T2DM Flashcards
What are the HbA1c thresholds for treatment? NAme each stage
42-48- Lifestyle advice
>48 Lifestyle advice and metformin
>58 Add a second drug (Sulphonurea) and potentially another if it is resistant
How often should you check HbA1c?
Every 3 months until stable then every 6
What is impaired fasting glucose caused by?
Hepatic insulin
What is glucose tolerance a test of?
Muscle insulin resistance= test for T2DM
What does HbA1c test?
3 months worth of blood sugar
What is the target BP in T2DM?
140/90
What lifestyle measures are used in T2DM?
Excercise
Weight loss
Dietary advice (glycaemic index tool)
How are diabetic feet checed?
Annually by diabetic nurse
How do you assess for peripheral neuropathy?
ABPI
Describe diabetic foot disease
Absent pulses Peripheral neuropathy Ulcers and cellulitis risk Intermittent claudication in legs Osteomyelitis risk
How do you check for diabetic nephropathy?
Cr 9 (early morning)
Albumin
Us and Es all checked annually
What is used to reduce risk of nephropathy?
BP control and statins
Describe diabetic peripheral neuropathy
PAINFUL
Glove and stocking distrobution
Glucose damages nerves
What is used to treat Neuropathy?
Trycyclics
Pregabalin/Gabapentin/Duloxetine
Rescue- Tramadol
What should you always check with retinopathy?
Acuity
What is the pathophysiology of retinopathy
Glucose build up causes vessels to be destroyed and reform (micraneurysm and revasculasation and ischeamia)
How does DKA present?
Pain
Polyuria
Polydipsia
(Reduced consiousness and vomit)
IS DKA more T1 or T2DM?
T1
How is DKA managed?
Fluids
Insulin
Potassium (to protect heart- but created cerebral oedema risk)
What is the main side effect of Metformin?
GI upset
Name 6 different kinds of diabetes medication
Metformin Sulphonureas is Glicaside SGLT2 Inhibitors ie Canagliflozin Gliptins ie Vildagliptin Pioglitazone Insulin
Which diabetes meds cause weight gain and hypos risk?
Sulphonureas
Insulin
Which Diabetes med causes weight loss?
SGLT2 Inhibitors BUT last line used as very expensive
What are the side effect of gliptins?
Pancreatitis
When is a second medication added to metformin and what can be added?
>58 HbA1c Sulphonurea Gliptin Pioglitazone SGLT2 Inhibitor
What is done if HbA1c remains >58 on 2 medications?
Go to triple therapy:
Sulphonurea and any of the others
OR INSULIN (continue metformin)
What is done if patients cannot tolerate Metformin?
If HbA1c >48 = Sulphonurea, Gliptin or Pioglitazone
If HbA1c >58 = Gliptin + Sulphonurea/Pioglitazone
What also needs to be treated in diabetes?
Other risk factors
ACEi for hypertension
Lipid modification
Antiplatelet for existing CV disease
