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PRE-REG-Thuri > ENDOCRINE- DIABETES MELITUS > Flashcards

ENDOCRINE- DIABETES MELITUS Flashcards

1
Q

What is diabetes mellitus?

A

Metabolic disorder characterised by hyperglycaemia.

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2
Q

What are two types of DM?

A

TYPE 1

TYPE 2

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3
Q

What is type 1 DM caused by?

A

Deficiency

autoimmune destruction of pancreatic beta- islet cells

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4
Q

What is type 2 diabetes caused by?

A

Unhealthy life style

e.g poor diet, High BP, cholesterol

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5
Q

What is treatment for type 1 diabetes?

A

Insulin

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6
Q

What is treatment for type 2 diabetes?

A

Anti-diabetics or Insulin if needed.

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7
Q

What are 3 symptoms of type 2 diabetes?

A

Unexplained weight loss

numbness

feeling very thirsty

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8
Q

What are 8 symptoms of diabetes melitus?

A

Hyperglycaemia

Polyuria

Polydipsia (thirst)

Polyphagia (excess appetite)

Poor wound healing

Fatigue

Weight loss

Blurry vision

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9
Q

What are 6 diabetic complications

A

Diabetic retinopathy

Diabetic nephropathy

Peripheral neuropathy

Stroke

Heart attack

Diabetic foot

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10
Q

What are 2 diabetic complications which are macrovascular?

A

Stroke

Heart attack

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11
Q

What are 3 diabetic complications which are mIcrovascular?

A

Diabetic retinopathy

Diabetic nephropathy

Peripheral neuropathy

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12
Q

What does microvascular complications mean?

A

disease affecting small vens

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13
Q

What does macrovascular complications mean?

A

disease affecting arteries

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14
Q

What is treatment for cardiovascular disease for primary + secondary prevention?

A

Low dose statin - primary prevention

low dose aspirin - secondary

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15
Q

What is potential treatment option for diabetic retinopathy?

A

Treat HTN

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16
Q

What is potential treatment option for diabetic nephropathy?

A

Treat HTN

Low dose ACEi/ARB

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17
Q

What is potential treatment option for diabetic neuropathy pain?

A

Neuropathic pain meds - analgesia, TCA, anti-epileptic

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18
Q

What is tx for erectile disfunction?

A

Sildenafil

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19
Q

What is diabetic ketoacidosis?

A

Serious complication of diabetes that can be life-threatening.

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20
Q

What are 5 risk factors to diabetic ketoacidosis?

A

Stress

Severe dehydration

Not eating

Surgery

illness

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21
Q

What are 10 symptoms of diabetic ketoacidosis?

A

Electrolyte imbalance (K+).
increased ketones in blood + urine
Weight loss
Polyuria
Dehydration + extreme thirst
N+ V
Diabetic coma
Abdo pain
Convulsions
FRUITY breath

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22
Q

When should fluids be given?

A

Especially in shock - restore normal volume

If not shock - rehydrate + maintain

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23
Q

When to NOT give potassium in diabetic ketoacidosis?

A

Do NOT give if anuric- no urine.

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24
Q

What is insulin regimen for diabetic ketoacidosis?

A

Continue LONG acting insulin

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25
Q

When to add in glucose for diabetic ketoacidosis?

A

When glucose is <14mmol/L

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26
Q

When to continue treatment of insulin in diabetic ketoacidosis?

A

If blood ketones <0.3 mmol/L

Blood pH > 7.3 = eat + drink

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27
Q

If Blood pH > 7.3, what to do?

A

Eat + drink

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28
Q

When to stop insulin in DKA?

A

1hour after S/C fast acting insulin + meal

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29
Q

MOA of insulin?

A

Lowers BG level by increasing uptake of skeletal muscle + adipose tissue

supresses hepatic gluconeogenesis

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30
Q

What is indication of insulin?

A

T1 +T2 DM

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31
Q

What are the 3 routes of insulin?

A

SC

IV

IM

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32
Q

What are the 3 conditions which require increased insulin level?

