Other Topics Flashcards
(25 cards)
Vigorous exercise impact on BG
increase is —— increase hepatic production
What can mild-moderate exercise do to BG
decrease during or after (up to 48 hours after)
— increase glucose use + insulin S
Exercise goals when DM
- min of 150mins/week of mod-vig aerobic activity
- > /=2 R training a week
- minimize time sedentary
T2DM: what to do if BG < 5 before exercise
take 10-20g of carbs
T1DM: what to do if pre-exercise BG is < 5
can decrease insulin dose OR increase CHO intake before
—-10-15/g hour of mild-mod
—30-60g/h of vig
WHen do we test for ketones after exercise if worried about hyper
BG> 16.7 + feel ill
Mechanisms to reduce hypo risk if T1DM in regards to exercise
1) decrease insulin dose (bolus)
2) increase CHO intake before, during and after
3) do max 10 seconds intensity before, during and after
4) do R training before aerobic
5) Pump: reduce dose for exercise duration if (</=45 mins) and lower basal overnight rate by 20%
What is MODY
maturity onset of diabetes in the young
- monogenic autosomal dominant disorder
- seen in those under 25; non insulin dependent
Mechanisms of drug induced DM
- decreased insulin S or production OR destruction of B cells
- liver: increase insulin R (keeps making glucose)
— muscle: decrease insulin S
What drugs can cause drug induced DM
glucocorticoids, atypical antipsychotics, statins
T or F: sickness can cause hypoglycaemia
F- likely to cause hyper due to increase in stress/ counter regulatory hormones
— increase glucose production in liver
What can happen to your insulin requirements when sick
increase even if food intake decreases
T or F: when sick, a T1DM should decrease their insulin doses to match their decrease in food intake
F- shouldn’t stop or decrease doses
What are the meds that should be stopped when sick
SAD MANS
- SU/M
- ACEi
- Diuretics or direct renin inhibitors
- metformin
- ARBs
- NSAIDs
- SGLT2i
What meds have a decrease clearance during sickness + therefore are stopped when sick
metformin + SUs
What meds can result in a decrease in renal fxn when sick and therefore are stopped
SGLT2i, ACEI/ARBS, NSAIDS, diuretics
When should ketones be tested for
when BG> 14 OR when have acute sickness/infection or injury
What is a ketostix
urine ketone test; negative or trace amounts is normal
What is a normal level of ketones in blood
< 0.6
What levels should we start to worry when it comes to ketones in the blood
0.6-1.5: retest BG + ketones in 2-4 hours
1.5-3: at risk of DKA
>3: medical emergency
Changes to basal insulin when preparing for surgery
stay the same or reduce by 20-50%
Changes to bolus insulin when preparing for surgery
dose based on CHO intake of clear fluid
- hold on day of procedure
- resume after once eating meals
T or F: we need to hold all non-insulin T2DM meds when we start the clear fluid diet in preparation for surgery
F
- DPP4: never have to stop
- SGLT2: stop 2-3 days before (DKA risk)
metformin, Sus, M, GLP-1: stop once start clear fluid diet
**hold all of them on day of procedure
How long does metformin need to be held after IV contrast
48 hours
- check renal fxn before restart
