Diabetes

Question 1

What is the management of diabetic ketoacidosis?

Answer 1

• Fluids - 0.9% normal saline
• Insulin infusion starts 1 hour after fluids to decrease risk of cerebral edema
• Replace potassium after initial fluid resuscitation
• Close monitoring
• Add glucose to fluids when BGL <14-15 mmol/L
• Change to sc insulin when patient able to eat

Question 2

What is the initial management for type 2 diabetes?

Answer 2

1. Lifestyle management with diet and exercise for 3 months
2. If unable to manage then add oral agent
   * If obese = metformin
   * If non-obese = sulfonylurea (tolbutamide preferred as short-acting)
3. If single oral agent therapy does not manage then combine
4. If dual therapy does not manage then see doctor for adding insulin

Question 3

What are some common sulfonylurea drugs and how do they work

Answer 3

• Sulfonylureas stimulate insulin release and can cause hypoglycemia
• Tolbutamide - short-acting (preferred agent for T2DM)
• Gliclazide - long-acting
• Glibenclamide - long-acting

Question 4

What is an example of a thiazlidendione and how do they work, when can they be used?

Answer 4

• Thiazolidinedones decrease peripheral insulin resistance
• E.g. Pioglitazone
• Take 2-3 months to take effect
• Can be used as an alternative to metformin or sulfonylurea when 2 agents are needed
• Should not be used in combination with insulin due to risk of hypoglycemia