DIABETES MELLITUS Flashcards
Fasting glucose profile for diabetes diagnosis
Normal: < 5.6mmol/l
Impaired fasting glucose : 5.6-6.9
Diabetes: >7
2 hour post prandial glucose profile for diabetes diagnosis
Normal: <7.8
Impaired glucose tolerance: 7.8-11.1
Diabetes: >11.1
HbA1c profile for diagnosis of diabetes
Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%
HbA1c profile for diagnosis of diabetes
Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%
Types of diabetes
Type 1
Type 2
Gestational
Secondary diabetes
Causes of type 1 diabetes
Autoimmune disorder
Idiopathic
Causes of type 1 diabetes
Environmental factors
Genetic factors causing defect in insulin action or secretion
Causes of secondary diabetes
Medication: corticosteroids
Pancreatic disease
Endocrine disorders: cushing’s syndrome, acromegaly
Symptoms of diabetes mellitus
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
Signs of diabetes
Lack of sensation in feet or hands
Foot gangrene
Pedal edema
Impaired visual acuity
Cataract
Retinal changes on fundoscopy
Investigations in newly diagnosed diabetes
Fasting glucose
Oral glucose tolerance test
Glycated hemoglobin
BUE/Cr
Fasting lipid profile
FBC
ECG in adults
Urinalysis
Urine ketones
When is urine ketones necessary in diabetes
Presenting with high initial blood glucose
Investigations during routine follow ups in diabetes
Blood glucose
HbA1c
Blood lipids
BUE/Cr
Urine microalbumin
How frequent should lipid profile be monitored in diabetes
Annually but more frequent if levels are abnormal or on lipid lowering drugs
How frequent should glycated hemoglobin be monitored in diabetes
At least twice a year
How frequent should BUE/Cr be monitored in diabetes
Annually but more frequently if levels are abnormal
How frequent should urine microalbumin be monitored in diabetes
Annually
Goals of therapy in management of diabetes
- Provide relief from symptoms
- Prevent treatment related hygoplycaemia
- Prevent acute hyperglycemic complications
- To reduce blood glucose to glycemic targets
- To prevent chronic complications
- To reduce weight in overweight and obese individuals
Blood pressure target in diabetes
<130/80
LDL cholesterol target in diabetes
<2.5mmol/L
Fasting blood glucose targets in diabetes according to STG
4-7mmol/l, less intensive targets in elderly patients
2-hour post-meal blood glucose target in diabetes according to STG
5-9mmol/l, less intensive targets in the ellderly
Glycated hemoglobin target in diabetes according to STG
7%, less intensive targets in the elderly
Dietary modifications in diabetes
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
According to STG, what is the recommended percentage of carbohydrate, fat and proteins in the diet of a diabetic
Carbohydrate- 60%
Proteins- 15%
Fat- 20%`
Recommendations on alcohol consumptions in diabetes
Avoid alcohol in children under 18
Low alcohol consumption is permissible in adults
Moderate to heavy alcohol consumption is not advised
Effects of moderate to heavy alcohol consumption in adults
Increases total caloric intake
Worsens weight and obesity
Increases risk of hypoglycemia
Recommended exercise regimen for diabetes according to STG
30 minutes brisk walking at least 3 days a week in ambulant patients
Consider patient’s age,complications and comorbidities
Daily insulin requirement for most adults and pre-pubertal children
0.6 to 0.8U/kg
These factors increase insulin requirements
Infections
Puberty
Stress
Accidental trauma
Surgery
Pregnancy
When should soluble insulin, NPH insulin and premix insulin be given
30 minutes before meals
Which type of insulin is given immediately before meals
Rapid acting insulins
The two regimens for insulin in diabetes and which one is preferred
- Twice daily pre-mixed insulin (soluble + intermediate acting insulin) before
breakfast and supper (preferred) - Twice daily injections of Soluble PLUS NPH 30 minutes before breakfast and
Soluble PLUS NPH 30 minutes before supper
Twice daily premix insulin regimen
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)
Twice daily injections of soluble plus NPH regimen
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)
Dose of glibenclamide
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
Dose of gliclazide
Gliclazide, oral,
Adults
40-160 mg 12 hourly
Dual therapy add-on for patients with uncontrolled diabetes after 3 months of metformin
Glibenclamide
or
Gliclazide
or
Glimepiride
or
Tolbutamide
First line treatment of type 2 diabetes
Metformin, oral,
Adults
500 mg-1 g daily
Then
Increase every 3 months to a maximum of 1 g 12 hourly if necessary
3rd agent add on oral agents for uncontrolled diabetes on dual therapy of metformin and SUR
Saxagliptin
or
Sitagliptin
or
Vildagliptin
or Pioglitazone
Treatment for Type 2 diabetes patients on oral medications; not achieving glycaemic targets with Triple Therapy
Add Insulin therapy to triple therapy
Dose for glimepiride
Adults
2-6 mg daily (as a single dose in the morning)
When should eye examinations be done in diabetes
After 5 years of diagnosis for both type 1 and type 2 diabtes
Dose for tolbutamide
Adults
250-1000 mg 8-12 hourly
In which patients is tolbutamide preferred
Impaired renal function
Elderly
Dose for saxagliptin
Adults
2.5-5 mg daily
Dose for sitagliptin
Adults
50-100 mg daily
Dose for vildagliptin
Adults
25-50 mg 12-24 hourly
Dose for pioglitazone
Adults
15-45 mg daily
Dose for insulin addon to triple therapy of oral medications in type 2 diabetes
Adults
2-20 units before bedtime
