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4th Year CCC > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

Is the HbA1c target set in stone?

A

No can individualise

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2
Q

What is HbA1c?

A

Average BM for last 2-3mths. glycated Hb

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3
Q

An HbA1c of what number = diabetes diagnosis?

A

48

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4
Q

What should HbA1c target be if controlled by lifestyle or a single agent?

A

48 (if not achieved indicates need further Rx)

Or 53 if the drug has a hypo risk

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5
Q

If HbA1c exceeds 58 what should you do?

A

Use dual therapy

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6
Q

What should HbA1c target be on dual therapy?

A

53

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7
Q

What should you do if HbA1c exceeds 58 on treatment?

A

Intensify therapy e.g. triple therapy or injectable

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8
Q

How often should you test HbA1c?

A

3-6monthly, then 6 monthly when stable

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9
Q

If the first drug you prescribe has a risk of hypo, should your HbA1c target change? If so, what should it be?

A

Yes should be 53 (if no hypo risk is 48)

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10
Q

If they are on triple therapy, what should HbA1c target be?

A

53

Or personal target

Or if they are elderly or frail, relax the target but max 70

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11
Q

What does individualised HbA1c target and care depend on?

A

HbA1c + HbA1c target

eGFR (drugs excreted renally)

BMI (some = wt change)

Age

Occupation (e.g. would a hypo be v bad?)

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12
Q

How do type 1 and type 2 presentations differ?

A

Type 1 is sudden onset, wt loss, ketones in urine dip

Type 2 gradual onset, wt gain and no ketones

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13
Q

What does microalbuminurea mean in diabetes?

A

Increased risk of renal and cardiac disease- consider ACEi/ARB

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14
Q

How can achieving the recommended physical activity levels help HbA1c?

A

Can reduce it by 10!

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15
Q

Name the 6 categories if pre-insulin drugs

A

Metformin

Sulfonylureas (gliclazide etc)

Gliptin (DPP-4 inhib)

Glitazones

GLP-1 agonist

SGLT2 inibitors (-flozin)

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16
Q

What is the action of metformin

A

Limits glucose release from liver and decreases insulin resistance

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17
Q

Does metformin work immediately?

A

No takes a while (month)

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18
Q

Does metformin have a risk of hypo?

A

Low risk

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19
Q

Does metformin cause weight gain?

A

No

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20
Q

What are the cautions/SEs metformin?

A

Caution in low eGFR

Risk lactic acidosis in dehydrated

GI SEs

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21
Q

Action of sulfonylureas?

A

Spank the panc to increase insulin prod

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22
Q

risk in sulfonylureas?

A

Hypo and wt gain

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23
Q

Name two sulfonylureas

A

Gliclazide

Glimepiride

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24
Q

Do sulfonylureas work quickly?

A

Yes

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25
Action of gliptins?
Inhibit DPP-4 which means GLP-1 is not broken down GLP-1 increases insulin production and decreases glucose
26
How are gliptins taken?
Once daily oral
27
Do gliptins have a hypo risk?
Low risk
28
Do gliptins effect weight?
No
29
What is the problem with gliptins
Often stop working
30
Can gliptins be prescribed in kidney disease?
Yes
31
SEs gliptins?
Headache, URTI, sinus infection
32
What do glitazones do?
Decrease insulin resistance
33
Do glitazones work straight away?
Take up to 12 weeks so no
34
SEs glitazones?
Weight gain Fluid retention Fracture risk
35
Should glitazones be prescribed in HF?
No as fluid retention SE
36
Liraglutide is an example of what sort of drug?
GLP-1 agonist
37
What do GLP-1 agonists do?
Mimic GLP-1 to stimulate pancreatic insulin production and decrease glucagon production.
38
Do GLP-1 agonists effect weight?
Yes wt loss as slows stomach emptying
39
How are GLP-1 agonists taken?
Injection
40
Do GLP-1 agonists have a hypo risk?
No
41
GLP-1 agonists SEs
N&V
42
What is a requirement in the patient for prescribing GLP-1 agonists?
>35 in caucasian patients as very expensive
43
What is the action if flozins/SGLT2 inhibs?
Prevent glucose reabsorption in kidneys- 'wee out sugar'
44
flozins/SGLT2 inhibs SEs?
Increased frequency, UTI, thrush (this may have implications for occupation)
45
Do SGLT2 inhibitors have a hypo risk?
No
46
Which diabetes drugs have a hypo risk
Sulfonylureas glinides Pioglitazones only if in combination with others
47
Which diabetes drugs risk weight gain?
Sulfonylureas Pioglitazones
48
What proportion of diabetics will have an MI or stroke?
75%
49
What is a good drug option for a patient who is a lorry driver so doesn't want GI side effects, can't risk a hypo and doesn't want to need a wee all the time. They are caucasian with a BMI of 33
Pioglitazone or Gliptins
50
What is more important in reducing MI/stroke- cholesterol, BP or HbA1c?
BP lowest number needed to treat
51
How can you advise a patient that they can prevent complications of diabetes?
Diet, exercise Stop smoking and drinking Control BM well Attend annual review
52
What is done at the annual review?
BMI Waist circumference Mood screen Smoking status Neuropathy (erectile, neuropathic pain, autonomic neuropathy (bladder and bowel), gastroparesis)
53
What else needs to be done annually?
Retinoapthy screen foot check Nephropathy - early morning urine A:CR and serum creatinine eGFR Cardio risk factors assessed
54
What are the cardiac risk factors that should be assessed in diabetics?
Age Albuminaemia Smoking BP Lipid profile FHx Waist circumference
55
What needs to be checked 6 monthly?
HbA1c
56
How should you manage a diabetic person presenting with a foot ulcer?
Fluclox, see again in 48hrs and refer to community diabetic nurse.
57
what are glinide's mode of action similar to?
Sulfonlyureas
58
Do glinides have a hypo risk?
Yes
59
How are glinides taken?
Before meals (up to TDS) to reduce post-prandial glucose spike.
60
Who are glinides good for?
If have unpredictable meal times.
61
SE glinides?
GI
62
What is metformin's drug class?
Biguanide

4th Year CCC (19 decks)

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