A

Infection or illness

Surgery or trauma

Puberty, pregnancy (2nd or 3rd trimester)

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33
Q

What are the 3 conditions which require decrease in insulin level given?

A

Reduced food intake , physical activity

Renal impairment

Endocrine disorders e.g addison’s disease

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34
Q

What is a MAIN SE of insulin?

A

Hypoglycaemia

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35
Q

What is usual Insulin administration route + sites?

A

SC injection

Abdomen, thighs, buttocks, upper arm.

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36
Q

What is an MHRA warning regarding insulin injection?

A

Risk of cutaneous amyloidosis at injection site

Different to lipodystrophy

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37
Q

What 4 counselling points to tell patient on insulin to prevent lipodystrophy + cutaneous amyloidosis on injection site?

A

Rotate injection site

Check site for reactions - infection, swelling, bruising, lipodystrophy

Do NOT miss meals , avoid strenuous exercise

Recognise warning signs of hypOglycaemia

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38
Q

What does the NHS improvement of safety alert regarding insulin talk about?

A

Severe harm and death withdrawing insulin from pen devices - can cause overdose.

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39
Q

How should insulin be prescribed?

A

Prescribe doses in units or international units.

overdose due to abbreviations = X

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40
Q

What 2 items need to be handed to a patient on insulin?

A

Insulin passport

Patient information booklet

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41
Q

What is insulin best stored at?

A

Fridge 2-8 degrees

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42
Q

Where to keep insulin after opened?

A

Keep room temperature, use by <28days.

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43
Q

What to do if insulin is frozen?

A

Discard

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44
Q

What does prandial mean?

A

Insulin secreted in response to glucose spikes after meals

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45
Q

What does basal insulin mean?

A

Insulin is secreted 24 hours a day

slow and long acting

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46
Q

What are the 2 types of insulin?

A

Bolus

Basal

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47
Q

What is bolus insulin split into ?

A

Rapid acting analogue

Short acting

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48
Q

What 2 activities is basal insulin split into ?

A

Intermediate acting

Long-acting analogue

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49
Q

What is short acting soluble insulin made from?

A

Human e.g. actrapid, humalin

Beef/pork - unacceptable religions

Route - SC + IM (IV is surgery/emergency)

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50
Q

When is bolus short acting insulin given?

A

15 to 30 mins before meals

Eat before 30 mins has past to avoid hypoglycaemia

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51
Q

What are 3 bolus rapid acting insulin analogues and their brands?

A

Aspart- novorapid

Glulisine- apidra

Lispro - humalog

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52
Q

What is route of bolus rapid acting insulin?

A

SC or IV in emergency

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53
Q

When is rapid acting bolus insulin given?

A

Just before meals

Lower risk of hypoglycaemia before meals + nocturnal

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54
Q

What is onset of bolus short actin insulin?

A

30-60 MINS to work

Peak 1 to 4 hrs

Duration up to 8 hrs

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55
Q

What is bolus rapid acting insulin onset?

A

15 mins to work

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56
Q

What is bolus rapid acting insulin duration?

A

2-5 hours

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57
Q

What is basal intermediate acting insulin example?

A

Isophane (NPH)

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58
Q

What is a common SE of Isophane (NPH)?

A

Allergic reaction

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59
Q

What is route of Isophane (NPH)

A

always IM

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60
Q

Why is Isophane (NPH) NOT given iv?

A

Thrombosis can happen

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61
Q

What is frequency of isophane?

A

BD

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62
Q

What are 5 long acting analogue basal insulin names/brands?

A

Degludec - tressiba - ultra

Determir - levemir (OD + BD)

Glargine (Lantus)

Protamine zinc (iv cause thrombosis)

Zinc insulin

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63
Q

What is frequency of long acting basal insulin?

A

Take OD same time each day

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64
Q

What is onset of basal intermediate acting insulin?

A

1-2 hrs

Peak - 3 to 12 hrs

Duration - 11 to 24 hrs

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65
Q

What is duration of basal long acting insulin?

