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Diabetes > Management > Flashcards

Management Flashcards

1
Q

What is the treatment for type 1 diabetes?

A

Insulin is life-saving. In the absence of beta cells, achieving near normoglycaemia without side effects is very difficult.
Also controlled carb diet and exercise.

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2
Q

What are examples of rapid-acting insulin?

A
  • Insulin aspart
  • Insulin glulisine
  • Insulin lispro
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3
Q

What are examples of long-acting insulin?

A
  • protamine zinc insulin
  • insulin zinc suspension
  • insulin detemir
  • insulin glargine
  • insulin degludec
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4
Q

What is the treatment for type 2 diabetes?

A
  • Reduced calories improve islet function and weight loss reduces insulin resistance.
  • Exercise improves insulin sensitivity with or without weight loss.
  • Decrease blood glucose
  • Decrease BP
  • Improve lipid profile
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5
Q

What drugs are used to reduce insulin resistance?

A
  • Biguanide and metformin

- Thiazolidenodiones

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6
Q

What drugs increase beta cell activity?

A
  • Sulphonylureas e.g. glucanizide, glipazide, glibenclamide

- Meglitinides e.g. nateglinide, repaglinide

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7
Q

What drugs increase GLP1 activity?

A
  • DPP4 inhibitors e.g. sitagliptan, vildagliptin, linagliptin, alogliptin
  • Incretins, GLP1 antagonists e.g. exenatides, luraglutide
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8
Q

What drugs slow glucose absorption?

A

Acarbose (alpha-glucosidase inhibitor)

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9
Q

What drugs enhance glucose secretion?

A
  • SGL2 antagonist (dapagliflozin, canagliflozin, empagliflozin)
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10
Q

How is glucose monitored?

A
  • Urine glucose - imprecise but useful in T2DM
  • Blood glucose - self-regulation, targeted for T2 on hypoglycaemic risk meds
  • HbA1c - risk assessment every 6 months
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11
Q

What does the annual care planning involve?

A
  • Risk factor review e.g. lifestyle, glucose, lipids, BP
  • Early detection of microvascular complications
  • Patient and professional review of results
  • Care planning - priorities and goals, managament plan, management of complications
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12
Q

What are the baseline annual checks to be done?

A
  • Lipids - TL/HDLC ratio (CV risk)
  • UACR
  • eGFR
  • Foot exam - pulses, deformity
  • Diabetic Eye Screening programme
  • BP
  • HbA1c
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13
Q

What is the secondary prevention for diabetic retinopathy?

A
  • Early detection of sight-threatening retinopathy (retinal screening)
  • Prompt and appropriate ALLC (anti-VEGF)
  • Glucose and BP control
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14
Q

What is the salvage therapy for diabetic retinopathy?

A

Vitrectomy - remove vitreous and repair retina behind

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15
Q

What are the stages of CKD?

A 
1 - eGFR >90 ml/min/1.72m2
2 - 60-90
3 - 30-59
4 - 15-29
5 - <15
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16
Q

What is the secondary prevention for diabetic nephropathy?

A
  • Early detection of minimal nephropathy (UACR, eGFR)
  • Intensive (<120/75) BP control (ACEi, ARBs)
  • Blood glucose and vascular risk factor control
17
Q

What is the salvage therapy for diabetic nephropathy?

A
  • Diet, Epo, calcium, vitD, bicarbonate
  • Early AVF, early transplantation
  • Dialysis and transplantation
18
Q

What is the primary prevention for complications in pregnancy?

A
  • Pre-pregnancy blood glucose control/folate

- Intensive blood glucose control

19
Q

What is the salvage therapy for complications in pregnancy?

A
  • Anomaly screening

- Foeto-placental monitoring

20
Q

What is the primary prevention for CV complications of diabetes?

A
  • Lifestyle
  • Metabolic control (glucose, BP, lipids)
  • ACEi, ARB, aspirin, statins/fibrates
21
Q

What is the secondary prevention for CV complications of diabetes?

A

Post angina, ACS, MI, TIA, CVA, claudication, ED - thrombolysis, aspirin, DIGAMI, beta blockers

22
Q

What should the care plan be for diabetic patients?

A
  • Lifestyle changes - diet, exercise
  • Agree target weight loss
  • Refer to smoking cessation service
  • Review in 3 months
  • Recommend add metformin if above HbA1c range - cons: can have bad GI side effects
23
Q

How do you prevent DKA/HHS disaster?

A

NEVER stop basal insulin

24
Q

What do you do to manage DKA?

A
  1. Hypovolaemic shock - fluid resuscitation (saline 1L over 1hr)
  2. Tests: ABG, glu, ketones, U+E, CRP, CXR, ECG
  3. Add insulin 50 units to 50ml saline (0.1 unit/kg/hr)
  4. Check tests frequently - blood glu, ketones hourly
  5. Continue fluids and assess need for K+
  6. Consider catheter if not passed urine
  7. Avoid hypoglycaemia
25
Q

How do you treat severe hypoglycaemia?

A
  • Able to cooperate - 30ml lucozade or equivalent
  • Unable to cooperate but conscious - glucose gel - buccal
  • Comatose, fitting - glucagon (sc, im, iv) or IV glucose 50% (venotoxic)
26
Q

What is the second-line treatment for T2DM?

A

If HbA1c rises to 58mmol/mol, consider dual therapy with:

  1. Metformin + DPP4 inhibitor e.g. sitagliptin
  2. MEtformin and pioglitazone
  3. Metformin and sulphonylurea
  4. Metformin and SGLT-2i (glifazon)
27
Q

What is the triple therapy options for T2DM?

A

HbA1c - 58mmol/mol

  1. Metformin, DPP4 inhibitor and SU
  2. Metformin, pioglitazone and SU
  3. Metformin, SU/pioglitazone and SGLT-2i
  4. Insulin-based therapy
28
Q

Which diabetic medications have a high risk of hypoglycaemia?

A
  • Sulphonylureas

- Basal insulin

Diabetes (4 decks)

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