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CCFP > Diabetes *** > Flashcards

Diabetes *** Flashcards

1
Q

Med for wt loss

A

Semaglutide 2.4mg SC q1weekly,

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2
Q

RF for T1

A

fam hx

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3
Q

Sx

A

Polyuria, polydipsia, wt loss

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4
Q

Complications

A

Macrovascular (CVD, CVA, PAD), microvascular (retinopathy, nephropathy, neuropathy), infection, ED

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5
Q

Hypoglycemia Sx

A

palpitations, sweating, trembling, anxiety, hunger, N/V, drowsiness, vision change, HA

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6
Q

Hypoglycemia RF

A

prior episode, low a1c, hypoglycemia unawareness, CKD, preschool/ adolescent/ pregnancy/ elderly

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7
Q

Hypoglycemia Rx

A

15g carbs (¾ cup juice, 1 tbsp honey) - restest in 15 mins and repeat if BG <4
Severe: 1mg glucagon SC/ IM

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8
Q

Hyperglycemia Sx

A

Polyphagia, polydipsia, polyuria, blurred vision, fatigue, paresthesia, arrhythmia

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9
Q

DKA sx

A

Kussmaul’s breathing, confusion, dehydration, impaired cognition, abdo pain, N/V

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10
Q

DKA precipitating factors

A

Infection, illness, missed insulin, infarction, intoxication

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11
Q

Dx of T1

A

If asymptomatic, repeat test on another day
8hr FPG >7
Random BG >11.1
Hba1c >6.5

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12
Q

Factors that increase a1c

A

iron deficiency, low B12, alcoholism, chronic opioid use

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13
Q

Factors that decrease a1c

A

use of iron/ B12/ ASA/ vit C, hemaglobinopathy, chronic liver disease, RA

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14
Q

Targets for pre + postprandial glucose (+ if frail)

A

Preprandial 4-7
Postprandial 5-10
If frail/ dementia = preprandial 6-9 and postprandial <14

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15
Q

Ix for new dx DM

A

ECG if >40 y/o, DM >15 yrs, end ogan damage, CVD RF (HTN, smoking, CKD, obesity, ED)
Stress test if cardiac sx

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16
Q

Monitoring (q6mo + annual)

A

q6mo
BP <130/80
A1C <7% adults, <7.5% children

Annual
Fasting lipids
Optometry (5 yrs after dx)
Albumin/Cr ratio + Cr (5 yrs after dx)
Monofilament + foot exam (5 yrs after dx)
Screen for ED, depression, eating disorder, NAFLD

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17
Q

Driving safety

A

Measure BG before driving
Keep supply of carbs in car
Do not drive if BG <4
Report to licensing if on insulin and 1) any severe hypo while driving in past 12 months or 2) >1 severe hypo while awake but not driving in past 6 months

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18
Q

Nutrition advice

A

Low glycemic index carbs
Fibre 30g day
Maintain consistent carb intake
Alcohol 2hrs after dinner can cause low glucose next AM

19
Q

Exercise advice

A

Aerobic exercise 150 mins over >3d/week
Resistance training >2x/w
Consider extra carbs for exercise

20
Q

Basal bolus regime

A

Basal
Long acting insulin e.g. glargine
Long acting degludec (reduced nocturnal hypoglycemia)
Bolus
Dose based on carb content, exercise, time since last dose and BG
Rapid acting (aspart) 0-15 mins before meal

21
Q

Management of complications:
HTN, nephropathy, neuropathy, retinopathy, ED, macrovascular

A

HTN: target 130/80, use ACEi/ ARBs, CCB, thiazide

Nephropathy: CKD + HTN: ACEi/ ARB. Consider kidney + pancreas transplant in ESRD

Neuropathy: pregabalin 1st, 2nd line: gabapentin, valproate, amitriptyline, duloxetine

Retinopathy: laser therapy + vitrectomy

ED: PDE5 inhibitor, consider hypogonadism if ineffective

Statin +/- ezetimibe: if macrovascular disease, age >40, DM >15 yrs + microvascular disease
ACEi/ARB: if CVD, age >55 w/ CV RF, microvascular disease
ASA: if CVD

22
Q

Metabolic syndrome measurements

A

Sex, Waist Circumference, Triglycerides, HDL, Blood Pressure, Fasting Glucose

23
Q

Screening for T2

A

Adolescents: screen q2yr if 2-3 of following: obesity, high risk ethnic group, FDR, S+S insulin resistance, PCOS, AP use
Adults:
>40 y/o q3yr
<40 y/o + CANRISK score ‘high risk’ q3yr
Screen earlier if additional RF (e.g. prediabetes)