A

up to 36 hrs

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66
Q

What insulin regimens are given via multiple injections? (basal-bolus)

A

short or rapid acting (before each meal)

intermediate or long acting - OD/BD

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67
Q

When is short or rapid acting bolus insulin given?

A

Before meals

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68
Q

What frequency is intermediate or long-acting basal insulin given?

A

OD or BD

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69
Q

What is the pros and cons of multiple injection insulin regime?

A

Flexible

More injecting

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70
Q

What is patient counselling for multi injection insulin regimen?

A

Match insulin dose to carb intake.

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71
Q

What are biphasic insulin options?

A

Short OR rapid acting

Mixed with

Intermediate acting (BD before meals)

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72
Q

What is counselling point for biphasic insulin regimen?

A

Regulate carb intake to match dose, BEFORE meal

Check insulin container + proportions

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73
Q

What is SC infusion of insulin?

A

Continuous soluble insulin delivered by infusion pump

either short or rapid acting

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74
Q

What insulin regimen is given for T1 diabetics as first line?

A

Multiple injections

of rapid acting (before meal) + detemir (BD)

{Basal-bolus or biphasic}

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75
Q

What is an alternative to multiple injection insulin regimen for T1?

A

Biphasic regimen BD

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76
Q

What 3 cases can SC infusion of insulin be used in?

A

Disabling, unpredictable hyperglycaemia

Poor glycemic control - HBA1C > 8.5% even after multiple injecting

Children under 12 - if MIR (MULTIPLE insulin regimen) impractical

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77
Q

What is 1st line insulin regimen for T2 diabetics if basal only?

A

Human isophane

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78
Q

When is Human isophane given in t2 diabetics?

A

OD or BD

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79
Q

What is pro and con of insulin pen?

A

easy to use

Residual insulin = not used

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80
Q

What is 1st line insulin regimen for T2 diabetics if multiple injection + biphasic used?

A

Human isophane

+

Human short acting (before meals)

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81
Q

What are 3 types of insulin devices?

A

Insulin pen

Pump

Syringe

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82
Q

What is pro and con of insulin pump?

A

Provides continuous basal + patient activated bolus

Con = only for certain t1 diabetics.

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83
Q

What is pro and con of insulin pump?

A

Less popular in children

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84
Q

What are SICK day rules?

A

Sugar - check BMs every 3-4 hrs until normal

Insulin = never stop itW

Carbs - normal meal pattern, replace meals with carb drinks, 3L fluid, get medical help if vomiting.

Ketones - check blood + urine ketones every 3 to 4 hrs

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85
Q

What must you never stop in sick day rules?

A

never stop insulin

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86
Q

When to check ketones in sick day rules + when to get medical help regarding ketones?

A

Ketones - check blood + urine ketones every 3 to 4 hrs.

If urine ketone > 2 OR blood ketone > 3mmol/L

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87
Q

What drug class can mask the symptoms of hypoglycaemia?

A

Beta blockers

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88
Q

What 3 drug classes can cause hypoglycaemia?

A

ACEi

ARB (cause hyperkalaemia)

Antidiabetic drugs

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89
Q

What 3 drug classes can antagonise insulin?

A

Corticosteroids

Antipsychotics

Thiazides

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90
Q

Which 2 antipsychotics can antagonise insulin?

A

Clozapine

Olanzapine

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91
Q

What should be given during major procedure, emergency or poor glycemic control for diabetic patient?

A

Sliding scale - soluble human insulin

Measured hrly based on BMs

Stop other insulins except long acting one - 80% dose given.

Continue until patient E +D + stable

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92
Q

What to give diabetic patient about to have minor procedure?

A

Adjust usual insulin

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93
Q

How are anti-diabetic drugs given?

A

nearly all given orally

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94
Q

What are the 4 oral hypoglycaemic drugs?

A

Sulphonylureas

GLP1 agonist

Gliptins - DPP4 inhbitors

Meglitinides

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95
Q

What 2 drugs are insuline sensitizers?

A

Metformin

Pioglitazone

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96
Q

What is MOA of metformin?

A

Causes less hepatic gluconeogenesis

Increases peripheral use

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97
Q

What is metformin used in 1st line for?

