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Endocrinology > Management of DM > Flashcards

Management of DM Flashcards

1
Q

How long will a diabetic spend with a healthcare professional?

A

3 hours

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2
Q

What are the management aims of type I DM?

A

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

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3
Q

How many type I DM are diagnosed in DKA?

A

1 in 4

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4
Q

What is available in Scotland for diabetics regarding information about blood glucose levels?

A

Standardisation of what glucose levels should be at different times before and after meals

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5
Q

What are the THINK symptoms?

A

Thirst
Thinner
Tired
Using Toiler more

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6
Q

What is the immediate test for suspected diagnosis?

A

Finger prick capillary glucose test

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7
Q

When is the diagnosis DM on finger prick capillary glucose test?

A

> 11 mmol/l

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8
Q

What investigations do you not wait for on suspected diabetes if they are presenting with think symptoms?

A 
DO NOT:
request a returned urine sample 
Arrange a fasting glucose test 
Arrange an OGTT
Wait for a lab result (urine or blood)
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9
Q

Who should you contact immediately on consultations about suspected DM?

A

Local specialist team for same day review

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10
Q

What is a red flag symptom in children with DM?

A

Bedwetting

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11
Q

What symptoms should you consider in children for DM?

A

heavier than usual nappies blurred vision
candidiasis (oral, vulval) constipation
recurring skin infections irritability,
behaviour change

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12
Q

What are the symptoms of DKA?

A 
Nausea and vomiting 
Abdominal pain 
Sweet smelling (ketotic breath)
Drowsiness 
Rapid and deep respiration 
Coma
Tachycardiac
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13
Q

What are key factors in supporting type I DM patients?

A

Education
Nutrition and lifestyle management
Skills training

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14
Q

What should you always check before injecting insulin?

A

Right insulin
Right dose
Right time
Right administration route

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15
Q

How many types of insulin are there?

A

Over 20

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16
Q

Where is education about type I DM available?

A 
Patient Handbooks 
Leaflets 
Websites 
Pregnancy 
Insulin Pump starts 
Rolling Programs/Topics Education Days 
CGM starts 
Apps CHO/fitness
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17
Q

What are the two ways insulin can monitor their BG at home?

A

Finger prick testing

Or can have a permanent pump

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18
Q

What is a CSII?

A

Continous subcutaneous insulin infusion

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19
Q

What is general advice for the administration of insulin injections?

A

Switch and rotate injection sites

Use fatty areas - buttocks, lower stomach, thighs

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20
Q

What is the twice daily insulin regimen?

A

Rapid acting mixed with intermediate actin

BB and BT

21
Q

What is the three times daily insulin regimen?

A

Rapid acting mixed with intermediate acting BB
Rapid acting BT
Intwrmediate acting at BBed

22
Q

What is the four times daily insulin regimen?

A

Short acting BB, BL, BT

Intermediate or long actinng Bbed

23
Q

What is hypoglycaemia?

A

Refers to any episode of low BG (<4mmol/l) with or without symptoms and may occur in patients taking insulin or sulphonylureas

24
Q

What are some causes of hypos?

A 
Too much insulin 
Inappropriate timing of insulin 
Injection site problem 
Inadequate food intake 
exercise 
Alcohol
25
Q

What should all diabetics carry with them?

A

Carbohydrates

26
Q

What can hypoglycaemia cause?

A

Coma, hemiparesis, seizures

27
Q

What is DKA?

A

Medical emergency

When the body starts breaking down and using Ketones

28
Q

What is the management of a patient with DKA?

A 
A,B,C,D,E
IV access
Vital signs 
Glucose 
Venous blood gases 
Urinanalysis 
U&amp;E 
FBC 
ECG 
Consider CXR
29
Q

What is the treatment for DKA?

A

Give IV saline
Give IV insulin
Give IV potassium
May need antibiotics

30
Q

What care should be given to a patient with DM?

A 
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
31
Q

What are the aims of diabetic treatment?

A

Relief of primary symptoms
Prevention of complications
Preservation of quality of life
Damage minimalisation

32
Q

What are the symptoms of Type II DM?

A 
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
33
Q

What is the step 5 frameowrk for choosing a glucose lowering drug?

A
  1. Set a target HbA1c
  2. ͞Take 5͟ Are there other risk factors that should be treated first?
  3. 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.

  1. Agree a review date and the target HbA1c with the patient
34
Q

What is the first line oral drug for type II?

A

Metformin

35
Q

What is the second line oral drug for type II?

A

Sulfonylurea
Glimepiride
Gliclazide
Glipizide

36
Q

What is the 3rd line oral drug for type II?

A

Thiazolidinedione

37
Q

How does metformin work?

A

Improves insulin sensitivity

38
Q

What are the advantages of metformin?

A 
Cheap 
Effective
Usually well tolerated 
Not associated with weight gain 
Reduced HbA1c by 12-17%
Can be used in pregnancy
39
Q

How do sulphonylureas work?

A

By increasing insulin

40
Q

What is the mechanism of action of sulphonylureas?

A 
Binds to its receptor 
Closes of ATP sensitive potassium channels 
Decrease potassiun 
Depolarisation 
Influx of calcium 
Insulin is exocytosed
41
Q

What are the advantages of sulphonylureas?

A 
Can be used with metformin 
Give rapid improvement in control 
Rapid titration 
Cheap 
Generally well tolerated
42
Q

What are the disadvantages of sulphonylureas?

A

Risk of hypos
Weight gain
Caution in renal and hepatic disease
Cant use in prenancy

43
Q

What is the action

of Thiazolidinedione?

A

They improve insulin resistance

44
Q

What are the advantages of Thiazolidinedione?

A

God for people with significant insulin resistance
Reduce HbA1c
Cheap
CVS safety is established

45
Q

What are the disadvantages

of Thiazolidinedione?

A

Increase risk of bladder cancer
Fluid retention
Weight gain
Fractures in females

46
Q

What is the main contraindication of metformin?

A

eGFR<30

47
Q

What is the main adverse effect of metformin?

A

GI upset

Diarrhoea

48
Q

What is the renal restriction with metformin, SU’s and Glitazone?

A

Metformin - stop if eGFR <30
SU’s - no restriction
Glitazone - no restriction

Endocrinology (19 decks)

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