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Flashcards in Endocrine Deck (18)
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1

T1D - HbA1c

monitor every 6 months - 48mol/mol target

2

T1D - glucose monitoring

4 times a day - before each meal and before bed

more if ill, sport. pregnant, breast feeding, hypos

3

T1D - blood glucose targets

Waking - 5-7
Before meals - 4-7

4

T1D - Insulin regimen

Basal bolus

2x daily levemir plus rapid acting before meals

metformin if BMI >25

5

T2D

1. lifestyle --> metformin
2. sulphonylurea (gliclazide)
gliptin

6

T2D HbA1c

48mmol, but only add other drugs if 58mmol (target 53)

7

action of gliclazide

inc insulin secretion

8

action of gliptin

DDP4 inhib - inc incretin release - inc insulin, reduce glucagon

9

thyrotoxicosis

propranolol and carbimazole
radioiodine

10

action and side effect of carbimazole

blocks TPO, agranulocytosis

11

Hypothyroid

Levothyroxine - monitor tfts 8-12 eks later

12

levothyroxine interactions

iron

13

DKA criteria

glucose >11
ph<7.3
bicarb<15
ketones >3/++ on dipstick

14

DKA treatment

1. Gastric aspriation - NBM and drain
2. Rehydration - 0.9% saline (1L stat in first hr)
3. Insulin IV - once glucose <15, add 5% dextrose
4. Potassium - correct if >5

15

Diabetic foot

Sugar control and advice
Pain - amitryptulline, pregabalin, gabapentin
tramadol
topical capsaicin

Prevention / Conservative / No Infection

Optimise diabetic control.

Patient education – self-care, self-examination

Refer to podiatry to optimize footwear, reduce pressure areas.

Dry gangrene – allow auto-amputation + healing by 2º intention.

Infected Diabetic Foot

Debridement & Revascularisation

Angioplasty / bypass

Wet gangrene - Amputation

Below knee – preserve mobility in young / active patient.

Above knee – absent femoral pulse; some mobility.

Through knee – already immobile patient.

Empirical antibiotics

16

Hyponatremia

not more than 0.5mmol/L/hr - central pontine myelinolysis

acute symptomatic e.g. seizures - 3% saline 150ml over 15mins. recheck after 20 mins (max 8-10mmol in 24hrs)

not symptomatic - 0.9% saline

17

Hypoglycaemia - conscious

oral glucose

18

Hypoglycaemia - unconscious

IM glucagon
iv 20% dextrose