Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Apr 2017; vol. 28 (no. 4); p. 148-152

Abstract:
The most recent National Institue for Health and Care Excellence (NICE) and European Association for the Study of Diabetes guidelines on management of type 2 diabetes (NICE, 2015; Inzucchi et al, 2015) emphasise the need to individualise glycemic targets and treatments, and highlight that working in partnership with the person concerned should be central to decision making. In addition to assessing the likely efficacy of a treatment, consideration should be given to tolerability and safety. The possibility of medication problems and side- effects needs to be anticipated and if a medication is chosen then a means for identifying and dealing with these should be considered in advance. Most adverse drug reactions are predictable and dose- dependent, the exception being allergic reactions. This article will consider problems arising with medications used for type 2 diabetes, excluding insulin.

Type of publication:
Journal article

Author(s):
*Morris, David Stuart

Citation:
Nurse Prescribing, 2016, vol./is. 14/Sup10(0-5)

Abstract:
This article will highlight best practice in managing type 2 diabetes in adults. HbA1c is the preferred diagnostic test for type 2 diabetes, the threshold for diagnosis being 48 mmol/ mol. Structured education is the cornerstone of management of type 2 diabetes with a focus on diet, exercise and weight loss. Multiple risk factors for complications need to be addressed including hypertension, dyslipidaemia and smoking (the most important factors in targeting macrovascular disease) and hyperglycaemia (more important in targeting microvascular disease). It is important to recognise that HbA1c targets need to be individualised. Metformin remains the first-line drug for hyperglycaemia in type 2 diabetes. Sulphonylureas, pioglitazone, DPP-4 inhibitors and SGLT-2 inhibitors are all recommended as possible add-on therapies to metformin, the choice again depending on individual circumstances. GLP-1 agonists and insulin can be considered in more intractable cases of hyperglycaemia.

Type of publication:
Conference abstract

Author(s):
*Kaldindi S.R., *Moulik P., *Macleod A.

Citation:
Diabetic Medicine, March 2015, vol./is. 32/(117-118)

Abstract:
A 42-year-old Afro-Caribbean female presented with 1 week history of polyuria, polydypsia and vomiting. She had a background of transfusion associated iron overload and renal failure secondary to sickle cell disease. She underwent a live donor renal transplant 8 months prior to admission. Immunosuppressive therapy included tacrolimus, mycophenolate, prednisolone 5mg once a day. There was no family history of diabetes. She had a normal body mass index. Results revealed a pH of 7.08, bicarbonate of 6.6mmol/l, capillary blood glucose tests recorded as greater than 28.7mmol/l, ketones 7.0mmol/l, Hb 84 g/l. Her creatinine was 101mumol/l (baseline 90), eGFR 52 and tacrolimus levels were within therapeutic range. No obvious precipitant for diabetic ketoacidosis (DKA) was found. She responded well to intravenous fluids and insulin. Her glutamic acid decarboxylase (GAD) and islet antigen 2 (IA2) antibodies were negative. Possible causes for her diabetes include iron overload, steroid therapy, tacrolimus. In her case, she presented with a short timeline of symptoms along with severe DKA. This is typical of Type 1 diabetes, even though her antibodies were negative. NODAT usually behaves like Type 2 diabetes but, rarely, such patients can also present with an insulin deficient state similar to Type 1 diabetes. The Renal Association suggests lower levels of tacrolimus to decrease NODAT risk and screening for diabetes post-transplant. A steroid sparing immunosuppressive regimen may help in reducing the incidence of NODAT.

Link to full-text [NHS OpenAthens account required]

Type of publication:
Conference abstract

Author(s):
*Rai D., *Kalidindi S., *Moulik P., *Macleod A.

Citation:
Diabetic Medicine, March 2015, vol./is. 32/(118)

Abstract:
Up to 5% of people with Type 1 diabetes have been reported to have gastroparesis. We present the case of a 19-year-old female who presented to hospital with diabetic ketoacidosis due to intractable vomiting. She developed Type 1 diabetes aged 8. Initial diabetes control was very poor, with a peak HbA1c of 167mmol/ mol and she developed severe non-proliferative diabetic retinopathy. One year prior to admission, she actively improved her blood sugars and dropped her HbA1c gradually down to 105mmol/mol. Paradoxically this seems to have worsened her vomiting. She denied any other symptoms of enteropathy and had no signs of autonomic or peripheral neuropathy. A CT and MRI brain were negative. She developed malnutrition requiring total parenteral nutrition and trials of prokinetics, dietary modifications were unsuccessful. A percutaneous endoscopic gastrotomy-jejunal tube was inserted which allowed simultaneous post pyloric feeding and gastric decompression. After a period of stable blood glucose with an HbA1c of 48mmol/mol, she had a formal gastric emptying study which confirmed severe delayed gastric emptying with a time (lag) of 87 min (normal <55) and half-life of 119 min (normal <80). Gastroscopy showed severe reflux oesophagitis consistent with delayed gastric emptying. She is currently awaiting a gastric pacemaker and manages to have small frequent meals with supplemental jejunal feeding. Diabetic gastroparesis is usually associated with peripheral and autonomic neuropathy, but she seems to have isolated gastroparesis. She also developed severe depression, psychological issues which required cognitive behavioural therapy. These issues could have worsened her symptoms.

Link to full-text: http://onlinelibrary.wiley.com/doi/10.1111/dme.12668_1/pdf

 

Type of publication:
Journal article

Author(s):
*Tan H.L., *Manjunatha R., *Barton D.

Citation:
BMJ Case Reports, July 2014, 1757-790X (21 Jul 2014)

Abstract:

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2014-205613.extract