Diabetes

Question 1

Blood Glucose vs HbA1c

Answer 1

Blood Glucose is the immediate measure of glucose levels in blood while HbA1c is measure of glycated Hb which reflects average blood sugar over last 10 weeks

Question 2

Name a Rapid,Short,Intermediate and Long acting Insulin

Answer 2

Insulin aspart, Soluble insulin, Isophane Insulin, Insulin glargine

Question 3

Side effects of insulins

Answer 3

Hypoglycaemia, Lipohypertrophy, Lipoatrophy, Renal Impairment

Question 4

Drug Interactions of Insulins

Answer 4

Need to ↑ Dose with steroids, Other hypoglycaemic agents

Question 5

What does Basal Bolus Dosing involve

Answer 5

Take a once a day long acting basal injection and take a rapid acting bolus injection before every meal

Question 6

How to treat DKA

Answer 6

Priority is Fluids then insulin, then correct potential rebound hypoglycaemia and K+ imbalence.

Question 7

Name a Biguanides

Answer 7

Metformin

Question 8

Side Effects of Biguanides

Answer 8

GI Upset, N+V, Diarrhoea, Kidney damage (Stop if eGFR <30ml/min), Supress Appetite so weight loss

Question 9

Contraindications/Drug Drug Interactions with Biguanides

Answer 9

ACEi,Diuretics,NSAIDS (Any drugs that may impair renal function), Thiazide likes can increase Glucose so reduce metformin action

Question 10

Name a Sulfonylureas (SU)

Answer 10

Gliclazide

Question 11

Side Effects of SUs

Answer 11

Mild GI Upset N+V etc., Hypoglycaemia, Weight gain through anabolic effects of insulin

Question 12

Drug Drug Considerations + Contraindictions with SUs

Answer 12

Other Hypoglycaemic agents, Thiazide Like Diuretics + Hepatic and Renal Impairment

Question 13

Name 2 Thiazoidinediones (glitazone)

Answer 13

Pioglitazone, Rosiglitazone

Question 14

Side effects of glitazones

Answer 14

GI Upset, Fluid Retention, Fracture Risk, Weight Gain

Question 15

Drug Drug Interactions + Contraindications of glitazones

Answer 15

Other hypoglycaemic agents + CVD concerns, Bladder Cancer

Question 16

Name 2 SGLT 2 inhibitors

Answer 16

Canagliflozin, Dapagliflozin

Question 17

Side Effects of SGLT2 Inhibitors

Answer 17

UTI and Genital Infection, Thirst and Polyuria

Question 18

DDIs with SGLT2 Inhibitors

Answer 18

Antihypertensives, Other Hypoglycaemic Agents

Question 19

Name 2 GLP1 Receptor Agonists

Answer 19

Exenatide, Liraglutide

Question 20

Side Effects of GLP1R Agonists

Answer 20

GI Upset, GORD, STOP if eFGR <30 ml/min

Question 21

DDIs of GLP1R agonists

Answer 21

Other hypoglycaemic agents

Question 22

Name 2 DPP-4 Inhibitors

Answer 22

Sitagliptin, Saxagliptin

Question 23

Side Effects + Contraindication of DPP4 Inhibitors

Answer 23

GI Upset, Small Pancreatitis Risk + Avoid in pregnancy

Question 24

DDIs of DPP4 inhibitors

Answer 24

Other Hypoglycaemics, Drugs that oppose action e.gThiazide Likes, Loop Diuretics

Question 25

Benefits of modified release drug tablets? + Why swallow tablet whole?

Answer 25

↓ GI upset, less frequent dosing needed as slower release. + The coating makes it modified release

Question 26

When to start metformin?

Answer 26

If HBA1c rises to 48 mmol/mol. + should aim to keep at level of 48 mmol /mol

Question 27

When to start dual therapy with metformin? + When to start triple therapy with metformin?

Answer 27

If HBA1c rises to 58mmol/mol + If HBA1c doesn’t go down from 58mmol/mol on a repeat test.