//Diabetes// Flashcards
(20 cards)
How often should a pt with T1DM monitor their HbA1c levels?
Every 3-6 months (NICE)
What is the target HbA1c for pts with T1DM?
< 48 mmol/ mol (or < 6.5%)
But a different target can be set based on the pts treatment and responses
What is a DPP-4 inhibitor? What’s the MOA? Give examples
Dipeptidyl peptidase-4 inhibitor (gliptins )
Blocks the action of DPP-4, therefore increases levels of the hormone incretin which helps produce more insulin when needed and reduce the amount of glucose produced by the liver
Examples: Sitagliptin, Linagliptin, Saxagliptin, Vildagliptan
What is an SGLT2 inhibitor? What is the MOA? Give examples
Sodium glucose co-transporter 2 inhibitor (gliflozosins)
Inhibition of SGLT2 prevents reuptake of glucose in the kidneys
Examples: Dapagliflozin (forxiga), canagliflozin, empagliflozin (jardiance)
What is the target HbA1c for a pt with T1DM and CKD who is not treated with dialysis?
Target can range from < 48mmol/mol (6.5%) and < 64mmol/mol (8%)
What equipment does a pt need in order to self-monitor glucose levels?
Glucose monitor, lancets, testing strips
When is continuous glucose monitoring recommended in pts with T1DM?
It is not routinely recommended, may be considered in certain circumstances i.e.
- extreme fear of hypoglycaemia
- more than 1 episode of severe hypoglycaemia a year with no obvious cause
- complete loss of awareness of hypoglycaemia
- persistent hyperglycaemia (HbA1c > 75mmol/mol) despite testing at least 10 times a day
- frequent (> 2 episodes) asymptomatic hypoglycaemia
How frequently should a pt with T1DM monitor their blood glucose levels?
At least 4 times a day - incl. before meals and before bed
they may need to take measurements > 4 times a day in some instances
When might a pt with T1DM need to monitor their blood glucose levels more than 4 times a day?
Monitor up to 10 times a day in the following instances:
- target HbA1c not achieved
- increasing frequency of hyoglycaemic episodes
- if legally required to do so before driving
- during periods of illness
- before, during, and after sports
- when planning a pregnancy and breastfeeding
- impaired awareness of hypoglycaemia
- pt’s lifestyle i.e. drive for long periods of time, undertake high-risk activity/ occupation or travel frequently or across time zones
What are the optimal plasma glucose self-monitoring targets for pts with T1DM?
Fasting plasma glucose on waking - 5-7 mmol/L
Plasma glucose level before meals at other times of day - 4-7 mmol/L
At least 90 minutes after a meal - 5-9mmol/L
When driving - ≥ 5 mmol/L - hypoglycaemia dangerous
There should be an agreed bedtime target plasma glucose level with the pt
What should the advice on drinking alcohol be for pts with T1DM?
If drinking alcohol do not drink more than 14 units a week and spread this evenly over ≥ 3 days
Avoid drinking alcohol on an empty stomach as alcohol will be absorbed faster and this can potentially mask an episode of hypoglycaemia
Alcohol can also exacerbate or prolong the hypoglycaemic effect of insulin
Wear a diabetes id of some sort (card, bracelet, necklace, watch) as hypoglycaemia can sometimes be confused with alcohol intoxication
What should you do if you suspect someone has diabetic ketoacidosis (DKA)?
Medical emergency - admit to hospital
If systolic BP < 90 - restore circulating volume - 500mL sodium chloride 0.9% by IV infusion over 10-15 mins; repeat if necessary and seek senior medical advice
When systolic BP >90 - sodium chloride 0.9% IV infusion at a rate that replaces deficit and provides maintenance
Include potassium chloride unless anuria - measure plasma K+ every at 1hr, 2hrs, and e/ 2hrs thereafter - if outside normal range, measure every hr
IV infusion of soluble insulin + sodium chloride - fixed rate of 0.1U/kg/hr
Established SC long-acting insulin should be continued (detemir or glargine) during treatment of DKA
Monitor blood ketone + blood glucose - adjust insulin infusion rate accordingly
Once blood glucose < 14mmol/L - IV infusion of glucose 10% at 125mL/hr + sodium chloride 0.9%
Continue insulin infusion until ketones < 0.3 mmol/L, blood pH > 7.3 and pt is able to eat and drink - give SC fast-acting insulin and a meal - stop insulin infusion an hour later
What should the blood glucose level of a T1DM pt be when driving?
At least 5 mmol/L - hypoglycaemia is dangerous when driving
What are the possible symptoms of diabetic ketoacidosis (DKA)?
Significant hyperglycaemia i.e. finger prick glucose > 11 mmol/L - bare in mind this is NOT always present in DKA, particularly in children and young people on insulin therapy
Increased thirst
Increased urinary frequency
Weight loss
Inability to tolerate fluids
Persistent vomiting and/or diarrhoea
Abdominal pain
Visual disturbance
Lethargy
Confusion
Fruity smell of acetone on the breath
Acidosis breathing - deep sighing (Kussmaul) respiration
Dehydration - dry skin/ mucous membranes, reduced skin turgor, sunken eyes, prolong capillary refill time
Shock as a result of severe dehydration - tachycardia, poor peripheral perfusion, hypotension, lethargy, drowsiness, decreased level of consciousness, reduced urine output
What are symptoms of mild hypoglycaemia?
Hunger Anxiety or irritability Sweating Tingling lips Palpitations Tremor
What are symptoms of moderate-severe hypoglycaemia?
Weakness and lethargy Impaired vision Incoordination Reduced orientation Confusion Irrational behaviour Emotional lability Deterioration of cognitive function Convulsions inability to swallow Loss of consciousness Coma
What are the ‘sick day rules’ for pts with T1DM?
Never stop/omit insulin
Check blood glucose more frequently i.e. every 1-2 hours including through the night
Consider checking blood or urine ketone levels - i.e. every 3-4 hours incl through the night
Main their normal meal pattern, where possible, if appetite reduced
Aim to drink at least 3L of fluid a day to prevent dehydration
Seek medical advice if they are violently sick, drowsy, or unable to keep fluids down
When starting to feel better, continue to monitor blood glucose carefully until it returns to normal
What are the symptoms of diabetes
- Polyuria - frequent urination - excretion of glucose leads to osmotic diuresis
- Fatigue
- Polyphagia - increased appetite - glucose cannot be taken up by organs and so body tries to procure more glucose
- Erectile dysfunction - neuropathy
- Vaginal infections
- Numb/ tingling extremities - neuropathy
- Sudden weight loss - glucose cannot be used to produce energy due to lack of insulin (T1DM) or resistance of insulin (T2DM) - so the body breaks down fats/ muscle to produce energy
- Polydipsia - increased thirst due to osmotic diuresis
- Wounds that won’t heal
- Blurred vision
What’s the difference in symptoms between T1DM and T2DM?
They are the same except T2DM symptoms are insidious - happen gradually/ are more subtle
What is the pathophysiology of T1DM?
When pt produces little/ no insulin due to autoimmune destruction of islet of langerhans cells
- autoimmune response thought to be triggered by viral infection
