diabetes Flashcards
(164 cards)
1
Q
what is diabetes?
what are the 2 common types and define each one?
A
insulin resistance / insulin deficiency
type 1 [body not producing enough insulin]
type 2 [body resisting insulin and not responding to its action]
2
Q
give examples of other types of diabetes
A
gestational [pregnancy], secondary diabetes [caused by secondary disease] such as pancreatic damage, hepatic cirrhosis and endocrine disease
3
Q
what is diabetes insipidus?
what is a typical sign of diabetes insipidus?
A
diabetes caused by tumour or damage to hypothalamus/pituitary gland. Nothing to do with blood sugar more to do with water/imbalance of fluid. makes you pee out lots of urine. sign is excessive thirst
4
Q
what are the 2 types of diabetes insipidus? which out of the 2 are the most common forms of diabetes insipidus?
A
- cranial pituitary diabetes insipidus - most common
2. nephrogenic and partial pituitary diabetes insipidus.
5
Q
describe what cranial pituitary and nephrogenic partial pituitary diabetes insipidus is?
what is the treatment for each?
A
- cranial: body does not produce enough antidiuretic hormones [vasopressin/desmopressin]. caused by damage to hypothalamus or pituitary gland. treated by vasopressin or desmopressin which stop diuresis/urination. desmopressin more potent than vasopressin and has no vasoconstrictor effects. admin routes: oral, intranasal, injection
- nephrogenic: is enough antidiuretic hormones but kidneys not responding to it. nephro damage. treatment is carbamazepine or thiazide diuretics
6
Q
give a side effect of desmopressin
A
extreme dilution of water leading to hyponatraemia
7
Q
when should diabetic drivers inform the DVLA? 3
A
if they are taking insulin
if they have diabetic complications
if they are taking drugs with increased risk of hypoglycaemia [insulin, sulphonylurea, glinides]
8
Q
what does the dvla advice diabetic drivers to carry with them whilst driving?
A
glucose meter, testing strips, snacks, carbohydrate snacks
9
Q
- what should the blood glucose level be for a diabetic driver whilst driving?
- what blood glucose level is dangerous to be driving with and you cannot drive with it and why?
A
- above 5mmol/L
2. 4mmol/L or under. because could lead to unconsciousness
10
Q
what is the DVLA advice for pt who are already driving when their blood glucose level reaches 4mmol/L or under?
A
stop the car in a safe space, eat/drink something to get blood glucose levels back up and wait at least 45 mins after blood glucose levels resume to normal before continuing journey
11
Q
what does it mean when hypoglycaemic awareness is lost? can you drive if this happens? which drugs can mask the signs of hypoglycaemia?
A
it means pt does not recognise the signs of hypoglycaemia. you must not drive if this happens. ace inhibitors
12
Q
what is the concern with alcohol for diabetics?
A
can mask the signs of hypoglycaemia
13
Q
what is the oral glucose tolerance test and how do you use it? what kind of diabetes can it help to diagnose?
A
a test to diagnose if you have impaired glucose tolerance
can diagnose gestational diabetes
involves measuring blood glucose conc after fasting for 8 hours and then again 2 hours after drinking anhydrous glucose drink eg polycal
14
Q
what kind of measurement can be performed at any time of day and does not require special preparations eg fasting?
A
hba1c tests
15
Q
what is hba1c?
how many months can it provide an average plasma glucose conc?
A
a haemoglobin that is present when red blood cells come into contact with glucose.
over 2-3 months
16
Q
which type of diabetes mellitus can hba1c measurements be used to monitor glycaemic control in?
which type of diabetes mellitus can hba1c be used to diagnose?
A
- both type 1 and type 2
2. just type 2
17
Q
when and in which patients can hba1c NOT be used to diagnose diabetes?
A
in type 1 diabetes, in children, in pregnancy, in women up to 2 months post partum
18
Q
in which type of patients must hba1c be NEVER used in?
A
people with symptoms of diabetes occuring less than 2 months, ppl acutely ill or high diabetes risk, ppl on drugs that can cause hyperglycaemia, people with pancreatic damage, CKD and HIV
19
Q
what do lower HBA1C values indicate? is it good or bad
A
lower risk of long term vascular complications. the lower the value the better.
