diabetes 2 - complications + gestational diabetes Flashcards
(14 cards)
what to do in type 1 pts with CVD
offer statin for primary prevention in type 1 who:
- aged 40 and over
- diabetes for > 10 years
- established nephropathy
- other CVD risk factors
consider for pts 18-40
atorvastatin 20mg
what to do in type 2 pts with CVD
use QRISK3 score - measure risk in pts aged 25-84
offer atorva 20mg - 10 year risk of QRISK3 of 10% or more
can still give statin if score < 10% if patient prefers and pts > 84
what to do for hypertension?
type 1:
ACR < 70 - target BP < 140/90
ACR > 70 - target BP < 130/80
adults > 80 - target BP < 150/90
start off with ACE-i/ARB
type 2:
ACEi/ARB
what to do in nephropathy?
nephropathy - when pt has proteinuria - ACR of 3 or more
type 1:
- ACEi/ARB if ACR 3 or more
type 2:
- ACEi/ARB if ACR 3 or more
- add on SGLT2 - if ACR > 30
diabetic neuropathy treatments
chronic painful neuropathy:
- amitriptyline, duloxetine, gabapentin, pregablin
ED:
- sildenafil, vardenafil, tadalafil
gastroparesis:
- domperidone, metoclopramide
hyperhidrosis:
- antimuscarinics topical glycopyrrolate, oral oxybutynin and glycopyrronium bromide
other diabetic complications
peridontitis (gum inflammation)- regular oral health checks
eye disease - damage blood vessels in eyes (retinopathy) - regular/annual eye checks
feet problems - ulcers and infections - antibiotics
DKA features and diagnosis
severe hyperglycaemia
symptoms:
polyuria, thirst, ketone sweet breath, lethargy, confusion, deep/fast breathing
1 check blood sugar if symptoms of dka
2 if blood sugar > 11 mmol/L check ketones (via urine/blood)
3
0.6 - 1.5 mmol slight risk (retest in 2h)
1.6 - 2.9 mmol increased risk - contact GP
3+ mmol - medical emergency
DKA diagnosis - BG >11 mmol/L, ketones > 3 mmol/L, pH < 7.3
DKA treatment
IV fluids - 0.9% NaCl with or without KCl
IV insulin - human soluble insulin
IV glucose - if risk of hypoglycaemia
DKA resolution - when ketones < 0.6 and pH > 7.3
insulin changes during surgery
elective surgery (minor surgery + good glycaemic control)
- day before - reduce OD long acting by 20% - rest as usual
elective (major surgery or poor glycaemic control)
- day before - reduce OD long acting by 20% - rest as usual
on day:
- reduce OD long acting by 20% - stop other insulins till patient eating
- IV infusion of KCL + NaCl + glucose
- variable rate IV insulin via pump
- hourly blood glucose for 12 hours
- if BG < 6 mmol/L - IV glucose 20%
insulin changes post surgery
1 - convert back to SC insulin once pt can eat/drink w/o vomiting
basal bolus:
restarted with first meal, insulin infusion carried on 30-60 mins after first meal
long acting carries on at 20% reduced dose till pt leaves hopsital
twice-daily regimen:
restarted at breakfast or evening meal, insulin infusion carried on 30-60 mins after first meal
sick day rules
SICK acronym:
sugar levels - check BG regularly - every 1-2 hours
insulin - never stop taking insulin or anti-diabetics
carbohydrate - keep eating and stay hydrated
ketones - check ketones regularly every 3-4 hours
if risk of dehydration - ACEi, metformin, diuretics, NSAIDs, SGLT2, GLP1 could be stopped
diabetes in pregnancy and breastfeeding
increases risk to woman and foetus
before pregnancy:
- aim for <48 mmol/L
- to minimise risk of NTDs - diabetes pts - folic acid 5 mg - until week 12
meds:
- all oral anti-diabetics except metformin stopped and replaced with insulin
- isophane + rapid acting insulin 1st line
- if pt taking ACEi/ARB/statins - STOP
must be aware of hypoglycaemia risk +
always carry fast acting glucose
gestational diabetes - imp points
develops due to pregnancy - stop treatment after birth
fasting BG <7mmol/L
1 diet and exercise - if not helped in 1/2 weeks - step 2
2 metformin
3 insulin - if metformin ci/not tolerated
fasting BG > 7 mmol/L
1 - diet and exercise + insulin +/- metformin
fasting BG 6-6.9 with complications
1 - diet and exercise + insulin +/- metformin
hypoglycaemia - imp points and treatment
< 4 mmol/L
symptoms:
sweating, lethargic, dizziness, hunger, tremor, tingling lips, palpitations, pale, convulsions, coma
if pt conscious and able to swallow: (can be done in community)
- fast acting carb 10-20g by mouth: 3-6 glucose tabs, 2-4 heated teaspoons of sugar or 150-200ml fruit juice
- repeat every 15 mins for 3 cycles
oral not work/unconscious :
- IM glucagon or 999
- if due to alcohol - IV glucose needed in hospital
patients awareness of hypoglycaemia may become blunted:
- via increases no of hypo eps
- via BBs (BB may cover signs like tremor, palpitations etc.)
