An introduction to diabetes Flashcards
1
Q
____% of people with diabetes have type II
A
90
2
Q
___% of people with diabetes have type I
A
8
3
Q
2% have?
A
rarer forms
4
Q
presentations in type I?
most common in ______?
A
DKA toilet thirsty tired thinner (4 T's) children
5
Q
what is diabetic ketoacidosis? DKA
A
body has completely stitched to lipid metabolism
metabolites are acidic- can lead to death
6
Q
Symptoms in type II are __ _____ but _____ onset
A
same symptoms
slower
7
Q
TF: type II can increase episodes of genital thrush?
A
TRUE
8
Q
TF: type II diabetes have better wound healing
A
FALSE
9
Q
when is type I usually diagnosed?
A
childhood
10
Q
what happens in type I diabetes?
A
no insulin produced
11
Q
treatment of type I
A
replace insulin
12
Q
diet restrictions in type I
A
none- just careful monitoring of carb content
13
Q
type I is _____ likely to get complications than type II
A
MORE
such as nerves, eyes, heart attacks
14
Q
does type I have risk factors?
A
no- maybe a slight genetic link
15
Q
is insulin produced in type II
A
yes, but towards the end it stops due to pancreas exhaustion
16
Q
type II treatment is mostly related to
A
diet and exercise
17
Q
how can you stop the development of type Ii?
A
Losing 20% of body weight
18
Q
when is insulin given in type II?
A
last resort
19
Q
risk factors for type II?
A
ethnicity age obesity- 80% genetics smoking alcohol raised BP PCOS poor sleep
20
Q
stress hormones have what effect on blood glucose?
A
increase
21
Q
examples of stress hormones
A
adrenaline
cortisol
22
Q
how do sulfonylureas and meglitanides treat type II?
A
enhance insulin secretions
23
Q
when dont sulfonylureas and meglitanides not work?
A
type I
when there’s no pancreatic function
no point giving if not function
24
Q
how does pioglitazone and metformin work?
A
improving the effect of insulin at its end point
improving muscles uptake of insulin, reduces peripheral insulin resistance
these also a secondary effect: reduce hepatic glucose out put
25
why does pioglitazone and metformin not work in type I diabetics?
needs insulin in the body
26
how does DPP-4 inhibitors and GLP-1 agonists work?
secondary effect on liver- telling it to decrease glucose production.
27
how do acarbose and GLP agonists work?
reducing the amount of glucose you get from your food in the first place- stops you digesting carbohydrates
28
need a _____ BMI to use GLP1 agonists. why?
high
| slow gastric emptying, feel fuller for longer so dont each as much
29
GLP1 agonists also ____ hormone incretin action. effect?
| therefore do you need a working pancreas?
increase
hormone your stomach sends to pancreas to tell it to secrete insulin
yes
30
DPP-4 agonists work on the same pathway as?
GLP1 agonists
| both increase action of incretin and produce more insulin
31
why can't you use DPP-4 and GLP1 agonists together?
DPP4 is the enzyme that breaks down the hormone GLP1
32
what is the gold standard drug for type iI diabetes?
metformin
33
advantages of metformin?
cheap
natural
low hypo risk
34
why does metformin have a low hypo risk?
makes muscles more sensitive to insulin, not making more insulin than needed
35
disadvantages of insulin
GI side effects- weight loss
RARE BUT SERIOUS: lactic acidosis
short half life so must take often
contraindicated in eGFR of <30
36
what does the side effect of lactic acidosis make metformin use in patients inappropriate for?
have had:
heart attack
sepsis
resp disease
37
how can you reduce the side effects of metformin?
titrate doses up
38
when does metfomin become less favourable
as the disease progresses and the patient get complications
39
sulfonylureas gives _____ control over blood sugars
quick
40
advantages of sulfonylureas?
OD or BD
quickly lowers blood glucose levels
fewer GI side effects than metformin
41
disadvantages of sulfonylureas?
hypo
weight gain
need residual pancreas function
unpredictable in renal impairment and in the elderly
42
pioglitazone advantages?
OD
low risk of hypo
suitable in renal impairment
43
pioglitazone disadvantages?
associated with heart failure
increased risk of bladder cancer and fractures
weight gain- fluid
liver toxicity (rare)
44
pioglitazone time before you see benefit?
