DIABETES

Question 1

What are the different types of Diabetes

Answer 1

• Type 1 and 2
• Gestational DM
• Neonatal Diabetes
• Diabetes caused by Cystic Fibrosis , pancreatitis , glucocorticosteriod ( Crushing Syndrome )

Question 2

What are the clinical presentation of TYPE 1 DIABETES

Answer 2

Polydispia ( drink water )
Polyphagia ( hunger )
Polyuria ( increase urination)
weight loss

Question 3

Clinical presentation for type 2 diabetes

Answer 3

increase weight
nocturia
Polydispia
Polyurea

Question 4

What are the four different Criteria for Diagnosing DM

Answer 4

Hb A1C >= 6.5 %
Fasting (no food for the last 8 hrs) > 126mg/dl
OGTT >200mg/dl
RG > 200mg/dl

Question 5

name and state is the MOA of GLP 1 Agonist and their side effect

Answer 5

laraglutide (Saxenda)
semaglutide (Ozempic)
dulaglutide (Trulicity)

MOA ; this is a harmone that is release from the intestin and bond to the receptors in the brain to slow down apatite , the liver to prevent the release of glucose , stomach to slow down gastric emptying ,and in the pancreases to releases insulin .

SE; injection site reaction , pancretites ,Diarreah ,BBW thyroid cancer .

Question 6

Name the SGLT Antagonist and their MOA and side effects

Answer 6

INVOKANA (Canagliflozin) 300 mg tablet
JARDIANCE (empagliflozin ) 10mg and 20mg
FORXIGA (dapagliflozin)

they block the Na glucose transporter at the proximal tubules and prevent reabsorption of Glucose .

SE; increase thirst , dehydration , urinary infections .

Question 7

Name the DDP4 inhibitors , there MOA and side effects

Answer 7

JANUVIA (siptagliptin)
ONGLYZA (SAXAgliptin)
TRADJENTA (LIGNAgliptin)

inhibit the enzyme DDP4 which intern prevent the break down of GLP1 .

SE
rare cases of Steven Johnson Syndrome
facial edema

Question 8

Name the Thiazolidinediones , their MOA and side effects .

Answer 8

ACTOS (Pioglitazones )
AVANDIA (Rosiglitazone)

increase storage of fatty acid in adipose tissue thus decreases fatty acid in circulation cells are now more dippendent on glucose thus inhance insulin sensitivity in muscle , liver and fat tissues

SE cause peripheral edema thus contraindicated in stage 3 and 4 HF . Weight gain
Avandia cause an increase in triglycerides and LDL

Question 9

Name the different sulfonylureas , MOA and SE

Answer 9

DIMICRON (glyclazide) ( RECLIDE)

GLYNASE(glyburide\glibenclamide)

AMYRYL (glimipiride) ( GLYREE)

GLUCOTROL (Glipizide)

MOA; close the K pump causes an increase of K inside the cell this cause depolarization of the cell which result in the influx of Ca irons in the cell which result in the release of insulin from the bata cells

hypoglycemia
Weight Gain
Rash
IG Problems

Question 10

Name the Alpha Glucosidase inhibitors ,MOA, SE

Answer 10

PRECOSE( Acarbose)
GLENSET ( Miglitol)

a-Glucosidase is an enzyme that convert large sugar molecule in smaller molecules . there4 by inhibiting this may prolong Carbohydrate absorption .

Bloating abdominal discomfort and possible diarehha

Question 11

what are the non Pharmalogical approach in treating Diabetes

Answer 11

• -Exercise at lease 150min /week

- - Healthy balanced diet

Question 12

When education a patient about there diabetes what are some key point you need to tell them .