20
Q
- how often do you need to monitor type 1 patients using hba1c?
- how often do you need to monitor type 2 patients using hba1c?
A
- every 3-6 months but more if rapid changes in glucose levels
- every 3-6 months until medication and hba1c levels are stable and then every 6 months
21
Q
what is the biological cause of type 1 diabetes?
A
little to no insulin produced due to destruction of beta cells in the pancreatic islets of langerhan
22
Q
what are the 5 different diabetic complications?
A
- retinopathy
- nephropathy
- neuropathy
- premature CVD
- peripheral arterial disease
23
Q
what blood glucose measurement suggests hyperglycaemia?
A
over 11mmol/L
24
Q
what are the signs and symptoms of type 1 diabetes [there are 8]
A
- increased thirst
- increased urination
- unintentional weight loss
- hyperglycaemia
- fatigue and weakness
- mood changes
- extreme hunger
- blurred vision
25
what are the 5 aims of treatment for type 1 diabetes?
1. target gylcaemic control should be individualised for each pt
2. avoid disability by early detection of diabetic complications
3. insulin regimens
4. avoid hypoglycaemia
5. minimise long term macro/micro vascular complications
26
1. how many times should adults with type 1 diabetes measure their blood glucose conc and when?
2. when would you need to increase the amounts of times a patient measures their blood glucose?
1. at least 4 times daily
before each meal and before bed
2. increase when pt doing activities that may affect glucose conc eg exercise
27
what are the ideal hba1c targets for a type 1 diabetic patient when:
- in general?
- upon waking up?
- before meals?
- after meals?
- when driving?
- random measurement?
- in general type 1 diabetics target should be <48mmol/L
- 5-7mmol/L
- 4-7mmol/L
- 5-9mmol/L
- 5mmol/L
- under 11mmol/L
28
what is the main treatment for type 1 diabetes
insulin
29
what drug can you add to insulin for further glycaemic control and for which patients?
metformin as it does not cause weight gain. for pt with BMI >25 [or >23 for ethnics]
30
when would you need to adjust the doses of insulin treatment?
according to exercise, dietary intake etc. if pt eating more food requires more insulin. if pt exercising, requires less insulin
31
what are the 2 types of natural insulin secretion profile and define each one?
basal: continuous release of insulin from liver. slow and steady
bolus: insulin released from liver during mealtime. released in response to glucose absorbed from foods
32
what are the 3 types of insulin sources available in the uk and which is the most commonly used?
1. human - lab made to be identical to human insulin. genetically designed
2. human analogue - most common. designed to be like human insulin but modified to be faster and longer duration
3. animal - least used. animals including bovine and porcine
33
what is insulin inactivated by
GI enzymes
34
where should insulin be injected? what kind of injection [IV, SC, IM]?
inject in area with most sc fat like abdomen, outer thigh etc
SC injection
35
what could happen if a pt continues to inject insulin into the same site on their body and what is the risk of this? what is the associated advice?
could lead to lipohypertrophy. can cause bad absorption of insulin leads to poor glycaemic control. rotate sites and check for signs of infection
36
what are the 3 different types of insulin preparations?
1. short acting [soluble and rapid]
2. intermediate acting
3. long acting
37
give 3 examples of rapid acting insulins including brand names
LAG
insulin lispro [humalog]
insulin aspart [fiasp and novorapid]
insulin glulisine [apidra, solostar]
38
what is the onset of action of RAPID acting insulin and what is the duration of action?
onset within 15 mins. duration 2 - 5 hours
39
when is RAPID acting insulins injected? what happens if you fail to inject after this time
injected immediately before meals
| hypoglycaemia risk if injected during or after food
40
are short acting insulins basal or bolus?
bolus
41
when is SOLUBLE insulin injected? what is the onset of action and duration?
injected 15-30 mins BEFORE meals. onset of action 30-60 mins and lasts up to 9 hours
42
when is IV and IM soluble insulin given?
in emergencies
| IV given in DKA emergencies and peri operatively because of fast onset and v short half life
43
give 4 examples of soluble insulin
actrapid
humulin S
hypurin bovine/porcine
insuman
44
give an example of an intermediate acting insulin [brand as well]
isophane insulin [humilin i]
45
is intermediate acting insulin basal or bolus
basal
46
what is the onset of action, maximal effect and duration of action of intermediate acting insulin?
