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Year 3 GP > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Type 1 diagnosis

A

Random plasma glucose more than 11 mmol/L

+:

  • Polyuria.
  • Polydipsia.
  • Excessive tiredness
  • Ketosis
  • Weight loss.
  • Age of onset younger than 50 years.
  • Body mass index (BMI) below 25 kg/m2.
  • Personal and/or family history of autoimmune disease.
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2
Q

Mx of type 1 diabetes

A

Refer the child or young person immediately (on the same day) to a paediatric diabetes care team

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3
Q

DKA

A

blood glucose level greater than 11 mmol/L) and:

  • Polyuria and polydipsia
  • Dehydrated
  • Weight loss.
  • Persistent vomiting and/or diarrhoea.
  • Abdominal pain.
  • Visual disturbance.
  • Lethargy and/or confusion.
  • Fruity smell of acetone on the breath.
  • Acidotic breathing — deep sighing (Kussmaul) respiration.
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4
Q

Precipitating DKA factors

A
  • Infection
  • Physiological stress
  • Non-adherence to insulin treatment regimen
  • Diabulimia
  • Drug treatment e.g. corticosteroids, diuretics, and sympathomimetic drugs - salbutamol
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5
Q

Ix of type 1 diabetes

A
  1. Blood glucose

2. Ketones serum 3+mmol and urine 2+

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6
Q

Mx of type 1 diabetes

A

Child:

  • Care package
  • education
  • Immunised
  • T1DM identification
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7
Q

Education programme T1DM

A

DAFNE - dose adjustment for normal eating

Insulin therapy
Blood glucose monitoring,
The effects of diet, physical activity, and intercurrent illness on blood glucose control.
Managing intercurrent illness (‘sick-day rules’)
Detecting and managing hypoglycaemia, hyperglycaemia, and ketosis.

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8
Q

target HbA1c for children and young people with type 1 diabetes

A

48 mmol/mol (6.5%)

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9
Q

Optimal targets for glucose self-monitoring in children and young people with type 1 diabetes

A

Random glucose - 4–7 mmol/L

  • before meals
  • waking

Plasma glucose level of 5–9 mmol/L after meals.

For young people of driving age, plasma glucose level of at least 5 mmol/L when driving.

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10
Q

Sick-day rules

A

Never stop or omit insulin.

Insulin dose may need altering during illness; they should seek advice from their diabetes team

Check blood glucose and ketones more frequently

Maintain their normal meal pattern

Maintain adequate fluid intake to prevent dehydration

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11
Q

Type 1 follow up

A

Once a year, offer monitoring:

  • albumin:creatinine ratio
  • Hypertension
  • Thyroid disease
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12
Q

Screening for eye disease

A

eye examination by an optometrist every 2 years until the age of 12 years

After 12 diabetic eye screening programme

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13
Q

Types of diabetes

A

T1DM — an absolute insulin deficiency causes persistent hyperglycaemia

T2DM— insulin resistance result in persistent hyperglycaemia.

Gestational diabetes — hyperglycaemia develops during pregnancy and usually resolves after delivery, although the woman is at increased risk for overt type 2 diabetes in the future.

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14
Q

Macrovasular complications of diabetes

A

Atherosclerotic cardiovascular disease (CVD)

  • Stoke
  • Peripheral arterial disease
  • MI
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15
Q

Microvascular

A

Nephropathy - Diabetic kidney disease
Retinopathy - blindness
Peripheral neuropathy -
Autonomic neuropathy - postural hypotension

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16
Q

Diabetic foot

A

Due to peripheral neuropathy - can’t feel pain and ill fitted shoes

And

Peripheral arterial disease - insufficient blood supply can cause ulcers

17
Q

Hyperosmolar hyperglycaemic state (HHS) presentation

A 
Polydipsia and polyuria.
Weight loss.
Abdominal pain, nausea and/or vomiting.
Shortness of breath.
Lethargy, drowsiness, and/or confusion.
A possible history of precipitating factor(s).
Clinical signs:
Fruity smell of acetone on the breath.
Tachypnoea, acidotic breathing (deep sighing 'Kussmaul respiration').
Tachycardia, dehydration 
Blood or urinary ketones

Adult - test for blood or urinary ketones, even if plasma glucose levels are near normal.

Child - test for blood ketones, even if plasma glucose levels are near normal.

18
Q

T2Dm diagnosis

A

Symptomatic + either 1 abnormal HbA1c or fasting plasma glucose level

Asymptomatic + atleast 2 tests done on different days either HbA1c or plasma glucose

19
Q

Persistent hyperglycaemia

A

HbA1c of 48 + mmol/mol (6.5%)

Fasting plasma glucose level of 7.0 + mmol/L

Random plasma glucose of 11.1 + mmol/L in the presence of symptoms or signs of diabetes.

20
Q

When can HbA1c not be used

A
  • Children and young people less than 18 years of age.
  • Pregnant women or women who are 2 months postpartum.
  • Symptoms of diabetes for less than 2 months.
  • High diabetes risk who are acutely ill.
  • Medication that may cause hyperglycemia (long-term corticosteroid treatment)
  • Acute pancreatic damage, including pancreatic surgery.
  • ESRD
  • HIV infection
21
Q

HHS precipitating factors

A

Infection
Inadequate insulin or non-adherence with insulin treatment
New onset of diabetes mellitus or other physiological stress - trauma or surgery
Medical conditions - hypothyroidism or pancreatitis
Drugs - corticosteroids, diuretics, atypical antipsychotics, and sympathomimetic drugs such as salbutamol

22
Q

Hypoglycaemia

A

Blood glucose levels less than 3.5 mmol/L

23
Q

Mx of T2DM

A
  1. DESMOND

2. Medication - metformin

24
Q

HbA1c target with drug treatment associated with hypoglycaemia (such as a sulfonylurea)

A

53mmol 7%

25
Q

Sick-day rules T2Dm

A

Temporarily stop some drug treatments during acute illness. Medication restarted once the person is feeling better and eating and drinking for 24–48 hours

Stop:
- Metformin - if rehydrated due to risk of lactic acidosis

  • Sulfonylurea - hypoglycaemia
  • SGLT2
  • GLP - 1 agonist - if dehydrated due to risk of AKI

Do not stop insulin therapy

26
Q

Diabetes screening

A

Retinopathy - every 2 years for low risk or annually for high risk

Foot review - once a year

Kidney disease - annually
- Arrange an early morning first-void urine sample for assessment of microalbuminuria

Year 3 GP (20 decks)

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