A

T2 Diabetes

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98
Q

Can metformin be used in pregnancy + breastfeeding?

A

Yes -safe

99
Q

What other condition is metformin used unlicensed as?

A

PCOS

100
Q

What is a deficiency in patients using metformin + is a MHRA alert?

A

B12 deficiency - check + monitor level

101
Q

What are 3 SEs of metformin?

A
  1. GI disturbances- N, V, D
  2. Lactic acidosis
  3. Low B12 level
102
Q

What counselling points for metformin?

A

Take with or after meal or food.

Report signs of lactic acidosis

103
Q

What 2 criteria to avoid giving metformin?

A

When renal impairment, eGFR <30ml/min.

Tissue hypoxia

104
Q

What are 4 signs of AKI risk?

A

Severe infection , sepsis,
shock, dehydration

105
Q

What are 4 signs of tissue hypoxia?

A

Acutr HF

Respiratory failure

MI

liver impaired

106
Q

What is MOA of sulphonylureas?

A

Increased insulin secretion

107
Q

What are 5 signs of lactic acidosis?

A

Dyspnoea

cramps

abdo pain

hypothermia

asthenia

108
Q

What is name of long acting sulphonylurea?

A

Glimepiride

109
Q

What 2 sulphonylureas are good in elderly or RI as they are short acting?

A

Gliclazide

Tolbutamide

110
Q

What are 5 SEs of sulphonylureas? (JAW)

A

Hypoglycaemia - treat in hospital

HypOnatraemia

Weight gain

Jaundice

Allergic dermatitis

111
Q

What is an interaction between ARB/ACEI and sulphonylurea going to cause?

A

Hypoglycaemias

112
Q

What interacts with sulphonylureas to cause hypoglycaemia?

A

ARB/ACEi

113
Q

MOA of pioglitazone?

A

reduces peripheral resistance

114
Q

What class is pioglitazone?

A

thiazolidinediones

115
Q

What is 6 SEs of pioglitazone? (HHBB)

A

Heart failure

Bladder cancer

Hepatotoxicity

weight gain

Bone issues

visual impairment

116
Q

What are 3 MHRA warnings of pioglitazone?

A

Monitor signs of HF- oedema

Report blood in urine, dysuria, urgency

Report signs of liver disorder- jaundice, dark urine, abdominal pain, vomiting

117
Q

Which antidiabetic drug causes weight gain?

A

pioglitazone
+
Gliclizide

118
Q

What is a contraindication of pioglitazone?

A

Uninvestigated macroscopic haematuria

119
Q

What is MOA of SGLT2 inhibitors?

A

Inhibits sodium glucose co- transporter 2

Increased excretion of glucose

120
Q

What diabetic drug is NOT to be used in HF patients?

A

Pioglitazone

121
Q

What are 4 SEs of SGLT 2 inhibitors? (FARV)

A

Fournier’s gangrene

Atypical Diabetic Ketoacidosis - weight loss

Recurrent UTIs

Volume depletion

122
Q

List 4 SGLT inhibitors?

A

Dapagliflozin

Canaglifozin

Emagliflozin

Ertugliflozin (uncertain +Ve cardio effect)

123
Q

What is Fournier’s gangrene + what antidiabetic drug causes it?

A

Necrosis of groin

Caused by SGLT2 inhibitors- ‘flozins’.

stop using if happens

124
Q

What is 5 patient counselling points for SGLT2 inhibitors?

A

Report DKA signs, test ketones.

Monitor ketones if drug is stopped.

Hydrate yourself - report postural hypotension/dizziness

Report severe pain, red tender genitals and fever.

125
Q

What SGLT 2 inhibitor is NOT to be used in TYPE 1 DM?

A

Dapagliflozin (5mg)

126
Q

What can canagliflozin increase the risk of happening + what is a counselling point for this drug ?

A

Lower limb amputation - toes

Report skin ulcers, new pain, discolouration.

127
Q

What are 6 signs of DKA which can be caused by SGLT2 inhibitors?