24
Q

Prediabetes FPG + A1C

A

FPG 6.1-6.9
A1C 6-6.4

25
Q

Prevention in prediabetes

A

Wt loss > 5%
Mediterranean or DASH diet
Exercise >150 mins week over 5d
Consider metformin, especially in pts <60 y/o, BMI >35, hx of GDM

26
Q

Self monitoring when on insulin >1/d, 1/d or no insulin

A

On insulin >1/d = monitor >3x day w/ pre + postprandial
On insulin 1/d = FPG 1/d at varied times
no insulin = no CBG daily except if not on target or at risk of hypos

27
Q

Management T2

A

Lifestyle measures - if not in target in 3mo, start metformin
Metformin
Add insulin if metabolic decompensation + symptomatic hyperglycemia
Start basal insulin + titrate to achieve target
If >1.5% above target, metformin plus another agent

28
Q

Management of T2 + ASCVD, CKD, HF + CV RF

A

ASCVD: add dulaglutide (GLP1-RA) or empagliflozin (SGLT2i)
CKD: add empagliflozin (SGLT2i)
HF: add empagliflozin (SGLT2i)
CV RF: add dulaglutide (GLP1-RA)

29
Q

Management on sick days

A

Vomiting or diarrhea >6 hrs, feeling sick or fevers x few days
Check sugars Q4H
Check urine for ketones
Maintain adequate food and fluids, if not able to then eat concentrated carbs
Hold metformin, sulfonylureas and SGLT2 inhibitors
Hold ACEi, ARBs, diuretics, NSAIDs
Call doc if glucose >13.3 or >11 if pregnant
call doc w/ signs of DKA or dehydration
Avoid exercise

30
Q

HHS vs DKA pathology

A

HHS = Hyperglycemia -> intracellular water depletion -> osmotic diuresis
DKA = Absence of insulin -> reduced glucose utilisation -> increased TG breakdown -> ketone production

31
Q

What do you need to watch out for with SGLT2i in DKA?

A

SGTL2i can cause euglycemic DKA

32
Q

RF for DKA

A

Poor adherence ($, wt control, depression, understanding)
Not monitoring glucose

33
Q

Precipitating factors for DKA

A

Infection
Alcohol
Stress
Pregnancy
CV events (stroke, MI)
Trauma
Meds (steroids, cocaine, APs, thiazide)
Cushings, thyrotoxicosis
GI disease (pancreatitis, obstruction)
No cause

34
Q

Sx DKA

A

Polyuria, polydipsia, fatigue, weakness, AMS, HA
N/V, abdo pain
Tachycardia
Kussmaul breathing
Dehydration

35
Q

Ix for DKA + Ix for secondary causes of DKA

A

Glucose
Cr, urea, lytes, bicarb
Blood gas
Serum + urine ketones

Secondary causes:
Amylase/ lipase (?pancreatitis)
CBC
Urine + BC
CXR
ECG

36
Q

Rx for DKA in peds

A

Q1H glucose, lytes, ex lytes, urea, CBC, VBG, ECG
NS 10ml/kg over 1 hr then replace fluid deficit with 5ml/kg/hr NS + 40mmol KCl over next 24-48 hrs
When glucose <17 or dropping >5 mmol/hr, change to 0.45% NS and add dextrose (D51/2NS) and transition to SC insulin, then stop IV insulin
Start insulin 1-2 hrs after fluids at rate of 0.1 units/kg/hr

37
Q

Rx for adult DKA

A

Q2H glucose, lytes, urea, bicarb, AG, osmolality, fluid status, mental status
NS 1-2L/hr
Once euvolemic, check corrected sodium
If corrected sodium low = continue NS
If normal or high = switch to ½ NS
When glucose <14, D5W or D10W to maintain glucose 12-14
When K+ <5.5 AND pt urinating = add KCl

38
Q

Insulin infusion for DKA - when to start, when to reduce, dose

A

Start when K >3.3
0.1 units/kg/hr
When glucose <11.1, reduce to 0.02-0.05 units/kg/hr

39
Q

Potassium in DKA - when to start, when to reduce, dose

A

<3.3 = no insulin, give 40mmol/ hr
3.3-5.5 = give 10-40 mmol/ hr
>5.5 = check K Q2H, don’t give more

40
Q

Resolution of DKA criteria

A

Glucose <11.1
Bicarb >15
pH >7.3
AG <12

41
Q

Complications of DKA/ HHS

A

Mortality
Cerebral edema
Hypogylcemia
AKI
PE, stroke, DVT
ARDS, shock

42
Q

Meds that cause DM

A

glucocorticoids, atypical APs, statins, anti-rejection drugs

43
Q

RF for hypoglycemia

A

increasing age, long duration of dz, prev episodes of hypoglycemia

CCFP (67 decks)

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