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Yr3 - General Medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Treatment of hyperglycaemia

A

Oral fluids - 1L water or sugar free squash over 1 hour
Metformin - if eGFR > 45
Basal insulin
Aim for 6-10 mmol CBG

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2
Q

Criteria for hyperglycaemia

A

CBG > 12mmol/L

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3
Q

Criteria for hypoglycaemia

A

CBG < 4mmol/L

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4
Q

Features of DKA

A

Hyperglycaemia
Metabolic acidosis
Ketotic

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5
Q

Features of HHS

A

Hyperglycaemia
High serum osmolarity
Volume Depletion
Absence of significant acidosis

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6
Q

What is HHS

A

Hyperosmolar hyperglycaemic state

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7
Q

Definition of DKA

A

Ketonuria > 2 or blood ketone > 3mmol/L
Blood glucose > 11 mmol.L
Bicarbonate < 15mmol/L or venous pH < 7.3

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8
Q

Management of DKA

A 
Insulin - fixed rate IV invusion (FRIII)
Fluid 
Potassium 
Avoid hypoglycaemia
Identify and treat underlying cause
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9
Q

HHS definition

A

Hypovolaemia
Marked hyperglycaemia > 30mmol/L or acidosis pH > 7.3
Osmolality > 320mosmol/kg

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10
Q

Management of HHS

A 
Insulin - FRIII
IV fluid - 0.9% Sodium Chloride
Potassium
Low molecular weight heparin 
Identify and treat underlying cause
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11
Q

Features of hypoglycaemia

A

Autonomic symptoms
- pallor, sweating, tremor, tachycardia
Neuroglycapaenic symptoms
- loss of concentrations, behavioural changes, fits, transient neurological defects, reduced level of consciousness

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12
Q

Causes of hypoglycaemia

A 
Medical reasons
- inappropriately timed medication
- insulin error
- discontinuation of long term steroid therapy
- recovery from acute illness/stress
- change in activity levels
Reduced carbohydrate intake
- missed/delayed meals
- smaller meals
- change of time of meals
- lack of access to usual snacks
- prolonged starvation time - NBM, vomiting
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13
Q

Management of hypoglycaemia

A

Glucojuice or gluocse gel

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14
Q

Indications for insulin sliding scale

A

Type 1 diabetes
- unable to eat/drink
- recurrent vomiting
Type 1 or 2 with severe illness

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15
Q

Features of sliding scale

A

Prescribe dextrose too - prevent hypoglycaemia

Hourly CBG

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16
Q

Risk factors for HHS

A

Infection
Inadequate insulin or oral anti-diabetic therapy
Acute illness in pt with known diabetes
Nursing home residents

17
Q

Investigations for HHS

A

Plasma glucose - elevated
Serum/urinary ketone level - negative/low
Serum urea - elevated
Serum creatinine - elevated - due to volume depletion
Serum osmolality - raised - > 320 mOsm/kg

18
Q

Complications of HHS

A 
Insulin related hypoglycaemia
Treatment related hypokalaemia
Stroke
MI
PE
DIC
Cerebral oedema
Coma
19
Q

Define type 1 diabetes

A

Autoimmune destruction of beta-cells in the Islet of Langerhans
Complete insulin insufficiency -> hyperglycaemia

20
Q

Risk factors for type 1 diabetes

A

Genetic predisposition
Human enterovirus
Autoimmune disorders

21
Q

Clinical features of type 1 diabetes

A 
Young age
Weight loss
Fatigue
Polydipsia
Polyuria
22
Q

Investigaitons for diabetes mellitus

A

Random blood glucose > 11mmol/L
Fasting blood glucose > 7mmol/L
HbA1c > 6.5% / 48mmol/mol

23
Q

Management for type 1 diabetes

A

Insulin
- basal bolus + pre-meal corrections
DAPHNIE courses

24
Q

Complicagtions of diabets

A 
DKA (type 1) / HHS (type 2)
Hypoglycaemia
Hyperglyceamia
Microvascular
- neuropathy
- nephropathy
- retinopathy
Macrovascular
- increased cardiovascular disease risk
25
Q

Risk factors for type 2 diabetes

A 
Overweight/obese
Non-white heritage
Increasing age
Gestational diabetes
Pre-diabetes - HbA1c > 6%
Hypertension
Stress
PCOS
FHx
26
Q

Clinical features of type 2 diabetes

A 
Commonly asymptomatic
Recurrent UTIs/candidial/skin infections
Fatigue
Polydypsia
Polyuria
27
Q

Management of type 2 diabetes

A 
Lifestyle
Metformin
Sulfonylures - if metformin contraindicated/not tolerated
SGLT2 inhibitors
DPP-4 inhibitors
GLP-1 agonists
Basal insulin
28
Q

Lifestyle management of type 2 diabetes

A 
Nutrition advice
- weight loss
- low GI index
Increased activity
- 3-4 40 min sessions
Smoking cessation
Reduced alcohol consumption
29
Q

Metformin

A 
Reduces hepatic gluconeogensis and glycogenolysis
- reduces HbA1c
- reduces LDL
CVS benefit
Inexpensive
GI side effects
- diarrhoea
- N+V
- titrate up to reduce
- can give modified release 
1st line
30
Q

SGLT2 inhibitors

A

Empagliflozin
Reduces CVD risk
Risk of ketoacidosis
Increase amputation risk

31
Q

Sulfonylureas

A 
Gliclazide
Increases plasma-insulin concentrations
- modest weight gain
Risk of hypoglycaemia
1st line if metformin contraindicated or not-tolerated
32
Q

DPP-4 inhibitors

A 
Gliptins
No weight gain
Low hypoglycaemia incidence
No CVS benefit
Few side effects
33
Q

GLP-1 agonists

A 
Suppresses glucagon levels
Stimulate glucose dependent release of insulin
Delay gastric emptying
- weight loss
Increased CVS/kidney risk
Last line
34
Q

Basal inuslin

A

Added to metformin - bed time
Periodic home glucose monitoring
Educate on signs of hypoglycaemia

35
Q

Piogitazene

A

Several long term risk

  • heart failure
  • fluid retention

Yr3 - General Medicine (9 decks)

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