

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9
Q

Symptoms of diabetes mellitus

A

Polyuria
Nocturia
Polydipsia
Unexplained weight loss
Blurred vision
Recurrent boils
Recurrent pruritis vulvae
Erectile dysfunction
Symptoms related to chronic complications
Delivery of large babies >4kg

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10
Q

Signs of diabetes

A

Lack of sensation in feet or hands
Foot gangrene
Pedal edema
Impaired visual acuity
Cataract
Retinal changes on fundoscopy

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11
Q

Investigations in newly diagnosed diabetes

A

Fasting glucose
Oral glucose tolerance test
Glycated hemoglobin
BUE/Cr
Fasting lipid profile
FBC
ECG in adults
Urinalysis
Urine ketones

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12
Q

When is urine ketones necessary in diabetes

A

Presenting with high initial blood glucose

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13
Q

Investigations during routine follow ups in diabetes

A

Blood glucose
HbA1c
Blood lipids
BUE/Cr
Urine microalbumin

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14
Q

How frequent should lipid profile be monitored in diabetes

A

Annually but more frequent if levels are abnormal or on lipid lowering drugs

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15
Q

How frequent should glycated hemoglobin be monitored in diabetes

A

At least twice a year

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16
Q

How frequent should BUE/Cr be monitored in diabetes

A

Annually but more frequently if levels are abnormal

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17
Q

How frequent should urine microalbumin be monitored in diabetes

A

Annually

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18
Q

Goals of therapy in management of diabetes

A
  1. Provide relief from symptoms
  2. Prevent treatment related hygoplycaemia
  3. Prevent acute hyperglycemic complications
  4. To reduce blood glucose to glycemic targets
  5. To prevent chronic complications
  6. To reduce weight in overweight and obese individuals
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19
Q

Blood pressure target in diabetes

A

<130/80

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20
Q

LDL cholesterol target in diabetes

A

<2.5mmol/L

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21
Q

Fasting blood glucose targets in diabetes according to STG

A

4-7mmol/l, less intensive targets in elderly patients

22
Q

2-hour post-meal blood glucose target in diabetes according to STG

A

5-9mmol/l, less intensive targets in the ellderly

23
Q

Glycated hemoglobin target in diabetes according to STG

A

7%, less intensive targets in the elderly

24
Q

Dietary modifications in diabetes

A

Complex carbohydrates preferred
Avoid refined sugars
Artificial sweeteners and diet soft drinks may be used
Reduce total caloric content of food
Increase amount of fibre
Consume 400g or more of fruits and vegetables per day
Reduce salt intake to <5g/day

25
Q

According to STG, what is the recommended percentage of carbohydrate, fat and proteins in the diet of a diabetic

A

Carbohydrate- 60%
Proteins- 15%
Fat- 20%`

26
Q

Recommendations on alcohol consumptions in diabetes

A

Avoid alcohol in children under 18
Low alcohol consumption is permissible in adults
Moderate to heavy alcohol consumption is not advised

27
Q

Effects of moderate to heavy alcohol consumption in adults

A

Increases total caloric intake
Worsens weight and obesity
Increases risk of hypoglycemia

28
Q

Recommended exercise regimen for diabetes according to STG

A

30 minutes brisk walking at least 3 days a week in ambulant patients
Consider patient’s age,complications and comorbidities

29
Q

Daily insulin requirement for most adults and pre-pubertal children

A

0.6 to 0.8U/kg

30
Q

These factors increase insulin requirements

A

Infections
Puberty
Stress
Accidental trauma
Surgery
Pregnancy

31
Q

When should soluble insulin, NPH insulin and premix insulin be given

A

30 minutes before meals

32
Q

Which type of insulin is given immediately before meals

A

Rapid acting insulins

33
Q

The two regimens for insulin in diabetes and which one is preferred

A
  1. Twice daily pre-mixed insulin (soluble + intermediate acting insulin) before
    breakfast and supper (preferred)
  2. Twice daily injections of Soluble PLUS NPH 30 minutes before breakfast and
    Soluble PLUS NPH 30 minutes before supper
34
Q
A
35
Q

Twice daily premix insulin regimen

A

Insulin Premix, SC, (30% soluble insulin and 70% NPH insulin),
⅔ of total daily insulin requirement 30 minutes before breakfast
And
⅓ of total daily insulin requirement 30 minutes before evening meal
(supper)

36
Q

Twice daily injections of soluble plus NPH regimen

A

Soluble insulin, SC,
⅓ of total daily insulin requirement in 2 divided doses 30 minutes
before breakfast and supper
And
Insulin NPH, SC,
⅔ of total daily insulin requirement (⅔ of which would be given 30
minutes before breakfast and ⅓ 30 minutes before supper)

36
Q

Dose of glibenclamide

A

Adults
2.5-10 mg daily
(If required, not more than 5 mg of Glibenclamide could additionally
be given in the evening maximum total dose 15 mg

37
Q

Dose of gliclazide

A

Gliclazide, oral,
Adults
40-160 mg 12 hourly

38
Q

Dual therapy add-on for patients with uncontrolled diabetes after 3 months of metformin

A

Glibenclamide
or
Gliclazide
or
Glimepiride
or
Tolbutamide

38
Q

First line treatment of type 2 diabetes

A

Metformin, oral,
Adults
500 mg-1 g daily
Then
Increase every 3 months to a maximum of 1 g 12 hourly if necessary

39
Q

3rd agent add on oral agents for uncontrolled diabetes on dual therapy of metformin and SUR

A

Saxagliptin
or
Sitagliptin
or
Vildagliptin
or Pioglitazone

40
Q

Treatment for Type 2 diabetes patients on oral medications; not achieving glycaemic targets with Triple Therapy

A

Add Insulin therapy to triple therapy

41
Q

Dose for glimepiride

A

Adults
2-6 mg daily (as a single dose in the morning)

41
Q

When should eye examinations be done in diabetes

A

After 5 years of diagnosis for both type 1 and type 2 diabtes

42
Q

Dose for tolbutamide

A

Adults
250-1000 mg 8-12 hourly

43
Q

In which patients is tolbutamide preferred

A

Impaired renal function
Elderly

44
Q

Dose for saxagliptin

A

Adults
2.5-5 mg daily

45
Q

Dose for sitagliptin

A

Adults
50-100 mg daily

46
Q

Dose for vildagliptin

A

Adults
25-50 mg 12-24 hourly

47
Q

Dose for pioglitazone

A

Adults
15-45 mg daily

48
Q

Dose for insulin addon to triple therapy of oral medications in type 2 diabetes

A

Adults
2-20 units before bedtime

STG 2017 (88 decks)

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