onset - 1-2 hours
maximal - 3-12 hours
duration 11-24 hours
47
what is isophane insulin a mixture of?
insulin and protamine
48
what are pre mixed biphasic insulins and give 3 examples
intermediate insulins mixed with a short acting insulin [either rapid or soluble].
can be mixed by pt or pre mixed readily available
biphasic isophane insulin, biphasic isophane aspart, biphasic isophane lispro
49
when should biphasic isophane insulin be administered?
immediately before a meal
50
what types of insulin are these:
novomix 30
humalog mix 25 and 50
humulin M3
mix = biphasic
| all biphasic insulins
51
are long acting insulins basal or bolus
basal
52
what is the duration of action of long acting insulins?
| what is the onset of action of long acting insulins?
up to 36 hours
| duration: 2-4hours
53
can long acting insulins be prescribed in type 2 diabetes?
yes. in type 2 diabetics if insulin is required
54
list 5 examples of long acting insulins and brand names
1. determir [levemir]
2. glargine [toujeo, lantus]
3. degludec [tresiba]
4. insulin zinc suspension [rarely used]
5. protamine zinc insulin [rarely used]
55
how many times in a day is determir given? how many times in a day is glargine and degludec given?
determir - once or twice
| glargine and deglude - once
56
what are the 3 types of insulin regimens for type 1 diabetes management?
- biphasic insulin regimen
- multiple daily basal bolus insulin regimen
- continuous sc insulin infusion pump
57
which insulin regimen is 1st line recommendation for type 1 diabetics? why is this the most popular regimen
multiple daily injection - basal bolus regimen
because it mimics the bodys natural insulin secretion process and offers patients flexibility to tailor insulin infusion with carbohydrate load of each meal
58
what is included in the multiple daily injection [basal bolus]
either a intermediate or long acting insulin
plus
multiple bolus injections of a short acting insulin taken before meals [normally rapid acting]
59
what is the mixed [biphasic] insulin regimen? how many injections given daily?
1,2, or 3 daily injections of biphasic. short acting insulin plus an intermediate acting
60
who is biphasic regimens suitable for?
people with fixed dietary regime as gives fixed amount of insulin not flexible
type 2 diabetics
61
is biphasic regimen suitable for newly diagnosed type 1 diabetics or the acutely ill diabetics?
no
62
what insulins are in:
humalog mix 25 and 50
novomix
rapid acting and intermediate
63
what insulins are inside
humalin M2, M3, M5
insuman comb 15, 20, 50
soluble acting and intermediate
64
what hba1c levels must a patient have in order to be put on the continous sc insulin infusion pump?
over 69mmol/L
65
what is the continuous subcutanous insulin infusion pump?
rapid acting OR soluble acting
delivered continuously by pump via cannula or subcutaneous needle
initiated by specialists
66
who is the continuous subcutaneous insulin infusion pump recommended for?
pt at risk of recurrent hypoglycaemia
| those unable to control glucose level even with multiple injection regimens
67
1. which insulin regimen is recommended 1st choice for type 1
basal bolus regimen
68
1. which insulin should be offered as the long acting basal insulin therapy in the basal bolus regimen and how many times should it be adminstered?
2. which insulin should be offered if this one is not tolerated or if twice daily is not acceptable?
1. determir [levemir]
twice daily
2. glargine [lantus] once daily
69
are non basal bolus insulin regimens suitable for newly diagnosed type 1 diabetics?
no
70
should rapid acting or soluble acting be used as the bolus part of the basal bolus regimen?
when should it be injected?
rapid
| before meals
71
what regimen is 2nd line in type 1 diabetes
twice daily biphasic insulin regimen
72
list 8 factors that can cause hypoglycaemia and affect insulin requirements
- lifestyle [diet, alcohol, no exercise]
- psychological issues
- renal disease
- thyroid disorders
- injection site being injected continously [lipohypertrophy]
- injection technique being an issue
- blood glucose monitoring skills
- adherence
73
what can the following activities do to glycaemic levels and insulin requirements?
