Diabetes Flashcards
What is the rationale for drug use in T2DM? (3)
- Control symptoms
- Control BGLs
- Delay microvasculature and macrovasculature complications
What is the pathophysiology of T1DM?
Autoimmune destruction of Beta cells
What is the pathophysiology of T2DM?
Resistance to insulin and inadequate secretion of insulin response by the Beta cells
What are 5 symptoms of diabetes?
Lethargy, polyuria, polydipsia, blurred vision, dizziness, tremor, loss of sensation, poor wound healing, fungal/bacterial infection, ketosis and ketonuria
How many months might lifestyle alterations be trialled before starting drug treatment for T2DM?
2-3 months
What are 4 tests for diabetes?
BGLs, fasting BGLs, oral glucose tolerance test, glycosated haemoglobin
What are 2 risk factors of T2DM?
CVD, PCOS, being in particular ethnic groups, being overweight, anipsychotics, steroids, and IGT + IFG
What might you give someone with T2DM and atherosclerotic cardiovascular disease, heart failure or CKD? (2 drug classes)
SGLT2 inhibitor or GLP-1 analogue
How do you do an oral glucose test?
Fast and then do a BGL, have a sugary drink and then have BGLs tested after 1 hour and then 2nd hour.
What are 3 main areas of chronic complications of diabetes relating to microvasculture?
Eye disease, nephropathy and neuropathy
What are 2 pros and 2 cons to short acting insulins?
Flexible and better control by more of a risk of hypos and more injections
What are 2 pros and 2 cons to split mixed regimens?
Simple and convenient but not as flexible and cannot skip meals
What are 2 pros and 2 cons to longer acting insulins?
Lower risk of hypos and less injections but less flexible and less control
What are 2 pros and 2 cons to basal bolus injections?
They are more flexible and have better BSL control but requires more monitoring, does not cover snacks and higher risk of hypos
How should you treat a conscious vs an unconscious patient with hypoglycaemia?
A conscious patient should have oral glucose or sucrose, wait 10-15 minutes and then if responsive, have a longer acting carb. An unconscious patient should have an IM or iV injection of glucagon.
By how much do you bring down insulin if it is too high?
2-4 units
What are three chronic complications relating to macrovasculature in diabetes?
Coronary artery disease, pulmonary artery disease and cerebrovascular disease
What are 4 other chronic complications of diabetes?
Infections, genitourinary complications, dermatologic complications, glaucoma, periodontal disease, gastrointestinal complications.
What are 2 pros of metformin?
Low risk of hypos, does not affect weight, cardiovascular and renal benefits
What are 2 pros of SGLT2 inhibitors?
Weight loss and low risk of hypos
What are the 2 cons of sulfonylureas?
Weight gain and increased risk of hypos
What are two pros and one con for acarbose?
Weight loss and low risk of hypos but increased risk of GIT complications
What are the cons of insulin?
Weight gain and risk of hypos
What are the 2 pros and 1 con of DPP-4 inhibitors?
Weight loss and low risk of hypos but they are cleared by the kidney
After giving an oral administration of glucose or sucrose, what do you do?
Response should occur within 10 minutes for glucagon and within 4-5 minutes for glucose. Give longer acting carbohydrates if they respond
If you were commencing insulin for a patient starting with an overnight dose. What type of insulin would you use?
Intermediate acting
What are the second line agents to T2DM?
GLP1 agonists/ DPP-4 inhibitors and SGLT2 inhibitors
What are 3 signs of lactic acidosis?
Anorexia, nausea, vomiting, ab pain, cramps, malaise and weight loss
How does a basal bolus regime work?
Three daily short acting before meals and one daily night time insulin injection
If you are having a contrast scan and have metformin what do you need to do?
Withhold 24 hours beforehand
What is the role of DPP-4 inhibitors in T2DM management?
The inhibit DPP-4 which breaks down incretin hormones meaning that they last longer and continue to produce insulin and increase fullness.
If a drug ends in gliptin what does it mean?
It is a Dpp-4 inhibitor
Why don’t incretin hormones cause hypos?
Because insulin is released wth meals
If a drug ends with -tide, what are they?
GLP-agonists
Which DPP-4 inhibitor is cleared by the liver?
Linaglyptin
What is a con to GLP-analogues?
Eliminated by kidney and may cause nausea and vomiting
Do GLP-1 agonists cause hypos?
No
Which 2 GLP analogues reduce strokes and renal disease risks?
Semaglutide and Dulaglutide
Name 2 SGLT2 drugs?
Answer includes Dapagliflozon, Empagliflozin and Ertugliflozin
What do SGLT2 drugs do?
Reduce reabsorption of glucose in the kidney and excretion of glucose
Diabetes is the number one reason for which disease?
Kidney disease
What drug may cause euglycaemic DKA?
SGLT2 inhibitors
If a drug starts with gli, what are they?
Sulfonylureas
What is the Moa of sulfonylureas?
Increase pancreatic insulin secretion
If a drug ends with glitazones what is it?
Thiazolidinediones
Why are Thiazolidinediones not used very much? (3 reasons)
associated with heart failure, osteoporosis and bladder cancer
What is the MOA of Acarbose?
Inhibits carb digestion in the GIT thus increasing rate of glucose delivery in the blood.
When starting insulin, how do you do it?
10 units at bedtime (intermediate acting) in addition to oral medications
What is the MOA of Thiazolidinediones?
Increases insulin sensitivity
What is the MOA of Metformin?
Reduces hepatic glucose production and increases insulin use. Thereby increasing insulin sensitivity
What are two adverse effects to Thiazolidinediones?
MI, bone fracture, macular oedema and bladder cancer
What are two adverse effects to Acarbose?
Flatulence and bloating
What is the effect of DPP-4s? (3)
Increases glucose dependent insulin secretion, reduces glucagon production and delays gastric emptying.
What are 2 side effects of Metformin?
Nausea, vomiting, anorexia, ab pain, cramps, malaise and weight loss.
What are 2 adverse effects of GLP-1 analogues?
Nausea and vomiting, CKD, CVD and stroke
What is the MOA of GLP-1 analogues?
Mimics the effect of GLP-1
What is the MOA of SGLT2 inhibitors?
Inhibits glucose resorption in the kidney
What are 2 side effects of SGLT2 inhibitors?
Urinary and genital infections and euglycaemic DKA
If a drug ends in tide what class is it?
GLP-1 agonist
if a drug ends in flozin what class is it?
SGLT2
if a drug starts with gli what class is it?
sulfonylureas
if a drug ends in glitazone what class is it?
thiazolidinones
if a drug ends in glyptin what class is it?
DPP-4Is
Name 2 GLP-1 agonists?
Semaglutide and dulaglutide
Name 2 sulfonylureas
glibenclamide and glipizide
Name 2 DPP-4Is
linaglyptin and aloglyptin
Name 2 SGLT2Is?
dapagliflozin and empagliflozin
Name 1 thiazolidinones
pioglitazone
What drug class is acarbose?
alpha glucosidase inhibitor
What are two drug classes and 1 examples of them which can increase BSLs?
Atypical antipsychotics (olanzapine and clozapine)
Glucocorticoids (prednisone and prednisolone)
Why do people with diabetes experience symptoms?
Hyperosmolar effects of excessive glucose in the bloodstream
What are 3 symptoms are specific to T1DM?
Ketosis/ketonuria, polyuria, polydypsia, weight loss, rapid onset of symptoms and family history
What are 3 signs of insulin resistance?
Acanthosis nigricans, skin tags, hyperpigmentation of the skin, central obesity, menstrual irregularities and hirsuitism