A

N + V

Abdo pain

Weight loss

urine smell different

fruity breath

sleepiness

128
Q

What 2 things do if DKA suspected by SGLT2 inhibitors?

A

Stop tx in this case. (and if had major surgery)

Test for raised ketones.

129
Q

MOA of DPP4 inhibitor?

A

Inhibit dipeptidylpeptidase- 4

Increases incretin = increased insulin secreted.

130
Q

List 5 DPP4 inhibitors?

A

Alogliptin

Linagliptin

Saxagliptin

Sitagliptin

Vildagliptin

131
Q

What are 2 SEs of DPP4 inhibitors? (PH)

A

Pancreatitis

Hepatotoxicity

132
Q

Which DPP4 inhibitor has a higher risk of hepatotoxicity?

A

Vildagliptin

133
Q

Which anti-diabetic drug class has a lower risk of hypoglycaemia compared to sulphonlyreas?

A

DPP4 inhibitors

134
Q

Is weight gain associated with DPP4 inhibitors?

A

NO

135
Q

What are 2 counselling points for DPP4 inhibitors?A

A

Report severe abdo pain

Report signs of liver disorder

136
Q

MOA of GLP1 agonist?

A

acts on incretin receptors - increase insulin secretion

137
Q

List 4 examples of GLP1 agonist?

A

Dulaglutide

exenatide

lixisenatide

Liraglutide

semaglutide

138
Q

What is frequency of GLP1 agonist?

A

Taken OD

139
Q

When is GLP1 agonist used?

A

When other methods have failed

for patients who have a BMI of 35 kg/m2 or above (adjusted for ethnicity) + specific psychological or medical problems associated with obesity;

or

BMI less than 35 kg/m2 and for whom insulin therapy would have significant occupational implications,

or

if the weight loss with drugs would benefit.

140
Q

What are 2 MHRA warning about GLP1 agonists?

A

Fake versions being made- be vigilant about hypoglycaemia + report to yellow book

DKA report when insulin rapidly reduced so should carefully go down.

141
Q

What other effect does GLP1 agonist have on body?

A

Weight loss + improved cardiovascular outcomes

142
Q

What is a risk with GLP1 agonists which is linked to GI effect?

A

Dehydration

143
Q

Which GLP1 agonist is linked to increased heart rate?

A

Liraglutide

144
Q

What GLP1 agonist to avoid in end stage renal disease?

A

semaglutide

145
Q

What is route of GLP1 agonist?

A

SC

146
Q

What 2 GLP1 agonists is not stored in fridge?

A

Exenatide

lixisenatide

147
Q

What are 3 SEs of GLP1 agonists? (GP-D)

A

GI disturbances - N+ V

pancreatitis

DKA

148
Q

What to do if missed dose of Liraglutide?

A

Do not take after meal

If more than 12 hrs late, do not double dose, and take next one at the right time

149
Q

What to do if missed dose of Lixisenatide?

A

If missed dose, inject within 1 hour before the next meal—do NOT give after a meal.

150
Q

What to do if missed dose of Exenatide?

A

If -MR injection is missed, should be given asap, provided the next regularly scheduled dose is due in 3 days or more;

Then, patients can resume their usual once weekly dosing schedule.

If immediate release - continue to next dose.

151
Q

What GLP1 agonist is reviewed 6 months to see weight loss?

A

Semaglutide

need at least 5 % weight loss- determine whether to continue.

Only continued if there has been a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body-weight.

152
Q

What to do if missed dose of dulaglutide?

A

Should be given as soon as possible ONLY if there are at least 3 days until the next scheduled dose.

If less than 3 days left before the next scheduled dose,

+ the next dose should be taken at the normal time.

153
Q

What 2 GLP1 agonists need contraception? (EL)

A

MR exenatide

Lixisenatide

154
Q

What are 2 main SEs of acarbose? (DF)

A

Diarrhoea

Flatulence

155
Q

What is MOA of acarbose?

A

Inhibits alpha glucosidase.

Decrease starch + sucrose absorption.

156
Q

What drug does NOT help with flatulence when taking acarbose?

