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General Practice > Diabetes > Flashcards

Flashcards in Diabetes Deck (10):
1

What is the screening for Diabetes? 

  • Use AUSDRISK every 3 years from 40yo to screen people for diabetes
    • requires waist measurement, heritage, FHx, gender, , levels of physical activity, diet, smoking, BP, and gestational diabetes Hx 
    • use FBG or HbA1c for a score of 12 or more 
  • individuals at high risk should be screened every 12 months
    • IGT (impaired glucose tolerance) 
    • Hx of CVD
    • >35 from china, subcontinent, or pacific islands 
    • BMI >30 
    • PCOS or gestational diabetes 
    • antipsychotic medications 

2

Complications of Diabetes?

  1. Painful Neuropathy:

  • Paracetamol

  • TCA

  • Carbamazepine / pregabalin

  1. Erectile Dysfx

  • May be ~50% (macrovascular disease, autonomic neuropathy)
  • Can use PDE inhibitor
  • But must assess CV risk first

 

  1. Postural Hypotension
  • r/v exacerbating medications
  • Δ behaviour - eg. Sitting quietly after sitting b/f standing
  • Graded compression stockings
  • Fludrocortisone - if severe

 

  1. Gastroparesis
  • Domperidone - D2 antagonist
  • Cisapride - ↑gut motility (5HT4 receptor agonist - PNS-mimetic)
  • Erythromycin

 

  1. Driving
  • Can impair driving due to
  • Hypoglycemia
  • ↓VA
  • Must report to VicRoads
  • If diet controlled → safe to drive

Review

  • 5y = Ø insulin
  • 2y = insulin-dependent
  • Consider if retinopathy 

3

Go through some Oral Agents for Diabetes treatment, talk through some side effects. 

Consider it when 3-6 months of poor BSL control with diet treatments. 

  1. Metformin 
  • 2g/day (3g/day if obese) 
  • 60-90 eGFR 2g/day max 
  • 30-60 eGFR 1g/day 
  • <30 - can't use 
  • side effects lactic acidosis, GI disturbance 

Other OHG: 

  • Sulphonylureas (e.g. gliclazide) 
    • safe in renal impairment 
    • weight gain and hypoglyemia common 
  • DPP-4 Inhibitors (gliptins) 
    • pancreatitis 
    • do not use with GLP-1 
  • GLP-1 analogues (e.g. exenetide) 
    • only injectible 
    • weight loss - good efficacy 
    • SE = GIT 
  • SGLT-2 inhibitors (e.g. dapagliflozin) 
    • SE = dehydration, euglycemic ketoacidosis, UTIs 

4

What is the Annual Cycle of Care for Diabetes? 

  • 3-6mo

    • HbA1c

      • 3mo - after Δ rx / unstable

      • 6mo - stable DM 

    • ACR

    • Podiatry review (up to 5x / year)

    • ± urine dipstick (infx) 

  • 12mo

    • Full exam

    • ± ECG

    • Eye review

  • Eyes

    • Every 2y

    • Every 1y if nephropathy, poor control, ASTI, social disadvantage

    • 3-6mo if established retinopathy

  • Feet

    • Low risk = annual assessment

    • Medium/high risk = every 3-6mo podiatry r/v 

5

How do you diagnose Diabetes? 

  • should be confirmed in 3-6 months with an OGTT 
  • if symptomatic only need one suggestive result for a diagnosis 

A image thumb
6

What is the treatment for Diabetes? 

  1. Lifestyle + rx co-morbidities​​
  • Register w. National Diabetes Service Scheme + GPMP

  • Advise on obligations to VicRoads

  • Diabetes education

  • Dietary advice

  • Hypo education + action plan

  • Sick day mx

  • Tell someone so they can check on you

  • BSL every 2-4h

  • Keep eating + drinking

  • Eat normally if possible

  • If Ø eating normally

  • Easy to manage carbohydrates

  • If Ø food at all → check BSLs

  • >15 → unsweetened fluids

  • <15 → sweetened fluids

  • May need to Ø insulin temporarily

  • Call doctor if:

    • BSL ≥15mmol for ≥12h

    • Vomiting / diarrhoea for ≥12h

    • ↑unwell  / become drowsy

  • Alcohol intake

  • Vaccination

    • Flu

    • Pneumococcus

    • Tetanus when 50yo 

  1. Monotherapy

  2. Combination therapy

  3. Combination + insulin 

7

What is the management for a lady who has IGT? 

ST:

  • weight,
  • cholesterol,
  • BP 
  • Dietician.
  • Education about risk

More evidence program (LIFE! Program) - 5 sessions and a session before 40% power.

MT/LT

  • HbA1c in a year
  • BP, weight, PAP smear 

8

How would you manage someone with newly diagnosed diabetes? 

ST:

  • NDSS,
  • diabetes education nurse,
  • vicroads
  • medication ,
  • PAID  tool

MT:

  • chronic care plan

LT:

  • annual cycle of care 

9

Counsel someone who has just been prescribed insulin, what are some barriers to insulin initiation? 

Barriers to Initiation:

  • Hypoglycemia
  • Titration flow charts
  • Education and revisit on regular basis (diabetes australia)
  • Weight gain (2kg over 12month) - proportional to HbA1c
  • 1x a day injection starting on that.
  • Patient Factors: Stigma, fear, cognitive impairment, dexterity, fear of hypoglycemia
  • Doctor Factors: easier just to take a tablet (time), compliance, confidence (refer)

Counselling initiation: 

  • Rotating injection site = should be ≥3cm from previous injection site 

  • hypoglycemia (RFs for hypoglycemia flashcard) 

  • glycemic goals - generally start on basal insulin and may maintain site 

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10

Triggers for hypoglycemia? 

Triggers:

EX: exogenous insulin

P: pituitary failure

L: liver failure

A: adrenal failure (addison's)

I: insulinoma

N: non-pancreatic neoplasms

S: skipped meals