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33 Cards in this Set
- Front
- Back
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What is diabetes mellitus? |
A group of metabolic disorders in which persistent hyperglycaemia is caused by deficient insulin secretion (type 1) or by resistance to the action of insulin (type 2) |
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All drivers who are treated with insulin must notify the [×] |
DVLA |
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Drivers treated with insulin should always carry a glucose meter and blood glucose strips when driving. When do they need to check their blood glucose concentration? |
2 hours before driving and every 2 hours while driving |
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What should the blood glucose levels be whilst driving? |
Above 5mmol/L. If below, then a fast acting carbohydrate (e.g. 5 jelly babies - not chocolate or biscuits) |
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What should a driver do if their blood glucose is <4 mmol/L or experiences warning signs of hypoglycemia |
Stop the vehicle in a safe place, switch off engine, remove keys from ignition, move away from driver's seat, eat/drink a suitable source of sugar. Wait until 45 minutes after blood-glucose has returned to normal before driving off |
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What are the rules regarding alcohol? And what are the effects of alcohol on a diabetic? |
Alcohol can mask the warning signs of hypoglycemia and can delay it. It should be drank in moderation and accompanied with food |
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When are oral glucose tolerance tests used? |
Mainly for diagnosis of impaired glucose tolerance - not recommended or necessary for routine diagnostic use when severe symptoms of hyperglycaemia are present. Used to establish presence of gestational diabetes. Used in patients who have less severe symptoms and blood glucose concentration doesn't establish or exclude diabetes e.g. impaired fasting glycaemia |
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How do oral glucose tolerance tests work? |
Measuring the blood glucose concentration after fasting and then 2 hours after drinking a standard anhydrous glucose drink. An alternative drink is Polycal or as Rapilose OGTT oral solution |
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What is the HbA1c test? |
Used for monitoring glycaemic control in both Type 1 and Type 2 diabetes. And used for diagnosis in type 2. |
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When is HbA1c test not used? |
Those with suspected type 1 diabetes, in children, during pregnancy or in women who are up to 2 months postpartum. Shouldn't be used for patients who have end stage chronic kidney disease, acute pancreatic damage, HIV infection, treatment with medication that can cause hyperglycaemia, high diabetes risk and are acutely ill, had symptoms of diabetes for less than 2 months |
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When should HbA1c test be interpreted with caution? |
In patients with abnormal haemoglobin, anaemia, altered red cell lifespan, had a recent blood transfusion |
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Lower HbA1c is associated with a lower risk of ... |
Long term vascular complications |
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In a type 1 diabetic, HbA1c should be measured every |
3-6 months. And more frequently if blood glucose control is changing rapidly |
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In a type 2 diabetic, HbA1c should be monitored every.... |
3-6 months until HbA1c and medication is stable. Then it can be monitored every 6 months |
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For patients with disturbed erythrocyte turnover or for patients with a lack of/abnormal haemoglobin, HbA1c monitoring is invalid. What should be used instead? |
Quality-controlled plasma glucose profiles, total glycated Haemoglobin estimation (if there is abnormal haemoglobin) or fructosamine estimation can be used. |
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How does lab measurement of fructosamine concentration work? |
Measures the glycated fraction of all plasma proteins over the previous 14-21 days. But it's less accurate measure of glycaemic control, than HbA1c |
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What is glycated Haemoglobin? |
HbA1c which forms when red blood cells are exposed to glucose in the plasma. It reflects average plasma glucose over the previous 2-3 months and provides a good indicator of glycaemic control. It can be performed at any time of the day and doesn't have any special requirements like fasting |
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Urinalysis: how do they work |
Reagent strips are available for measuring glucose in the urine. Microalbuminuria can be detected with Micral-Test II, but it should be followed by a confirmation in the lab, since false positive results are common. |
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How do blood glucose monitors work? |
A meter is used to give a direct measure of the glucose concentration at the time of the test. Can detect hypo and hyperglycaemia |
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When should patients with type 2 diabetes self Monitor? |
If they are taking insulin, taking oral hypoglycemic drugs e.g. sulfonylureas (gliclazide), monitor changes in blood glucose concentration resulting from changes in lifestyle or medication, during intercurrent illness, ensure safe blood glucose concentration during activities e.g. driving |
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What is the unit of blood glucose concentration? |
mmol/L |
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Women with pre existing diabetes who are planning to become pregnant should aim to keep their HbA1c concentration below... |
48 mmol/mol |
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Women with pre existing diabetes should take folic acid... |
Folic acid 5mg before conception and until week 12 of pregnancy (3 months) |
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Which oral anti-diabetic can be continued during pregnancy? |
Metformin |
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Which oral anti-diabetic can be used during breastfeeding? |
Metformin! |
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What is the first choice for long acting insulin during pregnancy? |
Isophane insulin (Humulin) |
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If a woman has good blood glucose control when taking long acting analogues, can they be continued? |
Yes - insulin detemir (levemir) or insulin glargine (Toujeo, Lantus, Abasglar) |
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Pregnant women with type 1 diabetes should also be prescribed [X] if needed |
Glucagon 1mg |
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Which hypertension medicine should be stopped before conception? |
ACE inhibitors, ARBs, statins |
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Women with gestational diabetes diagnosis |
Fasting blood glucose <7mmol/L. Should try diet and exercise alone. If targets aren't met within 1-2 weeks, then Metformin (unlicensed) may be prescribed. Insulin can be added if Metformin not effective alone. Or insulin as an alternative if Metformin is contraindicated or unacceptable |
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If a woman's fasting blood glucose is <7 mmol/L, treatment is... |
Insulin immediately (with or without Metformin) in addition to changes in diet and exercise |
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If a pregnant woman's fasting plasma glucose is between 6-6.9 mmol/L, alongside complications e.g. macrosomia (large baby) or hydramnios (Too much amniotic fluid around foetus), treatment is... |
Immediate insulin treatment, with or without Metformin |
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Should hypoglycemic treatment be continued after birth for women with gestational diabetes? |
Immediately! |
