W7 Diabetes Type 2 (AG) Flashcards
What is the definition of Type 2 diabetes?
Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance.
Insufficient pancreatic insulin production also occurs progressively over time, resulting
in hyperglycaemia
What are the ranges for persistent hyperglycaemia?
*HbA1c of 48 mmol/mol (6.5%) or more.
*Fasting plasma glucose level of 7.0 mmol/L or more.
*Random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs
of diabetes
What are the clinical features of type 2 diabetes?
- Polydipsia, polyuria, blurred vision, unexplained weight loss, recurrent infections, and tiredness.
- Acanthosis nigricans (a skin condition causing dark pigmentation of skin folds, typically the axillae, groin, and neck), which suggests insulin resistance
What are the risk factors for type 2 diabetes?
*Obesity and inactivity
*Family history
*Ethnicity
*History of gestational diabetes
*Diet
*Drug treatments: statins, corticosteroids, and combined treatment with a thiazide
diuretic plus a β-blocker
*Polycystic ovary syndrome
*Metabolic syndrome: a combination of raised blood pressure, dyslipidaemia, fatty liver
disease, central obesity, and a tendency to develop thrombosis.
*Low birth weight for gestational age
What does DESMOND stand for?
Diabetes Education and Self Management for Ongoing and Newly Diagnosed
➢ Individualised care
➢ Education
What are the Treatment & HbA1c targets for T2DM? (2)
What is classed as poor control of diabetes?
- A target HbA1c of 48 mmol/mol (6.5%) is
recommended when managed by diet and
lifestyle alone or when combined with a single
anti-diabetic drug such as metformin - Adults prescribed a single drug associated
with hypoglycaemia (such as sulphonylurea),
or two or more anti-diabetic drugs, should aim for an HbA1c of 53 mmol/mol (7.0%) - Poor control of diabetes is defined as a
HbA1c of 58 mmol/mol (7.5%) or higher - drug treatment should be intensified
Blood glucose monitoring:
Self-monitoring of blood-glucose concentration is appropriate for which patients with type 2 diabetes? (2)
Why? (2)
- who are treated with insulin;
- who are treated with oral hypoglycaemia
drugs e.g. sulfonylureas
-to monitor changes in blood-glucose
resulting from changes in lifestyle or medication or during illness
-to ensure safe blood glucose during
activities including driving
Do not routinely offer self-monitoring of capillary blood glucose levels for adults with
type 2 diabetes unless? (4)
- the person is on insulin or
- there is evidence of hypoglycaemic episodes or
- the person is on oral medication that may increase their risk of hypoglycaemia while
driving or operating machinery or - the person is pregnant or is planning to become pregnant
Treatment guidelines
- Assess HbA1c, cardiovascular risk, kidney function
* Symptomatic hyperglycaemia- Insulin or a sulfonylurea
* Diet and lifestyle advice
Not at high CVD risk:
- Metformin
- Metformin MR (GI disturbance)
Chronic heart failure or established atherosclerotic CVD:
* Metformin
* Metformin MR (GI disturbance)
* As soon as metformin tolerability is confirmed- SGLT2 inhibitor (“flozin”)
High risk of CVD:
* Metformin
* Metformin (GI disturbance)
* As soon as metformin tolerability is confirmed- SGLT2 inhibitor (“flozin”)
First-line drug treatments?
DP-
Diabetes mellitus
Diabetes & driving:
- Drivers may be required to notify DVLA of their condition (if they’re taking insulin or have hypoglycaemic episodes). Drivers treated with insulin should always carry a glucose meter and strips when driving, must check no more than 2 hours before driving and every 2 hours while driving.
- Blood-glucose should always be above 5
mmol/L while driving. If it falls below 5 a fast-acting carbohydrate snack should be taken
If blood-glucose is less than 4 mmol/L or warning signs of hypoglycaemia develop- the driver should not drive:
* stop the vehicle in a safe place
* switch off engine, remove keys from the
ignition and move from the driver’s seat
* eat or drink a suitable source of sugar
* wait until 45 minutes after blood glucose has returned to normal, before continuing
journey,
Drivers must not drive if hypoglycemia awareness has been lost and the DVLA must be notified; driving may resume if a medical report confirms that awareness has been regained.
Diabetes mellitus- Acute illness
What rules must patients adhere to?
During a period of illness that does not require admission, remind the person to adhere to the following ‘sick-day rules’ which should have been provided by their diabetes team. They should:
- Not stop their insulin therapy.
- Monitor their blood glucose levels more frequently.
- Consider ketone monitoring (blood or urine).
- Maintain their normal meal pattern (where possible) if appetite is reduced.
- Aim to drink at least 3 L of fluid (5 pints) a day to prevent dehydration.
- Seek urgent medical advice if they are violently sick, drowsy, or unable to keep fluids down.
- When feeling better, continue to monitor their blood glucose carefully until it returns to normal
Diabetes mellitus- Acute illness
What are the SADMAN rules?
There are several drug classes that should be temporarily stopped in conditions that could lead to complications
S- SGLT2 Inhibitors (inc risk of euglycaemic DKA)
A- ACE inhibitors ( inc risk of AKI)
D- Diuretics ( inc risk of AKI)
M- Metformin (inc risk of lactic acidosis)
A- ARBs (inc risk of AKI)
N- NSAIDs (inc risk of AKI)
Complications of T2DM?
o Microvascular complications — retinopathy, nephropathy, and neuropathy.
o Macrovascular complications — cardiovascular disease (CVD), cerebrovascular disease, and
peripheral arterial disease (PAD).
o Metabolic complications — dyslipidaemia and diabetic ketoacidosis (DKA, uncommon).
o Psychological complications — including anxiety and depression.
o Reduced quality of life.
o Reduced life expectancy
What is HHS?
Symptoms?
Treatment?
Hyperosmolar hyperglycaemic state (HHS)
Definition: very high blood glucose levels (often over 40mmol/l).
HHS symptoms can frequently include:
* urination,
* thirst
* nausea
* dry skin
* disorientation and, in later stages, drowsiness and a gradual loss of consciousness.
Treatment:
* Fluids to hydrate you.
* Electrolytes (such as potassium) to balance the minerals in your body.
* Insulin to regulate your blood sugar levels.
