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Y3 Patient Sem 1 > diabetes > Flashcards

diabetes Flashcards

1
Q

how many people in the UK have diabetes?

A

4.7 million

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2
Q

what are the symptoms of type 1 diabetes?

A

4 T’s

  • toliet
  • thirst
  • tired
  • thinner
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3
Q

what it diabetic ketoacidosis?

A

where the body has swit ched to lipid metabolism. The product of this is ketone and this turns the blood to acid and can result in death if left untreated

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4
Q

how many type 1 diabetics presents with DKA?

A

¼ of patients

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5
Q

what is the presentation of type 2 diabetes?

A
  • asymptomatic
  • slower onset, tends to be older patients or those with high BMI
  • slow wound healing
  • increased episodes of gential thrush
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6
Q

what is type 1 diabetes/

A
  • no insuilin produced
  • can quickly turn life threatening
  • usually found in childhood
  • need to replace the insulin
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7
Q

what is type 2 diabetes?

A
  • insulin is produced but the body cannot respond to it the same as a healthy boyd
  • rarely life threatening
  • much treatment is the management of diet
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8
Q

what are the risk factors of type 2 diabetes?

A 
▫	Ethnicity
▫	Age
▫	Obesity
▫	Genetics	
▫	Smoking/alcohol
▫	Raised BP
▫	PCOS
▫	Poor sleep
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9
Q

what are the drug targets to reduce blood sugar?

A
  • enhance insulin secretions
  • enhance action of incretion
  • delay carbohydrate absorption
  • reduce hepatic glucose output
  • reduce glucose re-uptake from glomerular filtrate
  • reduce peripeheral insulin resistance
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10
Q

what are examples of drug which enhane insulin secretions?

A

Sulfonylureas, Meglitinides. This will not work unless you have some pancreatic function TYPE 2

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11
Q

what are examples of drugs which enhance the action of incretion?

A

GLP agonists DPP-4 inhibitors. – enhance hormone incretin, which is hormone which sends signals from stomach to pancreas to release insulin, so you need a working pancreas)

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12
Q

which are the examples of drugs which dekat carbohydrate absorption?

A

Acarbose (cheap, stops you digesting carbohydrates, side effects are pleasant tend to not use in UK), GLP1 agonists (have to have high BMIm delay gastric emptying so you eat less

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13
Q

which drugs reduce hepatic glucose output?

A

Metformin, Pioglitazone DPP4 inhibitors (ends in gliptin), GLP1 agonists. Secondary affect in reducing how much glucose is produced in liver. Injectables.

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14
Q

which drugs reduce glucose re-uptake from glomerular filtrate?

A

SGLT 1 inhibitors

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15
Q

which drugs reduce peripheral insulin resistance?

A

Pioglitazone, Metformin. You need insulin to be present in body for them to work. TYPE 2

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16
Q

what is metformin?

A

first line drug treatement for all patients.

GOLD standard for type 2 patients

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17
Q

what are the advantages of metformin?

A
  • Cheap
  • Weight neutral
  • Low risk of hypo – making muscles more sensitive to insulin not actually producing more than you need
18
Q

what are the disadvtanges of metformin/

A
  • Commonly causes GI side effects, start taking it initial weight loss as you don’t want to eat due to diarrhoea, but usually overcome it by giving one tablet with biggest meal, and increase the dose to with every meal as you can till you get to TDS. Modified release tablets are now available where you can have your dose all in one.
  • Rare but serious side-effects of lactic acidosis – cannot use with in patients with high risk of this (heart attack, sepsis, respiratory disease)
  • Short t1/2 so TDS frequency
  • Caution in eGFR < 45
  • Contraindicated in eGFR <30
19
Q

what are the advantages of sulfonylureas?

A
  • Can be OD or BD depending on MR or not
  • Quickly lower cBG so improves symptoms
  • Fewer GI side effects than metformin
20
Q

what are the disadvantages of sulfonylureas?

A
  • Can cause hypos – if you don’t have any food can have problems with low blood sugar. Don’t suggest to elderly
  • Can cause weight gain in some patients
  • Need residual pancreas function
  • Can be unpredictable in renal impairment and in the elderly
21
Q

what are the advantages of pioglitazone?

A
  • OD dosing
  • Low risk of hypo
  • Suitable in renal impairment
22
Q

what are the disadvantages of pioglitazone?

A
  • Associated with heart failure – contraindication as it causes fluid retention
  • Increased risk of bladder cancer and fractures – not for history of those with osteoporosis
  • Causes weight gain – stone weight gain in the year and is mainly fluid.
  • Rarely causes liver toxicity
  • Can take 3-6 months to show benefit
23
Q

what are the advantages of DPP-4 inhibitors?

A
  • Once a day
  • No weight gain
  • Low risk of hypo
  • Some can be used in renal impairment
24
Q

what are the disadvantages of DPP-4 inhibitors?

A
  • Commonly causes GI side effects, rash and UTI

* Rarely causes pancreatic inflammation

25
Q

what are the advantages of SGLT-2 inhibitors?

A
  • Can cause weight loss
  • Can reduce BP
  • Low risk of hypo
26
Q

what are the disadvantages of SGLT-2 inhibitors?

A
  • Can cause thrush and UTIs especially on starting treatment – due to you urine containing sugar which bacteria like
  • Only effective if reasonable renal function
  • Lower BP can increase fall risk
  • Risk of DKA – but this is an issue in type 1 diabetes as they are already at high risk already.
  • Risk of kidney injury and foot ulcers???
27
Q

what is GLP-1?

