Endocrine - Diabetic Complications

Question 1

CVD and Diabetes, what to consider adding medication wise

Answer 1

Consider low dose of atorvastatin

Question 2

Diabetics with which Conditions to consider to initiate low dose statin?

Answer 2

• age 40+ T1DM
• Diabetic for 10+ years
• Have Nephropathy or other CVD

Question 3

Diabetic Nephropathy treatment?

Answer 3

ACE/ARB

Question 4

What side effect will ACE-i have on antidiabetic meds/insulin?

Answer 4

Increase hypoglycaemic effects of insulin/anti diabetic meds

Question 5

Painful peripheral neuropathy treatment?

Answer 5

Anti depressants

Gabapentin/Pregabalin

Question 6

Autonomic Neuropathy?

Answer 6

Treat Diarrhoea with codeine or tetracycline

Question 7

Neuropathic Postural Hypotension?

Answer 7

Fludrocortisone
Or
Increase salt intake

Question 8

Gustatory sweating treatment?

Answer 8

Antimuscarinic
(Propantheline bromide)

Question 9

Erectlie dysfunction in diabetes treatment?

Answer 9

Sildenafil

Question 10

How often should you have diabetic eye tests?

Answer 10

Yearly

Question 11

DKA Symptoms?

Answer 11

Pear drop breath
Thirsty
Deep or fast breathing
Confusion
Lethargy/unconsciousness
Polyurea

Similar to drunk therefore misdiagnosed sometimes

Question 12

Slight risk levels for DKA?

Answer 12

0.6 - 1.5

Question 13

Slight Risk DKA what should you do?

Answer 13

Retest in 2 hours

Question 14

Increased risk of DKA levels?

Answer 14

1.6 - 2.9

Question 15

What should pt do if they have an increased risk of DKA?

Answer 15

Refer to GP

Question 16

Medical Emergency ketone levels?

Answer 16

3mmol and over

Question 17

At what blood sugar level would you start to test ketone levels?

Answer 17

Over 11mmol/L

Question 18

Three steps to DKA diagnosis?

Answer 18

1) Are DKA symptoms displayed?
2) Check Sugar levels - if over 11mmol/L
3) Check ketone

Question 19

DKA treatment less than 90 BP?

Answer 19

500ml IV NaCl 0.9%

Question 20

DKA ONCE 90 BP?

Answer 20

Maintain on IV NaCl 0.9%

Question 21

DKA step After IV NaCL?

Answer 21

Start IV INSULIN mixed with NaCl at rate at which:

• Ketone level falls at 0.5mmol/L
• Blood glucose conc falls at 3mmol/L/hr

Question 22

DKA: When blood glucose is less than 14mmol
What should be given?

Answer 22

IV Glucose 10%

Question 23

How do you know when to continue insulin till in DKA treatment?

Answer 23

Till ketone is below 0.3mmol/L
and
PH is greater than 7.3

Question 24

When to stop treatment of DKA?

Answer 24

1 hour after food

Question 25

Minor elective surgery good glycemic control treatment?

Answer 25

Reduce OD long acting dose by 20%

Question 26

Elective major procedure or poor glycemic control?

Answer 26

Day before: reduce od long acting dose by 20% On day: Reduce od long acting dose by 20% IV KCL + GLUCOSE + NaCl Variable rate of insulin given in NaCl 0.9 Hourly measure blood glucose for first 12 hrs

Question 27

During elective surgery in major procedure or with poor glycemic control what would happen if blood glucose dips below 6months/L?

Answer 27

Give IV Glucose 20%

Question 28

When to convert pt back to sc insulin after surgery?

Answer 28

When pt can eat/drink without vomiting

Question 29

When is basal/bolus regime restarted after surgery?

Answer 29

With first meal - continue infusion till 30-60mins after first meal short acting insulin administration

Question 30

What happens to long acting insulin post surgery?

Answer 30

20% reduced until pt leaves hospital

Question 31

When to restart BD regimen post surgery?

Answer 31

Breakfast/evening meal

Question 32

SICK Day rules

Answer 32

Sugar levels - Check Blood glucose levels Insulin - keep taking insulin Carbs - keep eating/hydrated Ketones - monitor ketones