```
exercise
intercurrent illness [vomiting]
reduced food intake
impaired renal function
addisons disease
```
can decrease insulin requirements
| can cause hypoglycaemia
74
list 4 things that could potentially increase insulin requirements
1. stress
2. pregnancy [2nd, 3rd trimester]
3. surgical/accidental trauma
4. infection
75
how can infection increase insulin requirement of a pt
having an infection means body increasing more sugar which means more insulin required
76
why has the NHS produced sick day rules for diabetic patients?
because during sickness glucose concs increase and so the pt at risk of getting diabetic ketoacidosis [DKA]
77
what are the sick day rules? [there are 4]
memory trick sick
s = monitor sugar in blood every 2-4 hours [not needed for type 2 unless on insulin]
i = continue taking diabetic meds and insulin
c = have carbohydrate foods and drinks and drink 3L of water a day to prevent dehydration
k = monitor ketones in blood and urine every 3-4hours.
78
when should you seek medical advice regarding ketone measurements in blood and urine?
go to doctor if ketones in urine >2mmol/L
| if ketones in blood >3mmol/L
79
what 6 kinds of medications do ill diabetic patients need to stop taking whilst they are ill
ACEi [stops kidneys working properly when dehydrated]
metformin [can cause dehydration and lactic acidosis]
ARB
GLP analogues
NSAIDs
diuretics
80
what are the 4 most common insulin errors that are reported?
1. failure to manage insulin
2. dosing error
3. frequency of insulin incorrect
4. delayed/omitted insulin
81
what kind of guidance has the EMA issued to help with preventing insulin errors? [there are 4]
- pt and carer must be provided with enough info
- train all health care professionals
- make pt and carer aware of insulin appearance and how they are different in each product
- check insulin container, needle size and pen with pt
82
what is the MHRA warning with insulin?
risk of cutaneous amyloidosis at injection site
amyloid protein deposited under skin on injection site can cause poor glycaemic control
present as lumps
rotate areas and do not inject in lumpy areas
83
why is withdrawing insulin from pens/cartridge devices dangerous
insulin syringe units different to units on pens/cartridges. could be giving yourself an over/under dose.
84
why is abbreviating the units of insulin dangerous?
can be misunderstood by pt and overdose risk
85
what blood glucose conc should patients try aim for most of the time?
4-7mmol/L
86
what resources should be offered to all patients receiving insulin? [2 things]
insulin passport - has details of all pt current preparations
PIL
87
what dose conversions should be made for the following:
- bovine to human insulin
- porcine to human insulin
- reduce dose by 10% then find the human equivalent
| - no dose change
88
define type 2 diabetes
| what is it associated with [risk factors]?
insulin resistance
| obesity, lack of exercise, high BP, dyslipidaemia
89
what are the 8 different anti diabetic drug classes and give an example of each
1. dipeptidylpeptidase-4-inhibitors [gliptins]: linagliptin
2. biguanides: metformin
3. sulphonylureas: gliclazide
4. glucagon like peptide 1 receptor agonist: liraglutide
5. alpha glucosidase inhibitor: acarbose
6. meglitinides: nateglinide
7. thiazolidinediones: pioglitazone
8. sodium glucose co transporter 2 inhibitors: canagliflozin
90
for each drug below, match it to its correct drug class
```
metformin
acarbose
alogliptin
albiglutide
nateglinide
dapagliflozin
glipizide
pioglitazone
```
```
alpha glucosidase inhibitors
dipeptidylpeptidase 4 inhibitor
glucagon like peptide 1 receptor agonist
meglitinides
sodium glucose co transporter 2 inhibitors
sulphonylureas
thiazolidinediones
biguanides
```
biguanides - metformin
alpha glucosidase inhibitor - acarbose
dipeptidyl peptidase 4 inhibitor - alogliptin
glucagon like peptide 1 agonist - albiglutide
meglitinides - nateglinide
sodium glucose co transporter - dapagliflozin
sulphonyureas - glipizide
thiazolidinediones - pioglitazone
91
what is step 1 and step 2 of the type 2 diabetes treatment?
