Management of DM Flashcards
How long will a diabetic spend with a healthcare professional?
3 hours
What are the management aims of type I DM?
Prompt diagnosis
Encouragement of the appropriate self-management skill set
Correction of acute metabolic upsets at diagnosis and thereafter
Facilitate long term health and well being
How many type I DM are diagnosed in DKA?
1 in 4
What is available in Scotland for diabetics regarding information about blood glucose levels?
Standardisation of what glucose levels should be at different times before and after meals
What are the THINK symptoms?
Thirst
Thinner
Tired
Using Toiler more
What is the immediate test for suspected diagnosis?
Finger prick capillary glucose test
When is the diagnosis DM on finger prick capillary glucose test?
> 11 mmol/l
What investigations do you not wait for on suspected diabetes if they are presenting with think symptoms?
DO NOT: request a returned urine sample Arrange a fasting glucose test Arrange an OGTT Wait for a lab result (urine or blood)
Who should you contact immediately on consultations about suspected DM?
Local specialist team for same day review
What is a red flag symptom in children with DM?
Bedwetting
What symptoms should you consider in children for DM?
heavier than usual nappies blurred vision
candidiasis (oral, vulval) constipation
recurring skin infections irritability,
behaviour change
What are the symptoms of DKA?
Nausea and vomiting Abdominal pain Sweet smelling (ketotic breath) Drowsiness Rapid and deep respiration Coma Tachycardiac
What are key factors in supporting type I DM patients?
Education
Nutrition and lifestyle management
Skills training
What should you always check before injecting insulin?
Right insulin
Right dose
Right time
Right administration route
How many types of insulin are there?
Over 20
Where is education about type I DM available?
Patient Handbooks Leaflets Websites Pregnancy Insulin Pump starts Rolling Programs/Topics Education Days CGM starts Apps CHO/fitness
What are the two ways insulin can monitor their BG at home?
Finger prick testing
Or can have a permanent pump
What is a CSII?
Continous subcutaneous insulin infusion
What is general advice for the administration of insulin injections?
Switch and rotate injection sites
Use fatty areas - buttocks, lower stomach, thighs
What is the twice daily insulin regimen?
Rapid acting mixed with intermediate actin
BB and BT
What is the three times daily insulin regimen?
Rapid acting mixed with intermediate acting BB
Rapid acting BT
Intwrmediate acting at BBed
What is the four times daily insulin regimen?
Short acting BB, BL, BT
Intermediate or long actinng Bbed
What is hypoglycaemia?
Refers to any episode of low BG (<4mmol/l) with or without symptoms and may occur in patients taking insulin or sulphonylureas
What are some causes of hypos?
Too much insulin Inappropriate timing of insulin Injection site problem Inadequate food intake exercise Alcohol
What should all diabetics carry with them?
Carbohydrates
What can hypoglycaemia cause?
Coma, hemiparesis, seizures
What is DKA?
Medical emergency
When the body starts breaking down and using Ketones
What is the management of a patient with DKA?
A,B,C,D,E IV access Vital signs Glucose Venous blood gases Urinanalysis U&E FBC ECG Consider CXR
What is the treatment for DKA?
Give IV saline
Give IV insulin
Give IV potassium
May need antibiotics
What care should be given to a patient with DM?
BG levels checked BP Blood lipids Eyes Screened •Feet checked •Kidney function •Weight •Smoking Cessation Support •Individual Care plan •Education Course •Emotional and psychological support
What are the aims of diabetic treatment?
Relief of primary symptoms
Prevention of complications
Preservation of quality of life
Damage minimalisation
What are the symptoms of Type II DM?
Frequent urination Increased thirst Blurry vision Feeling drowsy or sleepy Tingling pain or numbness in hands and feet Slow or inproper healing and cuts Genital itching or thrush
What is the step 5 frameowrk for choosing a glucose lowering drug?
- Set a target HbA1c
- ͞Take 5͟ Are there other risk factors that should be treated first?
- Are the current treatments optimised. Max dose? Tolerated? Taken?
4.What are the glucose lowering options?
•Remove any that are contraindicated
•Of the remaining what are the pros and cons
•Select the preferred choice.
- Agree a review date and the target HbA1c with the patient
What is the first line oral drug for type II?
Metformin
What is the second line oral drug for type II?
Sulfonylurea
Glimepiride
Gliclazide
Glipizide
What is the 3rd line oral drug for type II?
Thiazolidinedione
How does metformin work?
Improves insulin sensitivity
What are the advantages of metformin?
Cheap Effective Usually well tolerated Not associated with weight gain Reduced HbA1c by 12-17% Can be used in pregnancy
How do sulphonylureas work?
By increasing insulin
What is the mechanism of action of sulphonylureas?
Binds to its receptor Closes of ATP sensitive potassium channels Decrease potassiun Depolarisation Influx of calcium Insulin is exocytosed
What are the advantages of sulphonylureas?
Can be used with metformin Give rapid improvement in control Rapid titration Cheap Generally well tolerated
What are the disadvantages of sulphonylureas?
Risk of hypos
Weight gain
Caution in renal and hepatic disease
Cant use in prenancy
What is the action
of Thiazolidinedione?
They improve insulin resistance
What are the advantages of Thiazolidinedione?
God for people with significant insulin resistance
Reduce HbA1c
Cheap
CVS safety is established
What are the disadvantages
of Thiazolidinedione?
Increase risk of bladder cancer
Fluid retention
Weight gain
Fractures in females
What is the main contraindication of metformin?
eGFR<30
What is the main adverse effect of metformin?
GI upset
Diarrhoea
What is the renal restriction with metformin, SU’s and Glitazone?
Metformin - stop if eGFR <30
SU’s - no restriction
Glitazone - no restriction
