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ENDOCRINE - HIGH WEIGHTED > ENDOCRINE - T2D > Flashcards

ENDOCRINE - T2D Flashcards

1
Q

How long would you try diet management and exercise for before going on meds?

A

3 months

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2
Q

What would you suggest if hba1c was 48mmol/L?

A

Monotherapy

  • metformin (standard release then m/r)
  • If contraindicated = DPP or PIO or SU
  • Target = 48mmol/L and 53mmol/L with SU
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3
Q

What would you suggest if hba1c was 58mmol/L?

A

Dual therapy

  • Metformin with (DPP or PIO or SU or SGLT)
  • CI = (DPP and PIO) or (DPP and SU) or (PIO and SU)
  • If it continues to rise - triple therapy or insulin programme
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4
Q

What does metformin do?

A

decreases synthesis of glucose by the liver

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5
Q

What are the side effects of metformin?

A
  • Lactic acidosis if egfr <30ml/min - avoid in renal imp or tissue hypoxia
  • GI disturbance
  • weight loss
  • taste disturbance
  • reduced vit b12 absorption
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6
Q

Who is metformin contraindicated in?

A
  • renally impaired
  • general anaesthesia
  • iodine-containing contrast media
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7
Q

What do sulphonylureas do?

A

augment insulin secretion

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8
Q

What are some examples of short acting sulphonylureas?

A
  • gliclazide

- tolbutamide

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9
Q

What are some examples of long acting sulphonylureas?

A
  • glibenclamide (2nd and 3rd trimester)

- glimepiride

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10
Q

What are the side effects of sulphonylureas?

A
  • hyponatraemia
  • hypoglycaemia
  • weight gain
  • jaundice
  • hypersensitivity in first 6-8 weeks
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11
Q

What interacts with sulphonylureas?

A
  • warfarin and ACE = increased hypo

- NSAIDs = reduced renal excretion

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12
Q

What are the side effects of pioglitazone?

A
  • heart failure - CI if already existing
  • bladder cancer - CI if already existing
  • hepatotoxicity - stop if jaundice occurs
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13
Q

What are some examples of SGLT-2 inhibitors (gliflozins)?

A
  • empaglaflozin (jardiance)
  • dapaglaflozin (forxiga)
  • canagliflozin
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14
Q

What do the gliflozins do?

A
  • prevent glucose reabsorption in the kidneys

- increase urine output with glucose combined

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15
Q

What are the side effects of gliflozins?

A
  • life threatening atypical DKA with only moderately raised BG level - report symptoms
  • volume depletion - hypotension, dizziness
  • canagliflozin can cause increased risk of lower limb amputations
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16
Q

What do the gliptins do?

A

break down the hormone incretin therefore helps increase insulin secretion

17
Q

What are the side effects of gliptins?

A
  • pancreatitis - ab pain

- vidagliptin can cause liver toxicity

18
Q

What are examples of meglitinides?

A
  • repaglinide

- nateglinide

19
Q

What are the side effects of meglinitides?

A
  • hypersensitivity
  • visual disturbance
  • GI discomfort
20
Q

When would acarbose be used?

A
  • last resort - when other oral hypoglycaemics cant be taken

- delays digestion and absorption of starch and glucose

21
Q

What are the side effects of acarbose?

A
  • flatulence

- diarrhoea

22
Q

How would you diagnose T2D?

A
  • HbA1c blood test - 6.5% or above to diagnose type 2

- oral glucose tolerance test

23
Q

What would you monitor in T2D?

A
  • urinanalysis - ketones, protein (albumin), glucose

- blood monitoring - ketones and glucose

24
Q

What is the pre-prandial blood glucose target (Before meals) in T2D?

A

4-7 mmol/L

25
Q

What is the post-prandial blood glucose target (after meals) in T2D?

A

< 9 mmol/L

26
Q

How often does HbA1c need to be measured in T2D?

A

every 3 to 6 months

27
Q

What is the HbA1c target in diabetics?

A

6.5-7.5%

28
Q

What is the HbA1c target in pts at high risk of arterial disease?

A

< 6.5%

29
Q

What is the target blood pressure for diabetics with hypertension?

A
  • without complications = 140/80

- with complications = 130/80

30
Q

What BG level indicated hypoglycaemia?

A

< 4mmol/L

31
Q

What are some symptoms of hypoglycaemia?

A
  • hunger
  • pale skin
  • tingling lips
  • sweating/clammy
  • palpitations
  • dizziness/confusion
  • blurred vision
  • slurred speech etc
32
Q

How would you treat hypoglycaemia as a medical emergency?

A
  • 10-20g glucose/sucrose e.g. lucozade, coca cola, ribena

- if necessary repeat after 15 mins

33
Q

How would you treat hypoglycaemia if the patient was unresponsive or unconscious?

A
  • SC/IM glucagon

- If unresponsive after 10 mins = IV glucose

ENDOCRINE - HIGH WEIGHTED (7 decks)

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