1. lifestyle advice for 3 months
| 2. antidiabetic drugs
92
what antidiabetic drug is first line for all type 2 diabetics and why
metformin
| because does not cause hypoglycaemia
93
why should the dose of metformin be increased slowly from OD to BD to TDS
to prevent GI side effects
94
what are the 3 side effects of metformin
GI side effects [take with or after food]
lactic acidosis
vitamin B12 deficiency
95
what are the 4 contra indications of metformin?
metabolic acidosis
lactic acidosis
renal failure
ketoacidosis, renal failure, general anaesthesia
96
what egfr rate does metformin have to be avoided in and why
Less than 30
| increases lactic acidosis risk
97
is metformin suitable for pregnant and breast feeding women?
yes for both gestational [stop after childbirth] and pre existing diabetes
98
what is the monitoring requirement of metformin?
renal function before treatment and then annually
99
what is the cautions of metformin
| what is the pt and carer advice?
- caution in renal failure, and risk factors for lactic acidosis
- advice on risk of lactic acidosis and how to recognise signs
100
what are the 5 signs of lactic acidosis?
```
hypothermia
weakness [asthenia]
difficulty breathing [dyspnoea]
muscle cramps
abdominal pain
```
101
what drug class are the following drugs: gliclazide, glimepiride, glipizide, tolbutamide
sulfonylureas
102
can sulfonylureas cause hypo or hyper glycaemia and is the risk more common with longer or shorter acting ones?
hypoglycaemia
| more common with longer acting
103
1. are sulfonylureas safe in pregnancy/breastfeeding
| 2. are sulfonylureas safe in surgery?
no - avoid
no - change to insulin before surgery
104
give 2 examples of short acting sulfonylureas
gliclazide, tolbutamide
105
what are the side effects of sulfonylureas?
GI [N&V, diarrhoea, constipation]
allergic reactions in first 6-8 weeks
hepatic impairment [jaundice, hepatitis]
106
what are the contraindications and cautions of sulfonylureas?
caution in elderly [hypoglycaemia] and pt with G6PD deficiency
pt with acute porphyria and ketoacidosis
avoid/reduce dose in renal and hepatic impairment
107
give an example of a drug in the class alpha glucosidase inhibitors
acarbose
108
what is a common side effect of acarbose
GI side effects
109
why must you give pt experiencing hypoglycaemia and taking acarbose glucose instead of sucrose?
because acarbose works by interfering with the sucrose absorption
110
1. what drug class is pioglitazone in?
| 2. what is the MHRA advice associated with it?
1. thiazolidinediones
| 2. increased risk of heart failure [especially with insulin together]
111
when must you continue treatment of thiazolidinediones [hint something to do with hba1c levels]?
when hba1c levels decreased by at least 0.5% within 6 months of starting treatment bc that means it is working
112
list the side effects of thiazolidinediones? [there are 5]
list the monitoring requirement of thiazolidinediones
s/e: numbness, increased risk of infections, bone fracture, weight gain, visual impairment
monitoring: liver function and warn pt against signs of liver toxicity
113
```
what is the drug class of the following drugs
alogliptin
sitagliptin
saxagliptin
linagliptin
```
gliptins
| dipeptidylpeptidase-4-inhibitors
114
1. what is the common side effect of gliptins?
2. what is a contraindication of gliptins?
3. when must you stop treatment of gliptins [what symptom does the pt have to develop in order for stopping medication]?
1. GI and skin reactions
2. diabetic ketoacidosis
3. pt develops severe abdominal cramps = pancreatitis
115
list 3 examples of drugs in the sodium glucose co transporter 2 inhibitors
canagliflozin
dapagliflozin
empagliflozin
116
what is the mhra advice regarding sodium glucose co transporter 2 inhibitors?
what is the mhra warning regarding just canagliflozin
they all increase the risk of diabetic ketoacidosis
it increases the risk of lower limb amputation - mainly toes
117
```
what drug class are these following drugs
exenatide
dulaglutide
liraglutide
lixisenatide
albiglutide
```
glucagon like peptide 1 receptor agonist
118
what symptoms does a pt have to present in order for glucagon like agonists to be discountied?
is it safe for women of child bearing potential?
pancreatitis
no - effective contraception should be started because it is toxic
119
drug action of alpha glucosidase inhibitors [acarbose]?
inhibits alpha glucosidase in intestines. affects sucrose and starch absorption so lowers glucose
120
drug action of biguanides [metformin]?
