T2DM counselling

Question 1

brief intro to T2DM

Answer 1

normally CHDs broken down and taken up by cells for energy

insulin helps uptake by cells

cells don’t respond to insulin anymore –> high glucose in blood

xs sugar goes to urine –> draws water from cells and blood –> xs urination –> thirsty & lose weight & tired

sugar attracts infections/UTIs

Question 2

RFs

Answer 2

obesity
age
Asia, African-Caribbean
FH

Question 3

complications

Answer 3

immediate - dehydration, drowsy

long-term - nephropathy, retinopathy, neuropathy

Question 4

Tx philosophy & steps

Answer 4

keep glucose within normal range (4-7 or <10 2hrs after)

lifestyle - weight loss can have significant effects, smoking, BP, activity

meds - metformin, sulphonylureas

insulin if meds don’t work

sick day rules

Question 5

warn of hypo with Tx

Answer 5

<4mmol/l

too much meds // missed meals // unplanned exercise

tremor // sweating // anxious // blurred vision

Question 6

regular checks

Answer 6

annual reviews

HbA1C & BP 6-monthly checks

cholesterol measurements // kidney check (U&Es // ACR // eGFR)

dietician referral

eye checks // foot check

flu vaccine each autumn // pneumococcus vaccine once

NHS prescription exemption (for all meds)

conception advice // group education programmes

Question 7

counselling structure

Answer 7

explanation diabetes & symptoms
explain complications
discuss screening for complications & reviews
impact on living & lifestyle
treatment options

Question 8

sick day rules

Answer 8

continue insulin but monitor BM & ketones

stop the following medication until eating/drinking for 24hrs:
ACE/ARB/metformin/diuretics/GLP1/NSAIDs - AKI
metformin (lactic acidosis)
sulphonylureas (hypoglycemia)

if unable to eat/drink:
replace meals with carb containing drinks (sugar free if blood sugars high)