diabetes Flashcards
What is the definition of diabetes mellitus
it is a group of metabolic disorders in which persistent hyperglycaemia is caused due to deficient insulin secretion or by resistance to the action of insulin
what are the three types of diabetes mellitus
type 1
type 2
secondary diabetes
what may cause secondary diabetes
gestational diabetes
OR
pancreatic damage
What are the symptoms of diabetes
Polyphagia
Polydipsia
Polyurea
Weight loss
Fatigue
Blurred Vision
What does a patient need to present with to be diagnosed with diabetes
A patient must present with 2 or more of the symptoms
A random venous plasma glucose of 11.1mmol / l or more
A fasting plasma glucose of 7 mmol / l or more
An oral glucose tolerance test result of 11mmol / or more
What would a patients random venous plasma glucose result be if they had diabetes
11.1mmol or more
what would a patients fasting plasma glucose result be if they had diabetes
7mmol or more
what would a patients ogtt result be if they had diabetes vs if they had impaired oral glucose tolerance
11.1 mmol or more for diabetes
7-11 mmol for impaired oral glucose tolerance.
how would we monitor a patient with diabetes
we would take the hba1c as it is a good indicator of the three “opathy” complications
how often should we take a hba1c for a type 1 patient
every three to six months
how often should we take a hba1c for a type 2 patient
every 3 months till stabilized then every 6
What is the process by which glucose is converted to acetylcoa which is later used for atp synthesis
glycolysis
What is the process by which glucose is converted into glycogen
glyycogenesis
what is the process by which acetylcoa are broken down into glucose
glyconeogenesis
what is the process by which glycogen is converted to glucose
glycogenolysis
what is the aim of treatment for type 1 iabetes
use insulin regiments to achieve optimal control of blood pressure
what is the target hba1c for a type 1 diabetec
less than 48 mmol / l
what is the target hba1c for a type 1 diabetic in %
less than 6.5%
how many times a day should a type 1 diabetic measure their blood glucose
4 times
one before each meal and one before bed
what are the rules around a type 1 diabetic driving
must inform dvla
must also take their blood glucose 2 hours before driving and 2 hours every 2 hours after
what is the fasting glucose goal for a type 1 diabetic
5-7 mmol/l
what is the aim for glucose before meals for type 1 diabetics
4-7 mmol / l
what is the aim for glucose after meals for type 1 diabetics
5-9 mmol / l
what is the minimum blood glucose a type 1 diabetic should have before driving
5mmol/l
what is the gold star insulin regimen
basal - a baseline with intermediate or long acting insulin
bolus - a rapid acting insulin before meals
this mimics the bodys natural insulin production system
what is a insulin regimen that is gaining popularity
continuous subcutaneous insulin infusion
how does continuous subcutaneous insulin infusion work
it pumps a rapid acting insulin every hour as a baseline
it then provides a bolus dose based off the meal and the number of calories it has
For basal bolus insulin regimen what are the choices for the basal insulin
insulin detemir bd
insulin glargine bd
insulin determir od
What type of insulin is insulin lispro
rapid
what type of insulin is humalog
rapid - lispro
what type of insulin is aspart
rapid
what type of insulin is novorapid
rapid - aspart
what type of insulin is glulisine
rapid
what type of insulin is apidra
rapid - glulisine
what type of insulin is fiasp
rapid - aspart
what is the onset of action of rapid acting insulin
within 15 mins
when is the peak of rapid acting insulin
1 - 2 hours
what is the duration of action of rapid acting insulin
2 - 5 hours
What additional ingredient does fiasp have that speeds up the onset of action
vitamin b3
What type of insulin is actrapid
short acting
what type of insulin is insuman rapid
short acting
what type of insulin is humulin s
short acting
what is short acting insulin also known as
soluble insulin
When should we inject short acting insulin before food
15-30 mins before
what is the onset of action of short acting insulin
30-60 mins
what is the peak of short acting insulin
1-4 hours
what is the duration of action of a short acting insulin
5-8 hours
What is the benefit of being able to give short acting insulin intramuscularly / intravenously
Can give it to a patient who is not conscious i.e. if a patient has diabetic ketoacidosis
What type of insulin is NPH
intermediate acting
what type of insulin is isophane
intermediate acting
what is the onset of action of intermediate acting insulin
1-2 hours
what is the peak of intermediate insulin
3-12 hours
what is the duration of action of intermediate insulin
11-24 hours
what is intermediate insulin used in
biphasal insulin meaning two insulins together
what are two examples of biphasal insulins
novodisk
novonordisk
humalog mix 25
what type of insulin is insulin glargine
long acting
what type of insulin is insulin detemir
long acting
what type of insulin is inssulin degludec
long acting
what type of insulin is lantus
glargine
what type of insulin is levemir
detemirw
what type of insulin is tresiba
degludec
What is the duration of action of a long acting insulin
varies but can last up to 42 hours
how long does it take to achieve a steady state level
2 - 4 days
how often is insulin glargine given
bd
how often is insulin degludec given
od
how often is detemir given
od or bd
name 3 dpp4 inhibitors
sitagliptin
linagliptin
saxagliptin
what is the moa of a dpp4 inhibitor
prevents the breakdown of incretins
increases insulin secretion
reduces glucagon release
when on a dpp4 inhibitor what medication doses may need to be reduced
insulin
sulfonylurea
when should we discontinue a dpp4 inhibitor
acute pancreatitis e.g. persistent and severe abdominal pain
name an alpha glucosidase inhibitor
acarbose
what is the moa of alpha glucosidase inhibitor
delays the digestion and absorption of starch and surcrose reducing blood glucose
what are the main side effects of acarbose
diarrhoea
gi discomort
antacids with mg and aluminium are not suitable when treating a diabetic patient with what
acarbose
can a pregnant or breastfeeding patient take acarbose
avoid
what advice can we give around taking acarbose
tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.
