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MPharm > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is type 1 diabetes

A

Immune mediated destruction of beta cells in the pancreas which results in absolute insulin deficiency

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2
Q

How would you diagnose T1DM

A

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

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3
Q

BGL of hyperglycaemia

A

> 15 mmol/L

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4
Q

What is diabetic ketoacidosis

A

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

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5
Q

What are some symptoms of diabetic ketoacidosis

A

Rapid breathing
Flushed cheeks
Abdominal pain
Sweet acetone smell
Vomiting
Diarrhoea

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6
Q

What is the target BGL for the management of T1DM

A

Fasting: 4-6mmol/L
Two hrs after main meals: 4-10mmol/L

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7
Q

Explain the differences between basal and bolus

A

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

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8
Q

Give examples of basal formulation of insulin

A

Long acting
Determir 100
Glargine 100
Glargine 300

Intermediate
Isophane

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9
Q

Give examples of bolus formulation of insulin

A

Rapid acting
Aspart 100
Glulisine 100
Lispro 100
Lispro 200

Short acting
Neutral 100

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10
Q

Give examples of fixed-dose combination of insulin

A

Rapid/intermediate
Aspart/aspart protamine 100
Lispro/lispro protamine 100

Short/intermediate
Neutral/isophane

Long/rapid
Degludec/aspart

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11
Q

What is a continuous subcutaneous insulin infusion

A

Is a battery-driven pump that contains an insulin reservoir. It continuously delivers basal dose whilst can be programmed to deliver bolus dose

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12
Q

Explain dual wave and square wave in terms of programmable bolus delivery

A

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

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13
Q

What is mixed insulin regimen

A

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

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14
Q

Explain the honeymoon period

A

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

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15
Q

What is the total daily insulin required for pre-adolescent and during puberty

A

Pre-adolescent children: 0.7 IU/kg
Puberty: 1.2-1.5 IU/kg

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16
Q

How do you calculate basal insulin dose

A

TBD = 0.2 x weight
OR TBD = 0.4 x total daily insulin dose (IU)

17
Q

How would you calculate bolus dose

A

amount of carbohydrate covered by 1 unit of insulin = 500/ total daily insulin dose

18
Q

What is a supplemental insulin dose and how would you calculate it

A

Given when there’s a drop in BGC

Insulin sensitivity factor = 100/ total daily insulin dose

19
Q

What is hypoglycaemia

A

BGL < 4mmol/L

20
Q

How would you treat a non-severe hypoglycaemia

A

Children <25kg or under 5yrs old
Glucose 5g PO

Children >25kg or over 6years old
Glucose 10g PO

Adult
Glucose 15g PO

21
Q

How would you treat severe hypoglycaemia

A

Children <25kg
Glucagon 0.5mg SC or IM

Children >25kg
Glucagon 1mg SC or IM

Adult
Glucagon 1mg SC or IM

22
Q

What is type 2 diabetes

A

Pancrease does not produce enough insulin and/or insulin is not effective and the body do not respons to it

23
Q

What are some non-pharmacological interventions for T2DM

A

Exercise and diet

24
Q

What is the first line treatment for T2DM

A

Metformin IR
Metformin MR

25
Q

What does sulfonylurea (SU) do

A

Increase insulin secretion via sulfonylurea receptor in the pancreas

26
Q

Examples of sulfonylurea are

A

Gliclazide IR
Gliclazide MR
Glibenclamide
Glimepiride

27
Q

What does dipeptidyl peptidase 4 (DPP-4) inhibitor do

A

Increase endogenous concentration of incretin hormones which helps regulate insulin

28
Q

Give examples of DPP-4

A

Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin

29
Q

Glucagon-like peptide 1 receptor agonist (GLP1RA)

A

Increase insulin secretion and reduce glucagon secretion

30
Q

What are some examples of GLP-1RA

A

Dulaglutide
Exenatide IR
Exenatide MR
Liraglutide

31
Q

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

A

Inhibit reabsorption of glucose from the PCT

32
Q

Give examples of SGLT2 inhibitors

A

Dapaglifoxin
Empaglifozin
Ertugliflozin

33
Q

How would you manage T2DM

A

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

MPharm (20 decks)

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