A

Antacids

157
Q

What to do if patient experiences diarrhoea on acarbose?

A

Reduce dose OR stop

158
Q

What is patient counselling point for acarbose?

A

Chew with first mouthful of food OR

swallow whole with little liquid immediately before food.

Carry glucose to avoid hypoglycaemia

159
Q

When is acarbose given as treatment?

A

If other oral anti diabetic drugs fail.

Has poorer anti-hyperglycaemic effect.

160
Q

Can pregnant women have acarbose?

A

NO

161
Q

MOA of meglitinide?

A

Increase insulin secretion

162
Q

List 2 meglitinides?

A

Nateglinide

Repaglinide

163
Q

What are the 2 SEs of meglitinides? (HD)

A

Hypoglycaemia

Diarrhoea (common)

164
Q

What is patient counselling on how to take meglitinides?

A

take 30 mins before main meal

165
Q

What is 1st line treatment for T2 DM?

A

Metformin tablets

166
Q

What is 1st line treatment for T2 DM if metformin causes GI issues?

A

Try MR version of Metformin

167
Q

What diabetic drug regiment to give if patient has CVD (HF, CVD, QRISK >10%)?

A

Metformin + SGLT2

168
Q

What is a risk of using metformin + SGLT2 inhibitors as part of T2 DM therapy?

A

Risk of DKA - especially in illness, episode or Keto diet.

169
Q

What to give if CVD status develops during diabetic treatment?

A

Add or replace drug with SGLT2 inhibitor

170
Q

If metformin Triple therapy does not work for DM, what should be given?

A

GLP1 agonist

OR insulin therapy with metformin only.

171
Q

What is dual metformin therapy if patient does not have CVD risk/status?

A

Metformin + one of the below

( SU, PIO, DPP4) SGLT2 (if SU contraindicated)

172
Q

When is SGLT2, given after metformin?

A

when sulfonylureas are contra-indicated or not tolerated, or if the patient is at significant risk of hypoglycaemia

173
Q

What 2 drugs are stopped temporarily for sick day rules in T2 DIABETES?

A

Metformin

SGLT2 inhibitor

174
Q

Why is metformin + SGLT2 inhibitor stopped in sick day rules?

A

Due to risk of AKI from lactic acidosis + volume depletion/dehydration risk.

175
Q

What to do if diabetic patient is going to undergo major procedure in Type 2?

A

sliding scale insulin

Stop antidiabetics -except GLP1 agonist

176
Q

What to do if diabetic patient is going to undergo Minor procedure (short fasting period) in Type 2?

A

Leave out anti-diabetic dose

Continue Pio, DPP4, GLP1 agonist

177
Q

What 3 anti-diabetic drugs to stop in minor procedure?

A

SGLT2 = DKA

SU = hypoglycaemia if patient is fasting

Metformin - renal impairment = Lactic acidosis

178
Q

What is Hba1c level for pregnant women?

A

Less than 48mmol/mol

179
Q

What are 2 pregnancy planning things to monitor + do if patient is diabetic?

A

Hb1Ac level <48 mmol/mol

5mg Folic acid daily before conception until week 12

180
Q

What 3 treatment options for diabetic patients who are pregnant?

A

Rapid acting insulin + Isophane insulin

Can continue long acting ones - e.g. glargine or determir

SC infusion - if hard to receive glycemic control using multiple injections

181
Q

What is STOPPED in diabetic women who are pregnant?

A

Oral anti diabetic drugs other than metformin

Diabetic complications - ACEi/ARB + statin

182
Q

What 3 drugs are not good in pregnant women with diabeties?

A

ACEi/ARB

statins- not for pregnancy

183
Q

What is first line treatment for gestational diabetes if they have a fasting BM of less than 7mmol/L?

A

diet + exercise

If not work - metformin
(insulin if metformin not effective alone)

184
Q

What is first line treatment for gestational diabetes if they have a fasting BM of MORE than 7mmol/L?

A

Insulin immediately with or - metformin (optional)

and

diet/exercise

185
Q

What 2 drugs for diabetic patients who are breastfeeding?

