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S3 Case 4 - Endocrine > T2DM Care > Flashcards

T2DM Care Flashcards

(81 cards)

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1
Q

What is T2DM?

A

Insulin is secreted but not enough to overcome insulin resistance

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2
Q

What increased T2DM risk?

A

Obesity
Age
Family Hx
Gestational diabetes
Ethnicity
HTN

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3
Q

What are the presenting features?

A

NOT usually weight loss
No ketonuria
Onset over months

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4
Q

What is the fasting plasma glucose diagnosis?

A

> 7mmol/L

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5
Q

What is the 2hrs post-prandial glucose diagnosis?

A

> 11mmol/L

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6
Q

What is the HbA1c diagnosis?

A

> 48mmol/mol

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7
Q

What should diet be like?

A

Eat wide range of foods - fruit, veg + starchy foods
Keep sugar + fat to minimum
Do NOT skip meals

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8
Q

How much exercise?

A

30mins/day 5 days/week

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9
Q

What education is available?

A

DESMOND/XPERT

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10
Q

What is DESMOND/XPERT?

A

Prepare individuals to cope with disease
Help to make informed decisions about care
Help patients make behavioural changes

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11
Q

What are the benefits of weight loss?

A

Decreased insulin requirement
Decreased diabetes risk
Increase HDL
Decreased LDL, cholesterol + triglycerides
Decreased BP

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12
Q

What are the 3 treatment targets?

A

Lipids
BP
Blood glucose

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13
Q

What are the microvascular complications?

A

Cognitive impairment
Retinopathy
Neuropathy
Diabetic foot
Sexual dysfunction

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14
Q

What are the macrovascular complications?

A

Cerebrovascular disease
Coronary heart disease
Peripheral vascular disease

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15
Q

What is monotherapy?

A

Lifestyle management + metformin

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16
Q

What is dual therapy?

A

Lifestyle management + metformin + additional agent

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17
Q

What is triple therapy?

A

Lifestyle management + metformin + 2 additional agents

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18
Q

What is the MoA for Sulphonylureas + Meglitinides?

A

Stimulate pancreas + increase insulin production

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19
Q

What is the MoA for Biguanides?

A

Act on liver + cells to decrease glucose production

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20
Q

What is the MoA for Thiazolidinediones?

A

Act on liver + cells to reduce insulin resistance

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21
Q

What is the MoA for alpha-glucosidase inhibitors?

A

Acts in the gut to slow absorption of sucrose/starch

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22
Q

What is the MoA for DDP4-inhibitors?

A

Acts on pancreas + brain to increase the effects of incretin

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23
Q

What is the MoA for GLP-1 agonists?

A

Acts on pancreas + brain to increase the effects of incretin

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24
Q

What is the MoA for SGLT-2 inhibitors?

A

Acts in the proximal tubules of nephrons in kidney to inhibit sodium-glucose co-transporter 2 leading to increased glucose excretion