decreases production of new glucose, increases utilisation of glucose. only acts in presence of insulin so pt must have some function of pancreas
121
drug action of dipeptidylpeptidase 4 inhibitors [alogliptin]?
inhibits dipeptidyl peptidase. therefore increases insulin secretion and decreases glucagon secretion
122
drug action of sulfonylureas
increase production of insulin. works only if pancreatic beta cells are present and functioning. this is why they can cause hypoglycaemia bc they increase insulin production
123
drug action of sodium glucose co transporter 2 inhibitors
inhibits sodium glucose co transporter 2 in renal proximal convoluted tubule. reduces glucose reabsorption and increases urinary glucose excretion
124
drug action of meglitinides
stimulates insulin secretion
125
drug action of glucagon like peptide 1 receptor agonist
increases glucose dependent insulin secretion and slows gastric emptying
126
when is metformin considered? and what to give when standard release metformin is not tolerated?
when hba1c levels rise above 48mmol
| then consider modified release metformin
127
when must 1st intensification occur? [dual therapy]
when hba1c levels rise above 58mmol/L
128
what should metformin be combined with in 1st intensification therapy?
pioglitazone
sulfonylurea
dipeptidylpeptidase 4 inhibitor
sodium glucose co transporter 2 inhibitor
129
what is the 1st line for dual therapy [1st intensification]?
metformin + sulfonylureas
[sodium glucose co transporters added only when sulfonylureas are contraindicated bc of hypoglycaemia]
130
if dual therapy is unsuccessful patients must be started on triple therapy. which drugs can be added?
- metformin & pioglitazone & sulfonylurea
- metformin & pioglitazone & sodium glucose co transporter 2 inhibitor
- metformin & sulfonylurea & dipeptidylpeptidase 4 inhibitor
- metformin & sulfonylurea & sodium glucose co transporter 2 inhibitor
131
is dapagliflozin [sodium glucose co transporter 2 inhibitor] indicated for triple therapy with pioglitazone?
NO
132
what should be considered next if triple therapy [2nd intensification] fails?
insulin regimens
133
what should be offered to a patient that lifestyle intervention was ineffective for, if they cannot tolerate metformin? and which is 1st line?
- pioglitazone
- sulfonylurea - 1st line
- dipeptidylpeptidase inhibitor
- sodium glucose co transporter [last possible choice]
134
what are the options for a patient who is intolerant to metformin about to start dual therapy?
- dipeptidylpeptidase inhibitor & pioglitazone
- dipeptidyl peptidase inhibitor & sulfonylurea
- sulfonylurea & pioglitazone
135
what is the MHRA warning of:
1. pioglitazone
2: canagliflozin
3. all sodium glucose co transporter 2 inhibitors
1. increased bladder cancer, bone fracture and heart failure
2. increased risk of lower limb amputation
3. increased risk of diabetic ketoacidosis
136
what are the signs of hypokalaemia and what are the urgent ones that require A&E referral? [11 alltogether]
- shaking
- sweating
- hunger
- palpitation
- pins and needles on mouth
- headache
- double vision
urgent signs:
- confusion
- unconsciousness/change of behaviour
- difficulty concentrating
- slurred speech
137
what is the treatment for an adult dealing with hypoglycaemia and has a blood glucose reading of over 4mmol/L?
light carbohydrate snack eg slice of bread, normal meal etc
138
how should a patient with hypoglycaemia be treated if their blood glucose reading is under 4mmol/L?
- treat with fast acting glucose. taken orally eg lift glucose liquid, glucose tablets, glucose gels etc
- pure fruit and sugar dissolved in water
- repeat after 10 mins if necessary. treatment can be done up to 3 times
139
for hypoglycaemia with blood glucose reading under 4mmol/L should orange juice be given?
avoid in patients who had a low potassium diet because it is high in potassium and may affect chronic kidney disease
140
for hypoglycaemia with blood glucose reading under 4mmol/L, who should not be given sucrose?
patients taking acarbose because it affects sucrose absorption
141
for hypoglycaemia with blood glucose reading under 4mmol/L , why should chocolates and biscuits be avoided?
low sugar content and high fat content, will not do anything
142
for hypoglycaemia with blood glucose reading under 4mmol/L:
what should be done if treatment worked and patient blood glucose reading now above 4mmol/L?
treat with long acting carbohydrate such as bread, biscuits or normal meal
143
what should you do if hypoglycaemia is unresponsive [blood glucose remains under 4mmol/L]?
after 30-45mins must treat pt with either IM glucagon or IV glucose infusion
144
what should you do if patient with hypoglycaemia becomes unconscious or starts having seizures?