Answer 12

• -foot care
• -eye care
• -dental care
• -self monitoring glucose level
• -complication of diabetes

Question 13

what are some of the key pints you need to consider when chosing a diabetic drug

Answer 13

–side effect of the drug

–the % A1C capability

–patient preferred root of administration

–how long the patient has diabetes -

Question 14

What is

HYPERGLYCAEMIC HYPEROSMOLAR NONKETOTIC SYNDROME (HHNKS) and how is it treated

Answer 14

This is when Plasma glucose levels > 600mg/dl, minimal to no ketones.
Mainly in type two diabetes

Start IV fluids 0.9% Saline

Correction of any hypokalaemia

Continuous IV infusion of REGULAR Insulin (as long as serum K is ≥ 3.3 meq/L)
▪Bolus dose 0.1 units/kgIV,

▪Maintenance dose 0.1 units/kg/h/IV

▪When BG approach 200mg/dl, solns should be changed to Dextrose 5W/0.45% NaCL .

Blood glucose levels should be lowered slowly with hypotonic fluids
and low-dose insulin infusions

Question 15

What is DIABETIC KETOACIDOSIS
(DKA)
And how is it treated

Answer 15

plasma glucose>250mg/dl but < 600mg/dl, positive urine and serum ketones, arterial PH<7.3, Na bicarbonate <15mEq/L

DKA requires immediate treatment:

▪ Start IV fluids 0.9% Saline

▪Correction of any hypokalaemia

▪Continuous IV infusion of REGULAR Insulin (as long as serum K is ≥ 3.3 meq/L)
▪Bolus dose 0.1 units/kgIV,
▪Maintenance dose 0.1 units/kg/h/IV

▪When BG approach 200mg/dl, solns should be changed to Dextrose 5W/0.45% NaCL . ( allow continuation of insulin therapy without causing hypoglycemia)

Question 16

How to treat HYPOGLYCEMIA

Answer 16

Blood glucose < 70 mg/dl

Mild: pt. should check their blood glucose level prior to treating, if possible. If BG is low:

▪15 grams of simple carbohydrate

▪ Glucose tablet (3) or gel

▪ 2 tsp honey or 3 tsp table sugar

▪ 1⁄2 Cup orange or apple juice

Moderate: 15-30 grams of simple

carbohydrate, BG level should be rechecked 15-20 mins after treatment

Severe: Glucagon injection, Glucose gel inside cheek, iv dextrose 25% or 50%

Question 17

How to STORAGE AND DISPOSAL insulin

Answer 17

Avoid heat, light and freezing
▪ Store unopened vials in refrigerator
▪ Keep insulin in use at room temperature
▪ Check vials for expiration date and appearance
▪ When using insulin analogs – check with manufacturer’s guidelines for storage and disposal
▪ Follow guidelines for disposal of used syringes

Question 18

How do you instruct a patient to take there INSULIN R and N ( 20 units of NPH 10 units of regular

Answer 18

Wash hands and wipe the injection site with alcohol

Inspect insulin for clarity

Rotate the NPH cloudy insulin in the palm of your hands

Wipe off the top of both vials with alcohol pads

Draw 20 units of air into syringe and inject it in the NPH vial

Then 10 units of air and in jest it in the Regular insulin vial

Invert the regular insulin vial and withdraw 10 units of regular insulin . Withdraw needle

Insert the needle into the -NPH. Vial and withdraw 20 units of NPH insulin

And minister the insulin

Wash hands and properly dispose of syringe

Question 19

What is a Contentious Glucose Monitoring and how does it work

Answer 19

CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every 5 minutes

It can be at the back of your upper arm ,
Abdomen , or children 2-17 yr on the upper bottom

Question 20

What is an insulin pump and how does it work

Answer 20

An insulin pump is a small, wearable device that delivers insulin into your body.

Insulin pumps work by delivering a basal, or set, rate of rapid acting insulin ( NOVOlog or Humalog ) through a tube called a cannula. The cannula is inserted just under the top layer of your skin.

Question 21

Name the different parts of an insulin pump

Answer 21

Cannula
Reservoir
Battery
Tubing

Question 22

Step in using the insulin pump

Answer 22

Fill the reservoir with insulin by injecting air in the insulin vial and then pulling up the insulin in the reservoir

Attached the reservoir with insulin to the the tubing connect to the cannula

Place and lock the reservoir in the pump

Prime the insulin pump by pressing control on the pump to remove air out of the tubing

Wipe the injection site area with alcohol ( abdomen , thighs , buttocks and arm ) then push the cannula under the skin and hold it in place with the adhesive patch .