A

Insulin

Metformin

186
Q

What to give women with fasting plasma glucose of 6- 6.9 with complications such hydramnios or macrosomia?

A

Insulin tx + metformin (if you want).

187
Q

What is hydramnios?

A

excess amniotic fluid

188
Q

What is macrosomia?

A

big baby

189
Q

What are some signs of hypoglycaemia?

A

Tingling lips

hunger

drowsy

palpitations

trembling

slurred speech

blurred vision

pale, clammy hands

Glucose < 4 mmol/L

190
Q

What are 3 steps to avoid loss of hypoglycaemic awareness?

A

BB mask symptoms

Avoid frequent Hypos

Switch insulin- with specialist

191
Q

What is treatment if blood glucose is > 4mmol/L?

A

Small carb snack or have next meal

192
Q

What is treatment if blood glucose is < 4mmol/L?

A

15 to 20g fast acting sugar or Long acting carb

193
Q

How many times to repeat fast acting glucose?

A

max 3 times - repeat after 15 mins

194
Q

What are 5 examples of fast acting sugar?

A

60-80ml liquid glucose

4-5 glucose tabs

1.5 to 2 tubes glucose oral gel

3-4 heaped tsp of sugar in water

150 to 200ml fruit juice (avoid CKD)

195
Q

What drug is 3-4 heaped tsp of sugar in water unsuitable in?

A

Acarbose

196
Q

What juice to avoid in low K+ diet in CKD?

A

Orange juice

197
Q

What is 2 long acting carb examples?

A

Two biscuits, 1 slice bread

200-300ml milk or next meal

198
Q

What does HBA1C measure?

A

Glycaemic control in last 2-3 months

good in T2 DM

199
Q

Who is HBA1C not effective for? (6)

A

T1 DM

pregnancy or less than 2mths PP

High DM risk + ill

Meds causing hyperglycaemia

HIV, end stage renal disease

acute pancreatic damage

200
Q

What is normal range of hba1c?

A

below 42mmol/mol

201
Q

What is prediabetic range of hba1c?

A

42-47

202
Q

What is T2 DM range of hba1c?

A

between 48-58

203
Q

What case is oral glucose tolerance test NOT suitable for?

A

Severe hyperglycaemia symptoms

204
Q

What 2 cases are oral glucose tolerance test good in?

A

Gestational Diabetes

Impaired glucose tolerance- pre diabetics

205
Q

How many times to monitor BMs in T1?

A

4 times before meals + bed

206
Q

What is fasting BM levels in diabetics upon waking?

A

5-7

207
Q

what is post prandial BM levels in diabetics 90 mins after eating?

A

5-9

208
Q

What blood glucose should it be if a diabetic patient can drive?

A

Has to be at least 5

209
Q

What is BP target for T1 DM?

A

<140/90 MMHG

210
Q

What is BP target for T1 DM Albumin creatinine ratio >70?

A

<130/80 mm hg

211
Q

What is BP target for T2 DM under 80?

A

<140/90 mm hg

212
Q

What is BP target for T2 DM over 80?

A

<150/90 mmhg

213
Q

What is total cholesterol limit in normal patients?

A

<5

214
Q

What is total cholesterol limit in high risk patients?

A

<4mmol/L

215
Q

What 4 cases should DVLA be notified in diabetes?

A

If on insulin

If hypoglycaemia = 2+ severe episodes in less than 1 year, disabling hypos while driving, impaired awareness

Group 2 vehicle - lorry

Diabetic complication -e.g. retinopathy

216
Q

What to do when hypoglycaemia while driving?

A

Stop vehicle in safe place, switch off

Wait 45 mins after treatment

217
Q

What is monitoring hypos while driving?

A

2 hrs before + every 2hrs in long journey

IF <4 mmol/L = NO DRIVING

218
Q

What BM level should you not drive on?

A

IF <4 mmol/L = NO DRIVING

219
Q

What 9 scenarios in which HBa1c Is not useful?