STOP iv glucose infusion and give glucagon!!!
145
what should you do if glucagon is unsuitable for a patient with hypoglycaemia experiencing unconsciousness?
if glucagon unsuitable or not working treat with 10% or 20% glucose infusion
146
how should an alcoholic patient be treated when dealing with hypoglycaemia and why?
give thiamine after glucose iv infusion to lower risk of wernickes encephalopathy
147
what are the 2 diabetic complications?
CVD
| diabetic nephropathy
148
what tests should be done for patients with diabetes and at high risk of diabetic nephropathy?
how should they be treated?
test urine for urinary protein and serum creatinine. test for microalbuminuria [early sign of nephropathy]
treat with ACEi or arb even if BP is normal
149
what pain killers can be used in diabetic nephropathy?
- analgesics paracetamol/NSAIDs
- duloxetine and venlafaxine
- gabapentin and pregabalin
- amitriptyline but unlicensed
- opioid analgesics
- capsaicin cream but may cause burning sensation at start
150
how is DKA caused?
severe lack of insulin in body causing build up of ketones and glucose which becomes toxic
151
what are the signs and symptoms of DKA? [there are 8]
- sweet smell to mouth
- sweet/metallic taste in mouth
- different odour to urine/sweat
- rapid weight loss
- N&V
- abdominal pain
- sleepiness
- fast breathing
152
what is the management of DKA?
1. give patient iv infusion of sodium chloride if bp reading is under 90mmHg for 10-15 mins. repeat if BP remains low and seek medical attention
2. mix 0.9% sodium chloride infusion with soluble insulin [eg ACTRAPID] to make a concentration of 1unit/ml and infuse at a rate of 0.1unit/kg/hour.
3. then monitor blood glucose and ketone every hour
4. if pt already on long acting insulin let them continue treatment
153
what should happen to a patients insulin on the day before surgery?
all insulin should be continued as normal
| only reduce the dose of long acting once daily insulins to 80% - if the pt is taking it
154
what should happen to a patients insulin on the day of the surgery?
stop all insulins
only carry on long acting once daily insulins [if pt is on it] at the reduced dose and only once the pt is eating and drinking again after surgery
155
what should happen to a patients anti-diabetic drugs during surgery?
which anti-diabetic medication is the only one that can be continued?
stop them all until pt is eating and drinking again after surgery
glucagon like peptide 1 receptor agonists
156
a patient is getting an intercurrent illness [eg severe infection, trauma, coma] and is taking anti-diabetic drugs. what would you recommend instead and why?
might need to replace with insulin as hypoglycaemia may not be controlled
157
what is given to women who are planning to get pregnant and have pre existing diabetes?
what should their hba1c level be under?
folic acid 5mg
under 48mmol/mol
158
what is the only anti-diabetic drug allowed in pregnancy and breastfeeding?
metformin
159
which insulins are suitable for pregnant and breastfeeding women?
what is the order of preference for them?
all are suitable
short, medium and lastly long
160
what is their a high risk of in the 3rd trimester for pregnant women taking insulin?
hypoglycaemia
161
a pregnant woman with diabetes has been taking an ACEi/ARB. why should they be discontinued and what should replace them?
discontinue bc risk of nephropathy
| replace with methyldopa or labetalol in pregnancy
162
what are the 1st line, 2nd line and 3rd line in gestational diabetes in pregnancy?
step 1: lifestyle advice
step 2: metformin
step 3: insulin added
163
what should be added if triple therapy with metformin and 2 other oral drugs is tried and not effective, not tolerated, or contra indicated?
glucagon like peptide 1 receptor agonist may be prescribed as part of a triple combo regimen with metformin and a sulfonylurea
164
What is a common side effect of insulin?
Oedema
