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Therapeutics > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Insulin regimens for Type 2 two types

A

Add on therapy: intermediate to long-acting, 10 units before bed but not after 10pm

Substitution therapy: biphasic (30 min before breakfast is 10 units and 30 min before dinner is 5 units)

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2
Q

Hypoglycaemia

A

Glucose less than 4

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3
Q

Mild hypogly

A 
Mainly autonomic symptoms
Pallor
Sweating 
Tachycardia
Palpitations
Hunger
Paraesthesiae
Tremor
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4
Q

Mod hypogly

A 
Mainly neuroglycopenic symptoms
Inability to concentrate		
Confusion
Slurred speech			
Irrational behaviour
Slower reaction time		
Blurred vision
Somnolence			
Extreme fatigue
Weakness
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5
Q

Severe hypogly

A 
Associated with severe impairment of neurologic function
Completely disoriented behavior
Loss of consciousness
Coma
Seizures
Can be fatal
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6
Q

Mild hypogly treatment

A

Fast acting oral carbohydrates (at least 15g)
Sources include
Three glucose tablets (5g each)
2 ½ cups of fruit juice
½ to ¾ cup regular soda
1 cup of milk
If patient is unable to take orally give IV dextrose

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7
Q

Mod to Severe treatment hypogly

A

Dextrose - 50mL of 50% dextrose IV bolus after blood drawn, followed by 10% dextrose
Glucagon – 1mg IM or SC can be given (family or friend) – effective in treating hypoglycemia only if sufficient liver glycogen present
These measures raise blood glucose only transciently
Patient is urged to eat as soon as possible, once fully awake

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8
Q

Drugs that cause DKA

A 
Atypical antipsychotics
Coke
Interferon
Glucagon
Corticosteroids

Pregnancy

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9
Q

How does insulin affect K levels?

A

It shifts K into the cell
It stimulates Na H antiporter on membrane. This promotes the entry of Na INTO CELLS, activating NaKATPase, causing an electrogenic influx of K into the cell

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10
Q

DKA management

A

low K-give KCl

shortacting insulin

ketonaemia takes longer to resolve than hyperglycaemia

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11
Q

metformin MOA

A

phosphorylates GLUT 4 receptor, increasing insulin sensitivity

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12
Q

Diabetogenic drugs

A

Thiazide diuretics
Atypical Antipsychotics
Glucocorticoids
ARVs

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13
Q

are oral hypoglycaemic agents suitable for Type 1

A

No, need residual Beta cell activity

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14
Q

insulin and serum K and Mg

A

lowers

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15
Q

treatment of Type 1

A

Insulin

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16
Q

how is insulin administered

A

subcut (degraded in GIT so not oral)

IV (emergency)

17
Q

Types of insulin for Type 1

Short acting

A 
SC
3 times
30 min before meals
Human insulin
peak action: 2-5hrs
duration of action: 5-8hrs

ACTRAPID

18
Q

Intermediate acting insulin

A 
SC
1 or 2 daily no later 10pm
NPH form insulin
onset: 1-3 hrs
peak action:6-12 hrs
duration:16-24 hrs

PROTOPHANE

19
Q

Long acting insulin

A 
SC
Biphasic
1/2 daily
regular human insulin plus NPH
onset: 30 min
peak:2-12 hrs
duration:16-24hrs
20
Q

can sulphonylureas be used in pregnancy?

A

no

21
Q

sulfonylurea side effects

A

weight gain nooooooo

hypoglycaemia

22
Q

Type 2 Mainstay treatment

A

Add metformin to the combination of dietary modifications and physical activity/exercise
Combination therapy with metformin plus a sulphonylurea is indicated if therapy with metformin alone (together with dietary modifications and physical activity/exercise) has not achieved the HbA1c target
For persisting HbA1c above acceptable levels and despite adequate adherence to oral agents: add insulin and withdraw sulphonylurea
Ensure patient is adherent
Oral agents should not be used in type 1 diabetes

23
Q

HONK vs DKA

A

HONK more Type 2. there is still SOME BETA cell function so no ketogenesis. High glucose and renal impairment but no ketones. Occurs over days to weeks whereas DKA develops over just a few hours. Present with mental confusion, lethargy and coma.
Management same as DKA.

24
Q

Treatment DKA

A
  1. Isotonic saline to get rid of dehydration
  2. Potassium replacement-K is falsely elevated due to extracellular shift but actually losing K (osmotic diuretic?)
  3. Low dose insulin therapy

Therapeutics (6 decks)

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