diabetes therapeutics Flashcards
I what is gestational diabetes mellitus ?
glucose intolerance of variable degree with onset or first recognition during pregnancy
what is the screening test for GDM ?
100g , 3 hour oral glucose tolerance test for patients with an abnormal GCT test
what are the laboratory studies done in the first trimester?
HbA1c blood urea nitrogen serum creatinine TSH free T3/4 spot urine to creatinine ratio capillary blood sugar level
what are the second trimester laboratory studies ?
spot urine to creatinine ratio in women with elevated value in the first trimester
repeat HbA1c
capillary blood sugar glucose
what is the management in GDM ?
- ultrasonography :
first trimester - assessment for pregnancy dating and viability
second trimester - detailed anatomic ultrasonogram at 18-20 weeks and a fetal echo
third trimester - growth ultrasound to asses fetal size - diet :
goal is to avoid single large meals and avoid simple carbohydrates - Insulin
goal is to reach glucose profile similar to pregnant no diabetic women, only indicated if diet therapy fails
what management plan should be taken with a T2DM patient that has suffered from a STEMI ?
if the patient is on metformin then metformin should be stopped ( due to use of IV contrast) ideally 48 hours before the procedure and 6 months post operatively
what other diabetes medication should the STEMI patient be started on ?
SGLT-2 inhibitors
GLP-1 analogues
what information is required to give a pre-operative assessment report as regards of diabetes ?
her fasting blood glucose HBA1c CBC Urea and creatinine history of diabetes complications
a diabetic patient that is staying in the hospital ?
switched to basal bolus insulin or premixed insulin
what should the HbA1c levels ideally be pre-operativley ?
below 8.5%
what are the risks of a diabetes patient during fasting?
hypoglycaemia
hyperglycaemia
diabetic ketoacidosis
dehydration and thrombosis
what medications are at higher risk of hypoglycaemia ?
insulin
sulfonyl urea
sulfonylurea
what type of medication is lisinopril ?
ACE inhibitor
what is the management plan of a diabetic patient that wants too fast ?
blood glucose should be monitored more frequently
if insulin or sulfonylurea are taken they need to be changed or have the dosage decreased
in terms of diet foods with low glycemic index should be consumed , avoid dehydration
incase of both hyperglycaemia and hypoglycaemia break the fast
what week is screening for GDM done ?
24 - 28 weeks