what is the gold standard of diabetic type 2 treatment
use of a biguanide
what is the most common biguanide
metformin
what are the main side effects of biguanides
gi side effects that do pass after a couple of weeks
how can we avoid the gi associated side effects of biguanides
start on a lower dose and build them up over weeks e.g. OD for a week before or after meals then bd etc
what is the mechanism of action of biguanides
increased utilisation of glucose
and decreases gluconeogenesis
what is one of the major risks associated with the use of biguanides
lactic acidosis
what is lactic acidosis
build up of lactic acid in blood
name three sulponyl urea’s
gliclazide
glliplazide
glibenclamide
moa of sulphonylureas
act by stimulating the insulin release
what are the main side effects of sulphonyl ureas
weight gain
hypoglycaemia
what are the cautions for sulphonyl ureas
elderly
weight gain
g6pd deficiency
pregnant
breastfeeding
name two thiozolidinediones
pioglitazone
rosiglitazone
moa of thiozolidinediones
reduce insulin resistance
reduce blood glucose concentration as the insulin is having better effect
when pioglitazone is used alongside insulin what sort of disease has increased chance
cardiovasscular
bladder cancer
what are some rare but IMPORtant side effects of thiozolidinediones
liver dysfunction -> jaundice
if this presents discontinue use
can pioglitazone be used in pregnancy or breastfeeding
no
what does sglt2 inhibitor stand for
sodium - glucose co transporter 2 inhibitors
name 3 sglt2 inhibitors
canagliflozin
dapagliflozin
empagliflozin
what is the moa of sglt2 inhibitors
inhibits the transporter located in the proximal convuluted tubule
which reduces glucose reabsorption
increase urinary excreation
what are the ways in which sglt2 inhibs can be used
with metformin
or as monotherapy
Note what is there a risk of while using sglt2 inhibs
ketoacidosis
fourniers gangrene
what does the mhra reccomend aroudn the monitoring of the sglt2 inhibs
monitor ketones during surgical procedures and if they suffer from an acute medical illness
what are the side effects of sglt2 inhibs
back pain
balanoposthitis
DKA
can pregnant and breastfeeding women use sglt2 inhibs
no
When a patient becomes unwell with diabetes what rules come into play
the sick day rules
what do the sick day rules state in regards to lifestyle advice
Ensure to
STAY HYDRATED
DONT FAST
IF CANNOT EAT
take sugary drinks and or icecream
to replace the blood sugar
IF CAN BLOOD SUGAR MONITOR
do every 2 - 4 hours
IF NOT
look out for signs of hyperglycaemia
what are some signs of hyperglycaemia
Thirst
Polyurea
Weight loss
Fatigue
What medications need to be stopped when sick day rules come into place
Metformin
Sulfonylurea
GLP-1 Analogues
SGLT2 Inhibitors
Why does metformin need to be stopped during sick days
increased chance of lactic acidosis due to the increased thirst when we are sick
Why do Sulphonylureas need to be stopped during sick days if cannot eat or drink
If unable to eat or drink then makes more prone to hypoglycaemia
Why do GLP-1 Analogues need to be stopped during sick days
dehydration leads to higher chance of serious side effects
Why do SGLT2 Inhibitors need to be stopped during sick days
higher chance of keto acidosis
what adjustment to the insulin should be made when we are taking a sick day and we have a blood glucose of less than 4 mmol/ l
firstly treat the hypo by having a sugar snack e.g. jelly babies or ice cream
then reduce the regular insulin dose by 20%
what adjustment to the insulin should be made when we are taking a sick day and we have a blood glucose of more than 13mmol/l
Take carbs as a meal replacement
Sip sugar free fluids 100ml per hour to stay hydrated
Increase insulin dose by either 2, 4 or 6 units to increase depending on how high it is over 13
if < 17 then 2
if < 22 then 4
if > 22 then 6
What non diabetic medications may need to be stopped on a sick day for a diabetic patient
ace inhibitor
angiotensin receptor blocker
diuretics
nsaids
