Diabetes study note

Diabetes

Types of diabetes Type 1 Type 2 Gestational

Symptoms of diabetes ·         Being excessively thirsty ·         Passing more urine ·         Feeling tired and lethargic ·         Always feeling hungry ·         Having cuts that heal slowly ·         Itching, skin infections ·         Blurred vision ·         Gradually putting on weight ·         Mood swings ·         Headaches ·         Feeling dizzy ·         Leg cramps.

Symptoms of Hypoglycaemia Hypoglycaemia occurs when sugar level falls below 4 mmol/L, although this can occur in some people at sugar level above 4mmol/L ·         Weakness, trembling or shaking ·         Sweating ·         Light headedness ·         Headache ·         Dizziness ·         Lack of concentration/behaviour change. ·         Tearful/crying ·         Irritability ·         Hunger ·         Numbness around the lips and fingers

Symptoms of Ketoacidosis Most cases of ketoacidosis occur in people with type 1, it very rarely occurs in people with type High blood glucose levels and moderate to heavy ketones in the urine with: ·         Rapid breathing ·         Flushed cheeks ·         Abdominal pain ·         Sweet acetone (similar to paint thinner or nail polish remover) smell on the breath ·         Vomiting ·         Dehydration.

Treatment targets

BGL Ideal 4.0–6.0 mmol/L (fasting) ;  NHMRC 6.1–8.0 mmol/L (fasting) ; HbA1c ≤7%

Drugs for diabetes

Drugs	Dosage/ Mode of Ac	Counselling points	Contraindication/ precaution	Other comment
Metformin	Conventional tablet: Initial low, Maximum 3g daily CR tablet: Maximum 2g once daily Max for Renal impairment 60-90ml/min: 2g 30-60ml/min: 1g	-Take with food to reduce stomach upset. -Lactic acidosis ( Early symptoms: nvd, anorexia, abdo pain, cramps, weight loss, malaise -nausea,vomiting, diarrhoea (nvd)	Type 1 diabetes Ketoacidosis *Respiratory failure *Dehydration *Alcohol misuse *Heart failure	No hypoglycaemis, no weight gain Should try on all patient Surgery: Stop 2 days before, during and 2 days after surgery. Replace with insulin as required Can be used in polycystic ovarian syndrome
Sulfonylureas Gliclazide Glipizide Glimepiride Glibenclamide	-Increase pancreatic insulin secretion	Hypoglycaemia -          Take with food or immediately before food to reduce risk of hypoglycaemia -          Alcohol reduces sugar level and mask symptom of hypo. Avoid binge drinking and have something to eat when drink alcohol -       Educate friends and family on hypo	Type 1 diabetes Ketoacidosis	-Can cause weight gain ( because promote insulin secretion) -The longer the name of the drug, the higher the risk of hypoglycaemia
Acarbose	Initial 50mg. Maximum 600mg daily.	-Flatulence, diarrhoea, abdominal pain and distension -Take with first mouthful of food -GI adverse effect unlikely to be alleviated by taking an antacid		Should be safe in breastfeeding
Insulin	Varies	-Common side effect Hypoglycaemia, weight gain, lipoatrophy -refrigerate NOT FREEZE. Keep in the vegetable compartment of the fridge. Used insulin vial/pen can be kept at room temperature for 28 days http://www.youtube.com/watch?v=4ZYc6bjh9uA		Drug of choice for pregnant women See AMH 2011 page 400 for comparative information
Repaglinide	Increase pancreatic secretion Maximum 16mg daily	Hypoglycaemia as above -nausea, abdo pain,constipation,diarrhoea	-Type 1 diabetes -Ketoacidosis -Gemfibrozil
Thiazolidinediones Pio & Rosi	-Involve in lipid and glucose metabolism -decrease hepatic glucose output -increase sensitivity of peripheral tissue to insulin	Side effects Peripheral oedema ( swollen ankles eg), weight gain, headache, anaemia	-Type 1 diabetes -Ketoacidosis -Insulin – Rosi is contraindicated -Osteoporosis -Diabetic macular oedema -**Heart failure**	Rosi is associated with cardiovascular event, increase HDL and LDL cholesterol
Exenatide	Synthetic analogue of glucagon-like peptide, delay gastric emptying, reduce rate of glucose absorption and decrease appetite Initial, 5mcg bd Increase to 10mcg bd	-Nausea & vomiting ( in 50% of pts) BYETTA -Inject within 1 hour BEFORE morning and evening meals. Do not inject after meal. -Antibiotics to be taken 1 hour before or 4 hours after injection -To see how to use Byetta pen -can inject on arm, thigh and abdominal area http://www.youtube.com/watch?v=7g7fxMnUrOw - Must be kept in fridge at all time, discard after 28 days OR 30 days according to eMims	-severe GI disease -History of pancreatitis with exenatide -Comb with sulphonylurea-, may need to reduce dose of sulphonyurea
Di-peptidyl peptidase-4 inhibitor (-gliptin) Sita & Vilda	Increase concentration of incretin hormone and glucose-dependent-insulin secretion Sita : 100mg daily, reduce dose in renal impairment	SIta : Nausea and Stevens-Johnson Syndrome (SJS) Vilda: dizziness, peripheral oedema and arthralgia Take in the morning for once daily doseing Liver enzymes monitoring	-ACE inhibitor, vilda increase risk of angioedema	Less effective than metformin, sulphonylureas and thiazodinedione

Reference
AMH 2011, eMIMS 2011, Diabetes SA wesbite viewed on 2nd April 2012