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Patient > An introduction to diabetes > Flashcards

An introduction to diabetes Flashcards

1
Q

____% of people with diabetes have type II

A

90

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2
Q

___% of people with diabetes have type I

A

8

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3
Q

2% have?

A

rarer forms

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4
Q

presentations in type I?

most common in ______?

A 
DKA
toilet 
thirsty 
tired
thinner 
(4 T's)
children
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5
Q

what is diabetic ketoacidosis? DKA

A

body has completely stitched to lipid metabolism

metabolites are acidic- can lead to death

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6
Q

Symptoms in type II are __ _____ but _____ onset

A

same symptoms

slower

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7
Q

TF: type II can increase episodes of genital thrush?

A

TRUE

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8
Q

TF: type II diabetes have better wound healing

A

FALSE

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9
Q

when is type I usually diagnosed?

A

childhood

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10
Q

what happens in type I diabetes?

A

no insulin produced

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11
Q

treatment of type I

A

replace insulin

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12
Q

diet restrictions in type I

A

none- just careful monitoring of carb content

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13
Q

type I is _____ likely to get complications than type II

A

MORE

such as nerves, eyes, heart attacks

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14
Q

does type I have risk factors?

A

no- maybe a slight genetic link

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15
Q

is insulin produced in type II

A

yes, but towards the end it stops due to pancreas exhaustion

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16
Q

type II treatment is mostly related to

A

diet and exercise

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17
Q

how can you stop the development of type Ii?

A

Losing 20% of body weight

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18
Q

when is insulin given in type II?

A

last resort

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19
Q

risk factors for type II?

A 
ethnicity 
age 
obesity- 80%
genetics
smoking 
alcohol 
raised BP 
PCOS 
poor sleep
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20
Q

stress hormones have what effect on blood glucose?

A

increase

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21
Q

examples of stress hormones

A

adrenaline

cortisol

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22
Q

how do sulfonylureas and meglitanides treat type II?

A

enhance insulin secretions

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23
Q

when dont sulfonylureas and meglitanides not work?

A

type I
when there’s no pancreatic function
no point giving if not function

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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

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25
Q

why does pioglitazone and metformin not work in type I diabetics?

A

needs insulin in the body

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26
Q

how does DPP-4 inhibitors and GLP-1 agonists work?

A

secondary effect on liver- telling it to decrease glucose production.

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27
Q

how do acarbose and GLP agonists work?

A

reducing the amount of glucose you get from your food in the first place- stops you digesting carbohydrates

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28
Q

need a _____ BMI to use GLP1 agonists. why?

A

high

slow gastric emptying, feel fuller for longer so dont each as much

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29
Q

GLP1 agonists also ____ hormone incretin action. effect?

therefore do you need a working pancreas?

A

increase
hormone your stomach sends to pancreas to tell it to secrete insulin
yes

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30
Q

DPP-4 agonists work on the same pathway as?

A

GLP1 agonists

both increase action of incretin and produce more insulin

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31
Q

why can’t you use DPP-4 and GLP1 agonists together?

A

DPP4 is the enzyme that breaks down the hormone GLP1

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32
Q

what is the gold standard drug for type iI diabetes?

A

metformin

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33
Q

advantages of metformin?

A

cheap
natural
low hypo risk

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34
Q

why does metformin have a low hypo risk?

A

makes muscles more sensitive to insulin, not making more insulin than needed

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35
Q

disadvantages of insulin

A

GI side effects- weight loss
RARE BUT SERIOUS: lactic acidosis
short half life so must take often
contraindicated in eGFR of <30

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36
Q

what does the side effect of lactic acidosis make metformin use in patients inappropriate for?

A

have had:
heart attack
sepsis
resp disease

37
Q

how can you reduce the side effects of metformin?

A

titrate doses up

38
Q

when does metfomin become less favourable

A

as the disease progresses and the patient get complications

39
Q

sulfonylureas gives _____ control over blood sugars

A

quick

40
Q

advantages of sulfonylureas?

A

OD or BD
quickly lowers blood glucose levels
fewer GI side effects than metformin

41
Q

disadvantages of sulfonylureas?

A

hypo
weight gain
need residual pancreas function
unpredictable in renal impairment and in the elderly

42
Q

pioglitazone advantages?

A

OD
low risk of hypo
suitable in renal impairment

43
Q

pioglitazone disadvantages?

A

associated with heart failure
increased risk of bladder cancer and fractures
weight gain- fluid
liver toxicity (rare)

44
Q

pioglitazone time before you see benefit?

A

3-6 months

45
Q

why is pioglitazone associated with heart failure?

