Diabetes Flashcards
Advice to T1 diabetics during sick days?
Monitor glucose and urinary ketones more regularly
Drink 3-4L fluids a day
If they are struggling to eat, can have sugary drinks
What test is done to distinguish between T1 and T2 diabetes?
C-peptide: is a co-product with insulin so is low in T1 diabetes
T2 diabetes diagnosis
Fasting: >7.0
Random/oral glucose: >11.1 (7.8-11.1 is IGT)
HbA1c >48
If asymptomatic, tests must be positive on two separate occasions
First line treatment for diabetic neuropathy?
Gabapentin, duloxetine, amitryptiline, pregabalin
Tramadol as rescue therapy
Capsaicin if localised
Pain management clinic if resistant
T1 diabetes HbA1c target?
48
DKA management
IV normal saline
IV insulin (0.1 unit/kg/hour) LONG-ACTING - once target of <15mmol/L blood glucose reach, can start 5% dextrose
Correct hypokalaemia
DKA diagnostic criteria
> 11 mmol/L glucose
+++ urinary ketones
15mmol/L bicarbonate
HGV driving license and insulin
Adequate understanding of hypoglycaemia and risks
No hypoglycaemic event in last 12 months
Adequate control by regular monitoring at least twice daily and relating to times of driving
Management of HNF-1A MODY?
Sulfonylureas (gliclazide)
T1 blood glucose targets before eating and after waking?
Before eating: 4-7
After waking: 5-7
Whipple’s triad for insulinoma?
- hypoglycaemia on fasting or exercise
- reversal of symptoms with glucose
- low BMs at time of symptoms
Insulin and sulfonylurea are most common causes of hypoglycaemia in diabetics - what are the most common causes in non-diabetics?
Exogenous drugs (quinine, ACE) Pituitary insufficiency Liver failure Addison's Islet cell tumours (insulinoma) Non-pancreatic tumours
What would cause an overestimate in HbA1c?
Splenectomy - increases lifespan of RBCs
What conditions would cause an underestimate of HbA1c?
Beta-thalassemia
Sickle-cell anaemia
