Diabetes

Question 1

What is the MOA of Insulin

Answer 1

Aim to maintain a stable BGL that avoids hyper/hypoglycaemia

Question 2

What are the adverse effects of Insulin

Answer 2

Hypoglycaemia - low sugars, do not drive if experiencing
Weight gain - educate on a healthy eating plan
Lipohypertrophy - from not rotating injection sites

Question 3

Patient education for insulin

Answer 3

Educate on checking BGL levels, how to treat a hypo/hyperglycaemic event, weight management, lifestyle,

Question 4

What is the MOA of Metformin

Answer 4

Increase glucose uptake and utilisation in skeletal muscles
Reduce glucose production in liver
Increase insulin sensitivity
Reduces low and very low density lipoproteins

Question 5

What are the adverse effects of Metformin

Answer 5

GI upset- nausea, abdominal discomfort, diarrhoea, metallic taste
Lactic acidosis

Question 6

What is some patient education about Metformin

Answer 6

Take with food
Start with low dose
Avoid alcohol
Encourage healthy diet and excersie

Question 7

Metformin contradictions

Answer 7

Poor liver or renal function - increase risk of lactic acidosis
GI disturbances- diarrhoea= dehydration - potential lactic acidosis
Any condition causing decrease tissue oxygenation that may result in lactic acidosis

Question 8

Types on insulin

Answer 8

Rapid acting, short acting, long acting, intermediate acting

Question 9

What are the contraindications of insulin

Answer 9

hypoglycaemia, hypersensitivity to insulin, diabetic ketoacidiosis

Question 10

What is the MOA of Empagflozin

Answer 10

Acts on sodium glucose co-transporters in the renal tubules to inhibit reabsorption of glucose

Question 11

What are some adverse effects of Empagflozin

Answer 11

Urinary tract infection
Hypoglycaemia
Increased urination and increased thirst
Constipation
Puritis

Question 12

What is some patient education for Empagflozin

Answer 12

Take with food at same time everyday
Seek medical attention if symptoms of diabetic ketoacidosis
Keep genitals clean to avoid thrush
Stop if unwell
Avoid Keto diet while on this medication
Healthy diet and exercise

Question 13

What are some contraindications of Empagflozin

Answer 13

Keep genitals clean - pass more during (glucose); increase risk thrush/groin infections
Any changes to diet should be mentioned, increase risk ketoacidosis
Pregnancy
sick day; stop empaflozin until otherwise
Seek medical attention if s/s of diabetic ketoacidosis

Question 14

Glycogenesis

Answer 14

The formation of glycogen from sugar.

Question 15

Gluconeogenesis

Answer 15

The process of making glucose (sugar) from its own breakdown products or from the breakdown products of lipids (fats) or proteins

Question 16

Lipogenesis

Answer 16

The formation of fats from surplus glucose

Question 17

Glycogenolysis

Answer 17

Break up of glycogen into glucose

Question 18

Lipolysis

Answer 18

Break up lipids for gluconeogenesis

Question 19

What are some short term signs and symptoms of hyperglycaemia

Answer 19

Polyuria, this, polydipsia, fatigue, blurred vision, recurrent infection, unexplained weight loss

Question 20

Long term complications of hyperglycaemia

Answer 20

Degeneration of unmyelinated sensory neutrons

Question 21

Treatment for T1DM and monitoring

Answer 21

Insulin
Short acting admin 15-30min before meals
Oral hypoglycaemic agents cannot be used with T1

Question 22

T1DM risk factors

Answer 22

Prone to hypoglycemia and ketoacidosis
Insulin dependent
Often effects young people
Immune infiltration of pancreatic islets

Question 23

Risk factors of T2DM

Answer 23

Pre-diabetic
Metabolic syndrome
Physical inactivity
Unhealthy diet
Smoking
Genetics

Question 24

Name non-pharmacological interventions for T2 diabetes

Answer 24

Diet management
Increase physical activity - small achievable goals
Smoking cessation

Question 25

The blood test HbA1c is used in diagnosing and monitoring diabetes. Explain what the blood test is and what factors would need to be considered for a pt

Answer 25

Is known as glycated haemoglobin - the higher the glucose levels, more will bind to haemoglobin Measures glycated haemoglobin over 2-3 months Normal is under 40mmol/ml in person without diabetes Older age increase hyperglycaemia, irregular eating patterns, alone, poor motility

Question 26

Why is Metformin the first line med for T2 Diabetes

Answer 26

Effective for individuals that are overweight and increase lipid profile due to increase effectiveness of available insulin and reducing LDL and VLDL Has the benefit for not causing weight Does not affect Beta cells = does not increase insulin production and therefore does not have risk of hypoglycaemia

Question 27

What important drugs may cause hyperglycaemia and hypoglycaemia

Answer 27

Hyper - Corticosteroids, atypical antipsychotics, Beta 2 agonists, oral contraceptive, thyroid hormones Hypo - insulin, oral hypos, NSAIDs, alcohol, ACE inhibitors, beta blockers

Question 28

Education on how to manage hypoglycaemia

Answer 28

if in doubt treat Eat/drink one serving of quick acting carb e.g jelly beans After 10 mins test BGL if below 4mmol/l eat another

Question 29

Discuss the implications of taking prednisone with Empagflozin

Answer 29

prednisone may cause increase BGL as it inhibits glucose uptake in cells and inhibits glucose utilisation - decreasing effect of Empagflozin

Question 30

How should someone manage their diabetes while on prednisone

Answer 30

Check BGL more regularly due to risk of hyperglycaemia - could be 4x a day Monitor for ketones

Question 31

What is a basal bolus regime and rationale

Answer 31

Basal bolus regime - basal insulin injected once per day to ensure insulin in body at all times Mimics body natural rhythms of insulin release Short acting before eating to manage the post prandial rise and the intermediate/long acting insulin before bed to manage BGL

Question 32

Education on storage and handling insulin

Answer 32

Never freeze insulin Keep stock in fridge 2-5 days Admin at room temp Discard after one month of opening Don't shake

Question 33

Can pts take diabetic 'pills' instead of insulin injections

Answer 33

T1 diabetes means the body doesn't produce insulin so tabs not effective - they influence insulin already in body Tabs get broken down in gut and ceases to be insulin

Question 34

Two main adverse effects of insulin therapy and how to avoid those

Answer 34

Weight gain and hypos Diet/exercise management - caution increases of sugar, carbs and alcohol Hypoglycaemia - monitor BGL, educate s/s, don't skip means, care with alcohol