T2DM (Y6) Flashcards
What is the cause of blurred vision in diabetes mellitus?
Osmotic effects of glucose on the lens of the eye –> alter refraction and blur vision
Patient should NOT see optician until blood glucose normalised
What is the initial management of T2DM at diagnosis ?`
Advice on diet
Advice on physcial activity
Screening for diabetic complications
Why is metformin 1st line? What needs to be monitored on it?
Good glucose lowering efficacy and is weight neutral
Increase dose gradually to avoid adverse effects
If intolerable switch to modified release metformin
RENAL function must be monitored BEFORE and DURING use
Which T2DM treatments increase weight?
Pioglitazone (thiazolidinediones - increases sensitivity)
Gliclazide (sulfonylurea - stimulates beta cells)
When are patients at increased risk of lactic acidosis with metformin?
If they are in renal failure
Which T2DM drug has a side effect of fluid retention?
thiazolidinediones (glitazones) - can sometimes precipitate cardiac failure
What are the main SE of metformin?
nausea and diarrhoea
lactic acidosis (rare)
Which T2DM drug causes hypoglycaemia?
Sulfonylureas
Insulin
In addition to the previously mentioned therapies what else needs to be considered in T2DM?
Cardiovascular risk factors = consider HTN and lipid therapies
1st line HTN = ACEi e.g. ramipril
Irrespective of the lipid profile however, this patient requires lipid-lowering therapy as most authorities recommend starting statin therapy in all diabetic patients aged 84 years and younger with a QRISK2 score of 10% or more.
What do statins reduce?
LDL
Summarise the medications used for T2DM, their side effects and effects on weight and hypoglycaemia.
Summarise the algorithm for first line treatments in T2DM.
Summarise the treatment options in T2DM if further interventions are needed after first line therapy.
List the 4 complications of microvascular disease in diabetes.
Renal damage
Retinopathy
Neuropathy - autonomic and peripheral
How often do you get screening for complications in type 2 diabetes?
Eye screening - at diagnosis and every 2 years if low risk (no previous retinopathy) or annually if high risk (previous retinopathy)
Foot check - at diagnosis then annually
Diabetic kidney disease - annually
Cardiovascular risk - BP, full lipid profile, height weight BMI = annually
Peripheral and autonomic neuropathy - varies
What is shown?
- Rubeosis iridis (formation of abnormal blood vessels on the anterior iris).
- an ophthalmological emergency in diabetic retinopathy
How often should patients check their own feet in diabetic foot problems?
Every day - including the skin and between the toes
Avoid tight shoes and socks
Change socks daily
How is a diabetic foot check conducted?
Examine for:
- Peripheral neuropathy — a 10 g monofilament should be used as part of a foot sensory examination, to assess for loss of protective sensation (LOPS).
- PAD - palpate DP and PT; ABPI if indicated
- Ulcers or pre-ulcerative signs -
- Infection, inflammation
- Deformity
- Gangrene
- Charcot arthropathy
- Foot hygiene
Assess footwear and consider referral to podiatry
How do you assess for diabetic kidney disease?
Early morning first void urine analysis = look for microalbuminuria (by estimating ACR)
Serum creatinine at the same time = for eGFR measurement
Should you routinely give antiplatelet for prevention of CVD in diabetes type 2?
No
How do you assess for CVD risk in diabetes?
- Assess risk factors - smoking, blood glucose
- BP
- Albuminuria (CKD)
- Lipid profile - aim for 40% reduction in LDL
- Height, weight, BMI measurement
How do you assess for peripheral and autonomic neuropathy in diabetes?
- Sensory - ask for symptoms e.g. numbness, burning, shooting pains, paraesthesias in glove and stocking distribution
- Motor - wasting, cramps, twitching
Autonomic:
- Postural hypotension (30*mmHg drop on standing 1min and 3mins after lying down 5mins)
- Diabetic gastroparesis - bloating, delayed emptying, nausea, vomiting
- Lower GI - nocturnal diarrhoea, faecal incontinence
- Urinary - hesitancy, reduced frequency, inadequate emptying, retention
- Sexual dysfunction - ED or retrograde ejaculation
- Sweating - reduced in glove and stocking distribution
- Impaired awareness of hypoglycaemia
*other guidelines say 20mmHg but NICE says 30mmhg