3-6 months
45
why is pioglitazone associated with heart failure?
causes fluid retention- rosalitazone was taken off the market due to this
46
what drug classes are metformin and pioglitazone?
only drugs in their classes.
47
DPP-4 inhibitors advantages?
* Once a day
* No weight gain
* Low risk of hypo
* Some can be used in renal impairment
* Very few side effects so patients like this
48
DPP-4 disadvantages?
```
GIT effects
rash
UTI
rare: pancreatic inflammation
doesn't work amazingly
```
49
what does the SGLT-2 transporter do? how can we use this to treat diabetes?
transports glucose back into the blood once filtered out by the kidneys
block this
50
can SGLT-2 inhibitors be used in type I?
YES- dont need insulin
51
SGLT-2 advantages?
- weight loss
- decrease BP
- low risk of hypo
52
SGLT-2 disadvantages
```
can cause thrush
only effective is good renal function
lower BP= falls
DKA risk
kidney injury and foot ulcers
```
53
why can SGLT-2 cause thrush?
increased sugar in urine good for bacterial growth
54
GLP-1 is a _____ ______
last resort
55
advantages of GLP-1
weight loss
OD or weekly preparations
rare hypos
56
disadvantages of GLP-1
expensive- injections
GI SE's are common
need BMI >30 and complications from this BMI
57
why is GLP-1 given as injection?
big molecule
58
NICE guidelines for type II diabetes?
diet and exercise
+ metformin
+ another drug of patients choice
59
2 types of insulin injection?
basal bolus
| biphasic
60
which type of insulin injection is better if you dont want as many injections?
biphasic over basal bolus
61
how is basal bolus administered?
one or two long acting in morning and evening
| extra 3 doses of short/ rapid acting during the day before meals
62
how does biphasic insulin work?
given with a salt, some insulin is bound to the salt and some is free. free insulin is used, as this leaves the system the bound insulin leaves the salt
63
how is biphasic insulin administered?
two biphasic insulin doses- one in the morning and one at night
64
example of long acting insulin
Lantus
65
example of super long acting insulin
toujeo
| tresiba
66
example of rapid acting insulin
novorapid
67
which types of insulin are the most expensive?
rapid and super long acting
68
what is a good combination of insulins?
rapid and super long acting
long acting and rapid acting
69
what type of insulin is bad as you have to plan in advance before eating?
actrapid, humbling S
as works about 3 hours after eating
70
what is the dose of basal bolus regime based on?
| when is it taken?
carb intake
| with meals
71
non human insulin is _____ used. why?
rarely
mainly used for people who have used it for years and dont want to change
or if cant tolerate human insulin
72
why is it hard to adjust the dose in biphasic insulin?
as any increase in your fast acting insulin you're also increasing your basal insulin as they're a fixed ratio
73
disadvantage of biphasic insulin?
lose flexibility of food
74
why is biphasic insulin never first choice in type I diabetics?
as tight control of diet is important
| good in type II
75
what does biphasic insulin contain?
short or rapid acting insulin in a protamine suspension
76
biphasic insulin onset and duration?
1-2 hours
| 12 hours
77
examples of biphasic insulin?
humilin M3
humalog mix 25, 50
novomix 30
inhuman comb
78
TF: anything with a fast acting component or reaches a peak we always give with food.
TRUE-
79
why doesn't when you give it matter with long acting and ultra long insulin
maintained levels so can take whenever
80
which type is biphasic insulin most common I?
type II
| but also in type I where number of injections is problematic
81
when isn't continuous SC insulin infusion appropriate?
patients who struggle with compliance
| good for patients with good control of their diabetes
82
when is continuous SC insulin infusion appropriate?
HbA1c control with multiple daily injections result in disabling hypos
HbA1c levels have remained high (>69 mol/mol) on MDI therapy
83
issues with continuous SC insulin infusion
can become unstuck and you can go hyper without knowing
84
define disabling hypo
repeated and unpredictable occurrence of hypo that results in anxiety
85
what is a patients diabetes education course for type I?
DAFNE
86
type II education courses? what do they focus on?
X-PERT, DAFNE
| CV risk factors and diet
87
what are microvascular complications of diabetes?
effect of high insulin and blood sugar increases:
atherosclerosis
strokes
heart attacks
88
what are microvascular complications?
damage to vessels and nerves
amputations
kidney disease
retinas
89
___ times more likely to get depression. regardless of....
2
| complications