A

causes fluid retention- rosalitazone was taken off the market due to this

46
Q

what drug classes are metformin and pioglitazone?

A

only drugs in their classes.

47
Q

DPP-4 inhibitors advantages?

A
  • 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
Q

DPP-4 disadvantages?

A 
GIT effects
rash 
UTI 
rare: pancreatic inflammation 
doesn't work amazingly
49
Q

what does the SGLT-2 transporter do? how can we use this to treat diabetes?

A

transports glucose back into the blood once filtered out by the kidneys
block this

50
Q

can SGLT-2 inhibitors be used in type I?

A

YES- dont need insulin

51
Q

SGLT-2 advantages?

A
  • weight loss
  • decrease BP
  • low risk of hypo
52
Q

SGLT-2 disadvantages

A 
can cause thrush 
only effective is good renal function 
lower BP= falls
DKA risk 
kidney injury and foot ulcers
53
Q

why can SGLT-2 cause thrush?

A

increased sugar in urine good for bacterial growth

54
Q

GLP-1 is a _____ ______

A

last resort

55
Q

advantages of GLP-1

A

weight loss
OD or weekly preparations
rare hypos

56
Q

disadvantages of GLP-1

A

expensive- injections
GI SE’s are common
need BMI >30 and complications from this BMI

57
Q

why is GLP-1 given as injection?

A

big molecule

58
Q

NICE guidelines for type II diabetes?

A

diet and exercise
+ metformin
+ another drug of patients choice

59
Q

2 types of insulin injection?

A

basal bolus

biphasic

60
Q

which type of insulin injection is better if you dont want as many injections?

A

biphasic over basal bolus

61
Q

how is basal bolus administered?

A

one or two long acting in morning and evening

extra 3 doses of short/ rapid acting during the day before meals

62
Q

how does biphasic insulin work?

A

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
Q

how is biphasic insulin administered?

A

two biphasic insulin doses- one in the morning and one at night

64
Q

example of long acting insulin

A

Lantus

65
Q

example of super long acting insulin

A

toujeo

tresiba

66
Q

example of rapid acting insulin

A

novorapid

67
Q

which types of insulin are the most expensive?

A

rapid and super long acting

68
Q

what is a good combination of insulins?

A

rapid and super long acting

long acting and rapid acting

69
Q

what type of insulin is bad as you have to plan in advance before eating?

A

actrapid, humbling S

as works about 3 hours after eating

70
Q

what is the dose of basal bolus regime based on?

when is it taken?

A

carb intake

with meals

71
Q

non human insulin is _____ used. why?

A

rarely
mainly used for people who have used it for years and dont want to change
or if cant tolerate human insulin

72
Q

why is it hard to adjust the dose in biphasic insulin?

A

as any increase in your fast acting insulin you’re also increasing your basal insulin as they’re a fixed ratio

73
Q

disadvantage of biphasic insulin?

A

lose flexibility of food

74
Q

why is biphasic insulin never first choice in type I diabetics?

A

as tight control of diet is important

good in type II

75
Q

what does biphasic insulin contain?

A

short or rapid acting insulin in a protamine suspension

76
Q

biphasic insulin onset and duration?

A

1-2 hours

12 hours

77
Q

examples of biphasic insulin?

A

humilin M3
humalog mix 25, 50
novomix 30
inhuman comb

78
Q

TF: anything with a fast acting component or reaches a peak we always give with food.

A

TRUE-

79
Q

why doesn’t when you give it matter with long acting and ultra long insulin

A

maintained levels so can take whenever

80
Q

which type is biphasic insulin most common I?

A

type II

but also in type I where number of injections is problematic

81
Q

when isn’t continuous SC insulin infusion appropriate?

A

patients who struggle with compliance

good for patients with good control of their diabetes

82
Q

when is continuous SC insulin infusion appropriate?

A

HbA1c control with multiple daily injections result in disabling hypos
HbA1c levels have remained high (>69 mol/mol) on MDI therapy

83
Q

issues with continuous SC insulin infusion

A

can become unstuck and you can go hyper without knowing

84
Q

define disabling hypo

A

repeated and unpredictable occurrence of hypo that results in anxiety

85
Q

what is a patients diabetes education course for type I?

A

DAFNE

86
Q

type II education courses? what do they focus on?

A

X-PERT, DAFNE

CV risk factors and diet

87
Q

what are microvascular complications of diabetes?

A

effect of high insulin and blood sugar increases:
atherosclerosis
strokes
heart attacks

88
Q

what are microvascular complications?

A

damage to vessels and nerves
amputations
kidney disease
retinas

89
Q

___ times more likely to get depression. regardless of….

A

2

complications

Patient (19 decks)

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