Primary care aspects of diabetes Flashcards
Who is considered a high risk group and should be recalled annually for a plasma glucose?
Impaired glucose tolerance Impaired fasting lgucose Past history of gestational diabetes Non-causatian Family history of type 2 Obese with central adiposity Women with PCOS
In what patients should diabetes be suspected?
Thirst and polyuria Unexplained wight loss or tenderness Pruritus vulvae, balantits or recurrent UTIs Recurrent infections Blurring of vision Discoloured or ulcerated feet Acutely unwell - vomiting/ abdo pain
What are the criterea for diagnosing diabetes if there are classical symptoms present?
Random plasma venous glucose above 111.1
Fasting venous plasma lucose of 7.0
What is the criterea for diagnosing diabetes with no symptoms but an incidental finding of glycosuria or hyperglycaemia?
Single venous plasma glucose measurement
Additional testing on another day with a value in the diabetic range
What is the criterea for diagnosing diabetes if ketonuria is present?
Severe symptoms - vomiting and dehydration
Milder symptoms and weight loss
What is the oral glucose tolerance test (OGTT)?
No food or drink for 8/12 hours prior to test
Drink glucose
Blood tested 2 hours later
Above 11.1 = diabetes
What si the fasting plasma glucose test?
No food or drink prior to test
Blood drawn and tested for level of glucose in blood
Above 7 = diabetes
When should a new diabetic be referred to secondary care?
Definite or type 1 diabetes Patient with a low BMI All children Patients who are planning on pregnancy or are pregnant Pre-existing chronic renal impairement Under 40 with a diagnosis of type 2
What is the initial management for a new patient with T2DM?
Register with SCI-DC Retinopathy screening Initial support and info Refer for education Check baseline BMI, BP, urinalysis for protein/microalbumin/ ketones, bloods for HbA1c, creatinine/ /eGRF, lipid proflie Identify and treat other risk factors Manage CV risk Manage glyaemic control Foot screening and risk assessment
What is the initial treatment for a new diagnosis of T2DM?
3 month trial of lifestyle changes Weight loss Healthy eating Exercise Smoking cessation Alcohol consumption Lipids and BP management
What type of diet should be utilised in T2DM for weight loss?
Low carb diet can be safe and effective in the short term in managing weight, improving glycaemic control and CV risk in people with T2DM
What are the stages in the cycle of change?
Pre-contemplation Contemplation Preparation Action Maintenance
What are the barriers to change?
Locus of control Shame Stigma Lack of knnowledge Depression Lack of resources Cost
What psychosocial factors are present in T2DM?
Depression is more common in those with dabetes
Presence of micro and macro vascualr complications is associated with a higher prevalance of depression
Remission of depression is associated with an improvement in glycaemic control
How should an intercurrent illness be manged in T1DM?
Insulin should NEVER be omitted due to risk of DKA
ALWAYS check for ketones
What foods and fluids should be given to T1DM during an illness?
100-200ml every hour
Regular intake of carbs, regardless of blood glucose to facilitate insulin administration; insulin required to correct ketosis
At mealtimes, if unable to eat, but tolerating fluids, take carbs in the form of 200ml of hot chocolate/ ovaltine/ coca cola or lemonade
How often should blood glucose be monitored in T1DM who have an illness?
4 hourly
When should ketones be measured in those with T1DM who have an illness?
Check ketones in patients who are acutely unwell, vomiting and/or during pregnancy, irrespective of BG levels
What is the normal blood ketone level?
Less than 0.6 mmol/L
What should be done if ketone levels are greater than 0.6 mmol/L?
Consider extra insulin by increaseing routine insulin dose by 10% if blood glucose levels are elevated
Consider STAT dose of rapid acting insulin
Reckeck blood glucose and ketone levels in 1/2 hours
What is the recommended insulin management during illness in T1DM?
NEVER OMIT INSULIN
More insulin is often required
Increase routine insulin if the trend of recent blood gluose levels are elevated
During illness, extra insulin can be adminstered 2/4 hourly to address elevated blood glucose levels
If ketosis is evident with a low/ normal blood glucose then hospital admission is needed
What is the guidance for circulation of extra rapid acting insulin?
Increase usual insulin by 10% if recent trend of BG is over 10 mmol/L
Extra insulin can corret hyperglycaemia and clear ketones
Use short acting for STAT dosing (actrapid, novorapid, humalog)
Calculate STAT dose as 10-20% of patients daily dose of insulin
Reckeck blood glucose and ketones in 1/2 hours
When should type 1 diabetics be admitted to hospital in intercurrent illness?
Inability to swallow or keep fluids down
Persistant vomiting
Persistant diarrhoea
Strongly positive ketonuria with or without hyperglycaemia
When ketoacidosis is clinically obvious - dehydration, abdo pain, vomiting, rapid or laboured breathing
When should metformin be stopped in type 2 diabetes?
If severe infection or dehydration
Admission to hospital is recquired if there is severe dehydration or intractable vomiting
