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STG 2017 > DIABETES MELLITUS > Flashcards

DIABETES MELLITUS Flashcards

(51 cards)

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1
Q

Fasting glucose profile for diabetes diagnosis

A

Normal: < 5.6mmol/l
Impaired fasting glucose : 5.6-6.9
Diabetes: >7

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2
Q

2 hour post prandial glucose profile for diabetes diagnosis

A

Normal: <7.8
Impaired glucose tolerance: 7.8-11.1
Diabetes: >11.1

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3
Q

HbA1c profile for diagnosis of diabetes

A

Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%

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4
Q

HbA1c profile for diagnosis of diabetes

A

Normal: <5.7%
Pre-diabetes: 5.7-6.4
Diabetes:>6.5%

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5
Q

Types of diabetes

A

Type 1
Type 2
Gestational
Secondary diabetes

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6
Q

Causes of type 1 diabetes

A

Autoimmune disorder
Idiopathic

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7
Q

Causes of type 1 diabetes

A

Environmental factors
Genetic factors causing defect in insulin action or secretion

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8
Q

Causes of secondary diabetes

A

Medication: corticosteroids
Pancreatic disease
Endocrine disorders: cushing’s syndrome, acromegaly

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9
Q

Symptoms of diabetes mellitus

A

Polyuria
Nocturia
Polydipsia
Unexplained weight loss
Blurred vision
Recurrent boils
Recurrent pruritis vulvae
Erectile dysfunction
Symptoms related to chronic complications
Delivery of large babies >4kg

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10
Q

Signs of diabetes

A

Lack of sensation in feet or hands
Foot gangrene
Pedal edema
Impaired visual acuity
Cataract
Retinal changes on fundoscopy

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11
Q

Investigations in newly diagnosed diabetes

A

Fasting glucose
Oral glucose tolerance test
Glycated hemoglobin
BUE/Cr
Fasting lipid profile
FBC
ECG in adults
Urinalysis
Urine ketones

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12
Q

When is urine ketones necessary in diabetes

A

Presenting with high initial blood glucose

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13
Q

Investigations during routine follow ups in diabetes

A

Blood glucose
HbA1c
Blood lipids
BUE/Cr
Urine microalbumin

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14
Q

How frequent should lipid profile be monitored in diabetes

A

Annually but more frequent if levels are abnormal or on lipid lowering drugs

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15
Q

How frequent should glycated hemoglobin be monitored in diabetes

A

At least twice a year

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16
Q

How frequent should BUE/Cr be monitored in diabetes

A

Annually but more frequently if levels are abnormal

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17
Q

How frequent should urine microalbumin be monitored in diabetes

A

Annually

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18
Q

Goals of therapy in management of diabetes

A
  1. Provide relief from symptoms
  2. Prevent treatment related hygoplycaemia
  3. Prevent acute hyperglycemic complications
  4. To reduce blood glucose to glycemic targets
  5. To prevent chronic complications
  6. To reduce weight in overweight and obese individuals
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19
Q

Blood pressure target in diabetes

A

<130/80

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20
Q

LDL cholesterol target in diabetes

A

<2.5mmol/L

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21
Q

Fasting blood glucose targets in diabetes according to STG

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A

4-7mmol/l, less intensive targets in elderly patients

22
Q

2-hour post-meal blood glucose target in diabetes according to STG

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A

5-9mmol/l, less intensive targets in the ellderly

23
Q

Glycated hemoglobin target in diabetes according to STG

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A

7%, less intensive targets in the elderly

24
Q

Dietary modifications in diabetes

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A

Complex carbohydrates preferred
Avoid refined sugars
Artificial sweeteners and diet soft drinks may be used
Reduce total caloric content of food
Increase amount of fibre
Consume 400g or more of fruits and vegetables per day
Reduce salt intake to <5g/day

25
According to STG, what is the recommended percentage of carbohydrate, fat and proteins in the diet of a diabetic
Carbohydrate- 60% Proteins- 15% Fat- 20%`
26
Recommendations on alcohol consumptions in diabetes
Avoid alcohol in children under 18 Low alcohol consumption is permissible in adults Moderate to heavy alcohol consumption is not advised
27
Effects of moderate to heavy alcohol consumption in adults
Increases total caloric intake Worsens weight and obesity Increases risk of hypoglycemia
28
Recommended exercise regimen for diabetes according to STG
30 minutes brisk walking at least 3 days a week in ambulant patients Consider patient's age,complications and comorbidities
29
Daily insulin requirement for most adults and pre-pubertal children
0.6 to 0.8U/kg
30
These factors increase insulin requirements
Infections Puberty Stress Accidental trauma Surgery Pregnancy
31
When should soluble insulin, NPH insulin and premix insulin be given
30 minutes before meals
32
Which type of insulin is given immediately before meals
Rapid acting insulins
33
The two regimens for insulin in diabetes and which one is preferred
1. Twice daily pre-mixed insulin (soluble + intermediate acting insulin) before breakfast and supper (preferred) 2. Twice daily injections of Soluble PLUS NPH 30 minutes before breakfast and Soluble PLUS NPH 30 minutes before supper
34
35
Twice daily premix insulin regimen
Insulin Premix, SC, (30% soluble insulin and 70% NPH insulin), ⅔ of total daily insulin requirement 30 minutes before breakfast And ⅓ of total daily insulin requirement 30 minutes before evening meal (supper)
36
Twice daily injections of soluble plus NPH regimen
Soluble insulin, SC, ⅓ of total daily insulin requirement in 2 divided doses 30 minutes before breakfast and supper And Insulin NPH, SC, ⅔ of total daily insulin requirement (⅔ of which would be given 30 minutes before breakfast and ⅓ 30 minutes before supper)
36
Dose of glibenclamide
Adults 2.5-10 mg daily (If required, not more than 5 mg of Glibenclamide could additionally be given in the evening maximum total dose 15 mg
37
Dose of gliclazide
Gliclazide, oral, Adults 40-160 mg 12 hourly
38
Dual therapy add-on for patients with uncontrolled diabetes after 3 months of metformin
Glibenclamide or Gliclazide or Glimepiride or Tolbutamide
38
First line treatment of type 2 diabetes
Metformin, oral, Adults 500 mg-1 g daily Then Increase every 3 months to a maximum of 1 g 12 hourly if necessary
39
3rd agent add on oral agents for uncontrolled diabetes on dual therapy of metformin and SUR
Saxagliptin or Sitagliptin or Vildagliptin or Pioglitazone
40
Treatment for Type 2 diabetes patients on oral medications; not achieving glycaemic targets with Triple Therapy
Add Insulin therapy to triple therapy
41
Dose for glimepiride
Adults 2-6 mg daily (as a single dose in the morning)
41
When should eye examinations be done in diabetes
After 5 years of diagnosis for both type 1 and type 2 diabtes
42
Dose for tolbutamide
Adults 250-1000 mg 8-12 hourly
43
In which patients is tolbutamide preferred
Impaired renal function Elderly
44
Dose for saxagliptin
Adults 2.5-5 mg daily
45
Dose for sitagliptin
Adults 50-100 mg daily
46
Dose for vildagliptin
Adults 25-50 mg 12-24 hourly
47
Dose for pioglitazone
Adults 15-45 mg daily
48
Dose for insulin addon to triple therapy of oral medications in type 2 diabetes
Adults 2-20 units before bedtime

STG 2017 (88 decks)

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