Diabetes Flashcards
Insulin regimens for Type 2 two types
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)
Hypoglycaemia
Glucose less than 4
Mild hypogly
Mainly autonomic symptoms Pallor Sweating Tachycardia Palpitations Hunger Paraesthesiae Tremor
Mod hypogly
Mainly neuroglycopenic symptoms Inability to concentrate Confusion Slurred speech Irrational behaviour Slower reaction time Blurred vision Somnolence Extreme fatigue Weakness
Severe hypogly
Associated with severe impairment of neurologic function Completely disoriented behavior Loss of consciousness Coma Seizures Can be fatal
Mild hypogly treatment
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
Mod to Severe treatment hypogly
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
Drugs that cause DKA
Atypical antipsychotics Coke Interferon Glucagon Corticosteroids
Pregnancy
How does insulin affect K levels?
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
DKA management
low K-give KCl
shortacting insulin
ketonaemia takes longer to resolve than hyperglycaemia
metformin MOA
phosphorylates GLUT 4 receptor, increasing insulin sensitivity
Diabetogenic drugs
Thiazide diuretics
Atypical Antipsychotics
Glucocorticoids
ARVs
are oral hypoglycaemic agents suitable for Type 1
No, need residual Beta cell activity
insulin and serum K and Mg
lowers
treatment of Type 1
Insulin
how is insulin administered
subcut (degraded in GIT so not oral)
IV (emergency)
Types of insulin for Type 1
Short acting
SC 3 times 30 min before meals Human insulin peak action: 2-5hrs duration of action: 5-8hrs
ACTRAPID
Intermediate acting insulin
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
Long acting insulin
SC Biphasic 1/2 daily regular human insulin plus NPH onset: 30 min peak:2-12 hrs duration:16-24hrs
can sulphonylureas be used in pregnancy?
no
sulfonylurea side effects
weight gain nooooooo
hypoglycaemia
Type 2 Mainstay treatment
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
HONK vs DKA
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.
Treatment DKA
- Isotonic saline to get rid of dehydration
- Potassium replacement-K is falsely elevated due to extracellular shift but actually losing K (osmotic diuretic?)
- Low dose insulin therapy