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25
What is an example of Biguanides?
Metformin
26
What does metformin do?
Decrease hepatic glucose production Increase insulin sensitivity Improve peripheral glucose Delay intestinal glucose absorption
27
What are the side effects of metformin?
N+V Diarrhoea B12 deficiency = slow titration to avoid
28
What are the cautions of metformin?
Stop if eGFR <30L/min
29
What are the contraindications of metformin?
Risk tissue hypoxia in renal function (acute HF, resp failure + liver failure) If having general anaesthesia suspend at least 24hrs before
30
What is an example of Thiazolidinedione?
Pioglitazone
31
What does Pioglitazone?
Increase insulin sensitivity
32
What are the side effects of Pioglitazone?
Weight gain Oedema Anaemia GI disturbances Headaches Dizziness Liver toxicity = uncommon
33
What are the contraindications of Pioglitazone?
Hx HF Haematuria Previous/active bladder
34
What are the cautions with Pioglitazone?
Elderly = increased risk of fracture HF + bladder Ca Increased risk of fractures Bladder cancer risk CV risk
35
What is an example of sulphonylureas?
Gliclazide
36
What does gliclazide do?
Increase insulin secretion
37
What is the dose for gliclazide?
Oral up to TDS with meals
38
What are the side effects of gliclazide?
Hypoglycaemia GI disturbances Weight gain Rashes
39
What are the contraindications of gliclazide?
Ketoacidosis Acute porphyria Severe hepatic impairment
40
What are the cautions of gliclazide?
G6PD Renal impairment may increase risk of hypos
41
What is the dose of Pioglitazone?
Oral OD (does NOT needed to be taken with meals)
42
What is the dose of metformin?
Oral up to TDS with meals
43
What is an example of Meglitinides?
Repaglinide Nateglinide
44
What does Nateglinide do?
Increase insulin secretion with a rapid onset + short duration of action
45
What are the side effects of Nateglinide?
GI Hypos
46
What are the cautions with Nateglinide?
Elderly Malnourished
47
What is the off note of Nateglinide?
Can be used alone or in combo with metformin
48
What is the dose of Nateglinide?
Oral TDS with main meals (within 30mins before meal)
49
What is an example of DPP4 inhibitors?
Sitagliptin
50
What does sitagliptin do?
Increase insulin secretion Decreases glucagon secretion
51
What is the dose for sitagliptin?
Oral OD (does NOT have to be with meals)
52
What are the side effects of sitagliptin?
GI Weight neutral Headache Nasopharyngitis Rash Pancreatitis Joint pain
53
What are the cautions of sitagliptin?
Renal impairment = dose reduced Moderate to severe HF Hx pancreatitis
54
What are the contraindications of sitagliptin?
Ketoacidosis
55
What is an example of SGLT-2 inhibitors?
Dapagliflozin
56
What does dapagliflozin do?
Increase urinary excretion of glucose
57
What are the side effects of dapagliflozin?
Dyslipidaemia UTI Thrush Nausea Constipation Ketoacidosis Lower limb amputations/fractures
58
Which SGLT-2 increases risk of amputation?
Canagliflozin
59
What are the contraindications of dapagliflozin?
SGLT2 discontinued if eGFR <45 >60
60
What are the cautions of dapagliflozin?
Renal impairment Hx HTN Elderly CVD Vol depletion - eg. loop diuretics
61
What is an example of a GLP-1?
Liraglutide
62
What does liraglutide do?
Increase insulin secretion Reduce glucagon secretion Reduce gluconeogenesis Slow gastric emptying
63
What is the does of liraglutide?
Up to OW - S/C injection (does NOT have to be with meals)
64
What are the side effects of liraglutide?
GI Hypos
65
What is the cautions with liraglutide?
Elderly Risk of thyroid tumours? Pancreatitis
66
What are the contraindications of liraglutide?
Ketoacidosis Severe GI disease eGFR <30
67
When may insulin be introduced?
Transiently in special circumstances - eg. surgery Inadequate control Offer high dose
68
What is the dose for SGLT-2
10mg OD
69
What are the Sick Day rules?
If vomiting, diarrhoea, fevers, sweats or shaking STOP taking... ACEi ARBs NSAIDs Diuretics Metformin SGLT-2 Acarbose
70
Which medications must be reviewed on Sick Days?
Sulphonylureas/meglitinides = not eating may be at risk of low = consider decreasing dose/stopping GLP-1/DPP4's = medical advice if severe abdominal pain Pioglitazone = medical advice if SoB
71
What family planning is needed?
Folic acid 5mg OD Refer to pre-natal/gestational diabetes clinic ASAP Many medications teratogenic
72
What are precipitating factors of HHS?
Pneumonia UTI Cerebrovascular disease MI Trauma Inadequate fluid intake
73
When do you rehydrate fast for HHS?
AKI Consequence of profound dehydration
74
When do you rehydrate slowly for HHS?
Initial severity Elderly HF
75
How is fluid loss estimated for HHS?
Between 100-220ml/kg
76
How do you diagnose HHS?
Marked hypovolaemia Serum osmolarity >320 Marked hyperglycaemia Without hyperketonaemia Without significant acidosis
77
What are the treatment goals for HHS?
Normalise osmolarity Replace fluid + electrolyte abnormalities Normalise blood glucose
78
How do you monitor osmolarity in HHS?
0-6hrs = check every 1hr 6-12hrs = check every 2hrs 12-24hrs = every 4hrs (if not improved every 2hrs)
79
How do you monitor blood glucose?
0-6hrs = every hr 6-12hrs = every hr 12-24hrs = every hr
80
How do you monitor clinical status?
Cardiac Urine output Establish IV access
81
How do you monitor precipitating factors?
Review for sepsis, foot infection, treatment omission, vulnerable person + vascular event

S3 Case 4 - Endocrine (17 decks)

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