Management Flashcards
(28 cards)
What is the treatment for type 1 diabetes?
Insulin is life-saving. In the absence of beta cells, achieving near normoglycaemia without side effects is very difficult.
Also controlled carb diet and exercise.
What are examples of rapid-acting insulin?
- Insulin aspart
- Insulin glulisine
- Insulin lispro
What are examples of long-acting insulin?
- protamine zinc insulin
- insulin zinc suspension
- insulin detemir
- insulin glargine
- insulin degludec
What is the treatment for type 2 diabetes?
- Reduced calories improve islet function and weight loss reduces insulin resistance.
- Exercise improves insulin sensitivity with or without weight loss.
- Decrease blood glucose
- Decrease BP
- Improve lipid profile
What drugs are used to reduce insulin resistance?
- Biguanide and metformin
- Thiazolidenodiones
What drugs increase beta cell activity?
- Sulphonylureas e.g. glucanizide, glipazide, glibenclamide
- Meglitinides e.g. nateglinide, repaglinide
What drugs increase GLP1 activity?
- DPP4 inhibitors e.g. sitagliptan, vildagliptin, linagliptin, alogliptin
- Incretins, GLP1 antagonists e.g. exenatides, luraglutide
What drugs slow glucose absorption?
Acarbose (alpha-glucosidase inhibitor)
What drugs enhance glucose secretion?
- SGL2 antagonist (dapagliflozin, canagliflozin, empagliflozin)
How is glucose monitored?
- Urine glucose - imprecise but useful in T2DM
- Blood glucose - self-regulation, targeted for T2 on hypoglycaemic risk meds
- HbA1c - risk assessment every 6 months
What does the annual care planning involve?
- Risk factor review e.g. lifestyle, glucose, lipids, BP
- Early detection of microvascular complications
- Patient and professional review of results
- Care planning - priorities and goals, managament plan, management of complications
What are the baseline annual checks to be done?
- Lipids - TL/HDLC ratio (CV risk)
- UACR
- eGFR
- Foot exam - pulses, deformity
- Diabetic Eye Screening programme
- BP
- HbA1c
What is the secondary prevention for diabetic retinopathy?
- Early detection of sight-threatening retinopathy (retinal screening)
- Prompt and appropriate ALLC (anti-VEGF)
- Glucose and BP control
What is the salvage therapy for diabetic retinopathy?
Vitrectomy - remove vitreous and repair retina behind
What are the stages of CKD?
1 - eGFR >90 ml/min/1.72m2 2 - 60-90 3 - 30-59 4 - 15-29 5 - <15
What is the secondary prevention for diabetic nephropathy?
- Early detection of minimal nephropathy (UACR, eGFR)
- Intensive (<120/75) BP control (ACEi, ARBs)
- Blood glucose and vascular risk factor control
What is the salvage therapy for diabetic nephropathy?
- Diet, Epo, calcium, vitD, bicarbonate
- Early AVF, early transplantation
- Dialysis and transplantation
What is the primary prevention for complications in pregnancy?
- Pre-pregnancy blood glucose control/folate
- Intensive blood glucose control
What is the salvage therapy for complications in pregnancy?
- Anomaly screening
- Foeto-placental monitoring
What is the primary prevention for CV complications of diabetes?
- Lifestyle
- Metabolic control (glucose, BP, lipids)
- ACEi, ARB, aspirin, statins/fibrates
What is the secondary prevention for CV complications of diabetes?
Post angina, ACS, MI, TIA, CVA, claudication, ED - thrombolysis, aspirin, DIGAMI, beta blockers
What should the care plan be for diabetic patients?
- Lifestyle changes - diet, exercise
- Agree target weight loss
- Refer to smoking cessation service
- Review in 3 months
- Recommend add metformin if above HbA1c range - cons: can have bad GI side effects
How do you prevent DKA/HHS disaster?
NEVER stop basal insulin
What do you do to manage DKA?
- Hypovolaemic shock - fluid resuscitation (saline 1L over 1hr)
- Tests: ABG, glu, ketones, U+E, CRP, CXR, ECG
- Add insulin 50 units to 50ml saline (0.1 unit/kg/hr)
- Check tests frequently - blood glu, ketones hourly
- Continue fluids and assess need for K+
- Consider catheter if not passed urine
- Avoid hypoglycaemia
