Diabetes Flashcards
What is type 1 diabetes
Immune mediated destruction of beta cells in the pancreas which results in absolute insulin deficiency
How would you diagnose T1DM
Blood glucose levels
Fasting: 6.1-6.9mmol/L
Nonfasting: 7.8-11mmol/L
Diabetes
Fasting: 7mmol/L or more
Nonfasting: 11mmol/L or more
BGL of hyperglycaemia
> 15 mmol/L
What is diabetic ketoacidosis
It is when the body uses fat as energy instead of glucose which leads to a dangerous accumulation of ketones which can appear in the urine
What are some symptoms of diabetic ketoacidosis
Rapid breathing
Flushed cheeks
Abdominal pain
Sweet acetone smell
Vomiting
Diarrhoea
What is the target BGL for the management of T1DM
Fasting: 4-6mmol/L
Two hrs after main meals: 4-10mmol/L
Explain the differences between basal and bolus
Basal dose is usually 40-60% of total daily insulin dose which can be a long acting or intermediate acting dose formulation
Bolus is insulin dose given prior to a main meal or a large snack, rapid-acting insulin is usually used
Give examples of basal formulation of insulin
Long acting
Determir 100
Glargine 100
Glargine 300
Intermediate
Isophane
Give examples of bolus formulation of insulin
Rapid acting
Aspart 100
Glulisine 100
Lispro 100
Lispro 200
Short acting
Neutral 100
Give examples of fixed-dose combination of insulin
Rapid/intermediate
Aspart/aspart protamine 100
Lispro/lispro protamine 100
Short/intermediate
Neutral/isophane
Long/rapid
Degludec/aspart
What is a continuous subcutaneous insulin infusion
Is a battery-driven pump that contains an insulin reservoir. It continuously delivers basal dose whilst can be programmed to deliver bolus dose
Explain dual wave and square wave in terms of programmable bolus delivery
Dual wave delivers two sets of insulin, one is at mealtime followed by a continuous infusion over two hours
Square wave is a dose of bolus given over two hours
What is mixed insulin regimen
Free mixing of insulin instead of multiple daily injections
There’s a variation of rapid or short acting to intermediate acting or fixed dose combination
Explain the honeymoon period
Occurs a few weeks after diagnosis and initiation of insulin therapy
During this period there are functional beta cells that can secrete endogenous insulin
Decreasing exogenous insulin requirement
End of honeymoon period, rising BGL, HbA1c and need for exogenous insulin
What is the total daily insulin required for pre-adolescent and during puberty
Pre-adolescent children: 0.7 IU/kg
Puberty: 1.2-1.5 IU/kg
How do you calculate basal insulin dose
TBD = 0.2 x weight
OR TBD = 0.4 x total daily insulin dose (IU)
How would you calculate bolus dose
amount of carbohydrate covered by 1 unit of insulin = 500/ total daily insulin dose
What is a supplemental insulin dose and how would you calculate it
Given when there’s a drop in BGC
Insulin sensitivity factor = 100/ total daily insulin dose
What is hypoglycaemia
BGL < 4mmol/L
How would you treat a non-severe hypoglycaemia
Children <25kg or under 5yrs old
Glucose 5g PO
Children >25kg or over 6years old
Glucose 10g PO
Adult
Glucose 15g PO
How would you treat severe hypoglycaemia
Children <25kg
Glucagon 0.5mg SC or IM
Children >25kg
Glucagon 1mg SC or IM
Adult
Glucagon 1mg SC or IM
What is type 2 diabetes
Pancrease does not produce enough insulin and/or insulin is not effective and the body do not respons to it
What are some non-pharmacological interventions for T2DM
Exercise and diet
What is the first line treatment for T2DM
Metformin IR
Metformin MR
What does sulfonylurea (SU) do
Increase insulin secretion via sulfonylurea receptor in the pancreas
Examples of sulfonylurea are
Gliclazide IR
Gliclazide MR
Glibenclamide
Glimepiride
What does dipeptidyl peptidase 4 (DPP-4) inhibitor do
Increase endogenous concentration of incretin hormones which helps regulate insulin
Give examples of DPP-4
Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin
Glucagon-like peptide 1 receptor agonist (GLP1RA)
Increase insulin secretion and reduce glucagon secretion
What are some examples of GLP-1RA
Dulaglutide
Exenatide IR
Exenatide MR
Liraglutide
Sodium-glucose cotransporter 2 (SGLT2) inhibitors
Inhibit reabsorption of glucose from the PCT
Give examples of SGLT2 inhibitors
Dapaglifoxin
Empaglifozin
Ertugliflozin
How would you manage T2DM
Monotherapy
Use Metformin
SU or Insulin
Dual therapy
Metformin with
SGLT2 –> benefits in patients with HF or CKD
GLP-1RA –> lowers BP
DPP-4 inhibitor
SU
Insulin
Multiple therapies