A

Very expensive and patients sometimes don’t like them, injectables – big molecule. BMI <35 or <30 if you have complications from having this BMI. Not available on NHS – licensed down to BMI 25. Mostly sold through weight loss clinics. But must be weighed every 6 months and if they don’t reach targets they are stopped.

28
Q

what are the advantages of GLP-1/

A
  • Weight loss
  • Once a day (or weekly with some preparations!)
  • Rarely cause hypos
29
Q

what are the disadvantages of GLP-1?

A
  • Injections
  • Severe GI side-effects are very common
  • Suitable in moderate renal impairment
  • Rarely causes pancreatitis
30
Q

what is the aim of insulin?

A

• Keep as close to a non-diabetic as possible. Mimic what pancreas does. Healthy person usually doesn’t have a blood sugar above 7.
• But - what is realistic for an individual patient to achieve?
For Type 1:

31
Q

what is basal bolus in type 1 diabetics?

A

▫ One (or two) long acting in evening (and morning)

▫ 3 doses of short/ rapid acting during day before meals

32
Q

what is biphasic?

A

insulin and salt. Some insulin sticks to the salt so your body cant use it and then some of it is free in solution. The free in solutions goes round body and is used rapidly acting and then as that leaves system, the salt bound and leave and will cover basal insulin for rest of the day.
▫ Two biphasic insulin doses, one in the morning and one at teatime
▫ Dose split (breakfast/teatime) dependent on when biggest meals is eaten

33
Q

what happens with insulin in non-diabetics?

A
  • Insulin is released as soon as blood sugar increase
  • This is hard to mimic using injectable insuling. As the injectable insulin are subcatenous and you have time taking for insulin to get through the fatty tissue and into the blood.
34
Q

what is basal bolus regime?

A

first line therapy in type 1 diabetics adults and children
• Long-acting insulin analogue ONCE daily (night-time)
• Long-acting insulin analogue TWICE daily (breakfast and night-time)
• Rapid acting insulin analogue THREE times daily
• With meals
• Dose based on carb intake
• Blood glucose levels before lunch is the effect of the insulin you took at breakfast it is not the insulin you will have at lunch. Always adjust insulin on what you are eating and not on your blood glucose levels.

35
Q

what is short actin insulin?

A 
•	Soluble
▫	onset 1/2-1 hour
▫	peak 2-3 hours
▫	duration 8-10 hours
•	Human Actrapid®
•	Humulin S ®
•	Insuman Rapid®
•	Human insulin – same as you produce in the own body
36
Q

what is rapid acting insulin?

A 
▫	onset 5-15mins
▫	peak 30-90 mins
▫	duration 4-6 hrs
•	Humalog® = Insulin Lispro
•	Novorapid® = Insulin Aspart
•	Apidra® = Insulin Glulisine
•	Played around with DNA and changed pairs – reaches blood much faster
37
Q

what is intermediate acting insulin?

A 
•	Isophane (Neutral Protamine Hagedorn=NPH)
▫	onset 2 – 4 hours
▫	peak 4 -10 hrs
▫	duration 12-18 hours
•	Human insulatard
•	Humulin I
•	Insuman Basal
•	Cloudy insulins – shake before use as suspension sinks insulin to the bottom
38
Q

what is long acting insulin analogues?

A

Insulin Glargine (Lantus® or Abasaglar®) & Detemir (Levemir ®)
▫ Once (Glargine) or twice (Detemir) daily
▫ Flat insulin profile
▫ Onset 2 – 4 hours with duration of 20-24hrs
▫ No peak as mirrors basal Insulin output in non diabetics
▫ Less nocturnal hypoglycaemia is the greatest benefit
▫ Changed dna and amino acid sequence which makes it last longer in the body and makes them long acting, not the exact same as human insulin, longer

39
Q

what is ultra long acting analogues?

A

NICE 3rd line regime when other long acting insulins have failed
• Insulin Degludec (Tresiba®) or Insulin glargine (300units/ml) (Toujeo®)
▫ Once daily administration with flattest insulin profile
▫ Duration of action of up to 42 hours
▫ May be of benefit in patients with troublesome nocturnal hypoglycaemia or non adherent patients who forget to take insulin
▫ Prefilled vials
▫ 20% less bioavailable due to long acting formulation so body doesn’t get as much insulin as others
• Good for homeless, eating disorders, as its only once a day

40
Q

what is non human insulin?

A 
•	RARELY USED
•	Options for all durations
•	Used for patients:
▫	Taking historically
▫	Unable to tolerate human insulin
41
Q

what is biphasic insulin?

A

• Contain a short or rapid acting insulin in a protamine suspension
• Onset 1/2 hr, peak 1-2 hours, duration up to 12 hours
▫ Humulin M3
▫ Insuman Comb 15, 25, 50
▫ Humalog mix 25, 50
▫ Novomix 30
• Good for patients who struggle with multiple injections
• Good for patients who are not able to carb count
• Not the best choice for good control
• Used mostly in patients with Type 2 but also in Type 1 where number of injections is problematic
• 2 injections a day – commonly with Breakfast and evening meal

42
Q

what is SC insulin infusion?

A
  • known as a patient pump
  • specialist consdiers this if patient needs multiple injections a day
  • HbA1c levels have remained high ( > 69 mmol/mol) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care
  • patient is commited and competence to use

Y3 Patient Sem 1 (20 decks)

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