LTC Flashcards
Diagnostic criteria for diabetes
Random blood glucose >11.1mmol/L with osmostic Sx
Fasting blood glucose >7mmol/L
OGTT >11.1mmol/L
HbA1c >48mmol/mol (6.5%)
Process of OGTT
Fast for 8-12h before test - no food/ just water
Given sugary drink containing 75g glucose
Blood glucose taken either every 30 mins or just once at 2h
Gene associated with t1dm
HLA DR3/DR4
Risk factors for t2dm
Increasing age Smoking Obesity PCOS Hypertension Ethnicity - south asian / afrocarribean Family history Hx of GDM
Biguanide example, mechanism and side effects
Metformin
Decreases gluconeogensis, increases insulin sensitivity
S/E - Nausea, GI upset inc diarrhoea, abdo pain
Lactic acidosis if reduced renal function
Sulphonylurea example, mechanism and side effects
Gliclazide
Increases insulin secretion
S/E - main one is hypoglycaemia, also causes weight gain
DPP4 Inhibitor example, mechanism and side effects
Sitagliptin
Increases incretin, therefore decreases glucagon
S/E - headache, myalgia
Pioglitazone mechanism and side effecs
Increases PPAR-gamma expression, hence decreasing insulin resistance and decreasing gluconeogenesis
S/E - weight gain, increased infection risk, numbness, fluid retention
Suffix of DPP4 inhibitor drugs
Gliptin
Suffix of SGLT2 inhibitors
-Gliflozlin
SGLT2 inhibitor examples, mechanism, S/E
Empagliflozlin
Blocks glucose reabsorption in kidneys
S/E - increased infection risk
GLP analogue examples
Exenatide
Liraglutide
GLP analogue mechanism
Decreases gluconeongenesis, increases insulin production, decreases hunger, decreases GI motility (feel fuller)
Rapid acting insulins
Novorapid
Humalog
Short acting insulins
Actrapid
Humulin S
Intermediate insulins
Insulitard
Humulin I
Long/Ultralong Insulins
Determir
Glargine
Describe 3 insulin regimes
Once-daily basal insulin
Twice-daily mix insulin - breastfast and tea time, usually with Humulin M3
Basal-Bolus therapy - long acting basal with rapid/short boluses with meals
4 injection sites for insulin
Abdomen
Upper arm
Thigh
Buttock
Symptoms of HHS
History >1 week Dehydration Altered GCS Neurological signs - blurred vision, tremor N+V Malaise, weakness
Diagnostic features of HHS
Clinical dehydration Glucose >30mmol/L Low ketones pH >7.3 Osmolality >320mOsmol/kg
Management of HHS
Fluids
LMWH prophylaxis
K+ replacement
IV insulin if no improvement with fluids
Symptoms of DKA
Drowsiness N+V Abdominal pain Sweet smelling breath Kussmaul breathing - deep and laboured
May be history of trigger e.g. infection, MI, chemo, poor insulin compliance.
Diagnosis of DKA
Acidaemia - pH <7.3
Hyperglycaemia - glucose >11.0mmol/L
Ketonaemia - >=3mmol/L or ketonuria >++
Management of DKA
Fluids
IV insulin
Assess for K+ replacement
Management of hypoglycaemia
10-15g fast acting CHO e.g. 200ml orange juice
Buccal glucose gel if inconscious / drowsy
Reassess BM in 10-15 mins, can repeat CHO after
IV therapy:
- IV dextrose
- IV glucagon - won’t work if pt malnourished
After BM has been corrected (>=4mmol/L), give long-acting CHO e.g. toast
Diagnosis of diabetic nephropathy
Microalbuminuria - Albumin:Creatinine Ratio >=3
Two tests used to screen for diabetic nephropathy
Albumin-Creatinine Ratio
Serum creatinine - to estimate eGFR
Management of diabetic nephropathy
Control DM
Consider ACEi/ARB
Statin - to manage cardiovascular risk
Stage 1, 2 and 3 diabetic retinopathy and management
Stage 1 = background retinopathy.
Dots - red microaneurysms, blots = haemorrhage
Stage 2 = pre-proliferative retinopathy
Cotton wool spots - white ischaemia
Stage 3 = proliferative retinopathy
Ischaemia –> growth factor release –> formation of new, fragile blood vessels
Stage 2+ should be referred to ophthalmology for pan-retinal photocoagulation
9 things done in yrly diabetic review
- BP
- BMI
- Serum cholesterol
- Serum creatinine
- Albumin:Creatinine Ratio
- Smoking history
- Diabetic foot review
- Eye screening
- HbA1c
