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Pre Reg > Chapter 6 BNF (Diabetes and Hypoglycaemia) > Flashcards

Chapter 6 BNF (Diabetes and Hypoglycaemia) Flashcards

1
Q

When should long term complications be reviewed in diabetes?

A

Annually

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2
Q

How is neuropathy treated in diabetes?

A

By treating hypertension

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3
Q

How is nephropathy treated?

A

ACE inhibitors

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4
Q

What symptoms are associated with nerve damage in diabetes, how are they treated?

A 
Pain: Duloxetine, TCAs
Diarrhoea: Codeine
Gastroparesis: Erythromycin 
Erectile dysfunction: sildenifil
Postural hypotension: increase salt
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5
Q

When do insulin requirements increase in pregnancy?

A

2nd/3rd semester

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6
Q

What’s the target HbA1c in pregnancy?

A

48mmol

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7
Q

What insulin is first choice in pregnancy?

A

Isophane

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8
Q

Why should insulin dose be reduced post pregnancy?

A

Risk of postnatal hypoglycaemia

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9
Q

How is type 2 diabetes treated in pregnancy?

A

Stop all oral hypoglycaemics except metformin fans substitute with insulin

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10
Q

How should gestational be treated for patients with blood glucose below 7mmol/L

A

Diet and exercise

Add metformin

Add insulin

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11
Q

How should gestational diabetes be treated in patients with blood glucose levels over 7mmol/L?

A

Insulin

With or without metformin

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12
Q

What is diabetic ketoacidosis?

A

Severe hyperglycaemia = ketones

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13
Q

What is the treatment for ketoacidosis?

A 
IV soluble insulin 
Fluids 
Potassium 
Continue long acting insulin 
Add glucose when below 14mmol/L
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14
Q

What factors raise insulin requirements?

A

Infection
Stress
Puberty
Pregnancy

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15
Q

What factors reduce insulin requirements ?

A

Addisons

Hypopituitarism

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16
Q

What’s first line insulin regimen in type 1 diabetes?

A

Multiple injection regimen

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17
Q

What’s first line insulin therapy in type 2 diabetes ?

A

Isophane with soluble insulin

Biphasic or multiple

18
Q

What are the sick day rules in diabetes?

A

Monitor ketones and sugar every 3/4 hours

Don’t stop insulin

Maintain meal pattern (3L of water )

If fever/vomiting/diarrhoea stop metformin and gliflozins

19
Q

What’s the conversion from beef insulin to human insulin and the conversion from pork insulin to human insulin ?

A

Beef to human : reduce by 10%

Pork to human : don’t change

20
Q

How does metformin work?

A

Reduce hepatic sugar production, reduce gluconeogenesis

21
Q

What’s the side effects of metformin?

A

GI disturbance
Lactic acidosis in renal impairment
Taste disturbance
Reduce vit b12

22
Q

How do sulfonylureas and metglinides work?

A

Augmenting insulin secretion

23
Q

Which sulfonylureas are short acting and which are long acting?

A

Short: Gliclazide, Tolbutamide

Long: Glimepiride, Glimbenclamide

24
Q

What are the side effects of sulfonylureas?

A

Hypoglycaemia
Weight gain
Jaundice
Skin rashes

25
Q

How does pioglitazone work?

A

Reduces peripheral insulin resistance? What

26
Q

What are the side effects of pioglitazone?

A

Heart failure (with insulin)
Bladder cancer
Hepatotoxicity

27
Q

How do SGLT2 inhibitors work?

A

Reduce glucose reabsorption in the proximal convoluted tubule

28
Q

What are the side effects of SGLT2? What’s the MHRA on Canaglifozin ?

A

SE: ketoacidosis, volume depletion

Increased urinary infections

MHRA: amputation

29
Q

What are the side effects of DPP4 inhibitors?

A

Pancreatitis

Liver toxicity

30
Q

When should metglinides be administered?

A

30 mins before food

31
Q

How does Arcabose work?

A

Inhibits alpha-glucosides enzymes

32
Q

What are the side effects of acarbose?

A

Flatulence

Diarrhoea

33
Q

Which sugar should be used by patients on acarbose?

A

Glucose, not sucrose

34
Q

What are the side effects of GLP-1 ?

A

Pancreatitis

35
Q

What’s the advice on missed doses of different GLP-1 agonists?

A

*do not take after meal

Lixisenatide: inject within 1hr of next meal

Exenatide: continue with next scheduled dose

Dulaglutide: inject ASAP if more than 3 days before next dose

36
Q

What’s the insulin regimen for patients undergoing surgery?

A

Night before: usual insulin

Day of surgery: IV glucose and potassium if not hyperkaelimic
Insulin with NaCL piggybacked

37
Q

When is GLP-1 agonists considered in type 2 diabetes?

A

*triple therapy fails AND

•over 35 bmi + psychological issues with obesity OR
insulin would have occupational implications

•under 35 BMI + weight loss would benefit co-morbities

38
Q

What insulin therapy is recommended in type 2 diabetes?

A

NPH insulin + short acting

39
Q

When can NPH be switched to Determir or glargine in type 2 diabetes ?

A

If patient needs OD injection

40
Q

What’s the target BP for hypertension in diabetes?

With or without complications

A

With complications: 130/80

Without: 140/80

41
Q

What’s first line in hypertension for diabetics?

Non blacks and blacks

A

Non blacks: AcE

Blacks: ace + diuretic/CCB

Pre Reg (37 decks)

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