Exam Flashcards
Intercurrent illness means what with regard to diabetes?
Need to more tightly control BG.
We should aim for a target plasma glucose level of ___-___mmol/litre for adults with type 1 diabetes during surgery or acute illness.
5-8
A fasting plasma level of _____mmol/litre on waking and a plasma glucose level of _____mmol/litre before meals at other times of the day is recommended for type 1 diabetic adults.
5-7 fasting
4-7 before meals.
5-9 at least 90 minutes after eating.
ACR of above what is indicative of nephropathy
3.0
Target HbA1c
48-59mmol/mol
NICE remommend regime for T1D
Basal/bolus
Twice daily insuline detemir as basal insulin therapy for adults with T1D.
Novorapid TDS before meals = rapid acting analogue for bolus. q
Why would we consider adding metformin to T1D management?
Fat.
BMI >25 (>23 if asian)
to aid weight loss and improve blood glucose control.
What is the target BP in diabetes?
<140.90
130.80 if target organ damage (raised ACR)
ACEI first line as nephroprotective
What long term complications are there from uncontrolled blood glucose?
Macrovascular complications: MI, stroke, peripheral vascular disease.
Microvascular complications: Nephropathy, neuropathy, retinopathy.
Do we use QRISK for T1D?
No, offer statin anyway.
DO NOT OFFER ASPIRIN FOR PRIMARY PREVENTION IN ADULTS WITH T1D
Baseline monitoring for LMWH
APPT INR Platelets and at 4 days LFTS GFR (renal function)
Inhibition of aldosterone secretion by unfractionated or low molecular weight heparin can result in hyperkalaemia. Risk increases with duration of therapy.
Bruising, bleeding, platelets, anti-factor Xa in obese, pregnany etc.
Pros of NOACS (3)
No monitoring
Reduced bleed risk
Less drug/diet interactions
Pros of Warfarin (3)
Can monitor and therefore ensure efficacy
Less impact from missing a dose
Reversal agent
Do we avoid Ibuprofen in elderly?
Definitely
Do we avoid ibuprofen in asthmatics?
Maybe