A

Had symptoms of diabetes for less than 2 months

a high diabetes risk + are acutely ill;

Tx with medication that may cause hyperglycaemia

Acute pancreatic damage

end-stage chronic kidney disease

HIV infection.

In T1 DM

Children

pregnancy + within 2 months post-partum

220
Q

When is a fast acting carb given?

A

If blood glucose <4 mmol/L

221
Q

What is order of T2 DM management?

A
  1. Metformin
  2. Metformin + DPP4 inhibitor, OR pioglitazone, OR sulfonylurea.
  3. Metformin + consider SGLT2 inhibitors if sulfonylurea CI or hypoglycaemia risk
222
Q

If dual therapy for diabetes does not work what 3 options possible?

A

1.Metformin + sulfonylurea, + either SGLT2 inhibitors

  1. Metformin + pioglitazone, + either canagliflozin or empagliflozin;
  2. Metformin + a DPP-4 inhibitor + ertugliflozin (only if a sulfonylurea or pioglitazone is not appropriate).
223
Q

What 2 drugs are used as rescue medication if symptomatically hyperglycaemic at any point?

A

Insulin

Sulfonureas

224
Q

Patients prescribed a single drug associated with hypoglycaemia should aim for what HbA1c level?

A

53mmol/mol

225
Q

What eGFR to avoid starting dapagliflozin?

A

Avoid initiation if eGFR less than 15 mL/minute/1.73 m2.

226
Q

What eGFR to avoid starting empagliflozin?

A

Avoid initiation if eGFR less than 20 mL/minute/1.73 m2.

227
Q

Initial management dka?

A

intravenous fluid replacement,

then intravenous insulin;

patients who normally take long-acting insulin should continue their usual dose(s) throughout treatment.

K+ replacement + glucose administration may also be required to prevent subsequent hypokalaemia + hypoglycaemia, depending on potassium levels and blood glucose Levels.

228
Q

What is T1 DM blood glucose before meals?

A

a blood-glucose concentration of 4–7 mmol/litre before meals at other times of the day

229
Q

What 2 ultra long insulins can be given for T1 patients who struggle to inject?

A

insulin degludec, or insulin glargine 300 units/ml

230
Q

What long acting insulin can be given if concerned about nocturnal hypos?

A

Insulin degludec

231
Q

What is the 1st line insulin for T2 DM?

A

Nph - isophane

232
Q

What 2 insulins can be considered as alternative to nph if patient needs carer to inject?

A

Detemir or glargine

233
Q

What insulin to give if hba1c is 75 mmol or more?

A

NPH and short acting insulin

234
Q

When to give metformin in gestational diabetes?

A

If below <7mmol/L and BM target not met within 1-2 of diet/exercise

235
Q

What are other risk factors for DKA?

A

Stopping/ inadequate insulin therapy

acute illness e.g MI and pancreatitis, new onset of diabetes, or stress (e.g. trauma, surgery)

236
Q

Major Risk factor of DKA and HHS?

A

both DKA and HHS is infection.

237
Q

3 features of HSS?

A

hypovolaemia

marked hyperglycaemia (blood glucose above 30 mmol/L without significant hyperketonaemia or acidosis)

hyperosmolality

238
Q

Symptoms of HSS?

A

dehydration due to polyuria and polydipsia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, acute cognitive impairment, and in severe cases, shock

239
Q

Initial tx for HHS?

A

IV fluid replacement, followed by IV insulin

240
Q

If metformin is contra-indicated or not tolerated, what to give?

A

SGLT2) inhibitor 1st line if Chronic HF or established atherosclerotic CVD.

Others: DPP-4) inhibitor, or pioglitazone, or a sulfonylurea as 1st-line.

241
Q

What to do if BMs still 58?

A

Add on further tx - dual

242
Q

What is BM target is 2 or more anti-diabetics given?

A

When two or more antidiabetic drugs are prescribed, a target HbA1c level of 53 mmol/mol (7.0%) is recommended for patients in which it is appropriate.

243
Q

What should fasting blood glucose be?

A

Less than 5.5 mmol/L

244
Q

What should non fasting blood glucose be?

A

Under 11.1 mmol/L

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