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BNF Endocrine system > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Which diabetic patients must inform the DVLA

A
  • all insulin patients (unless temp treatment)
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2
Q

What advice does the DVLA recommend for diabetic drivers

A
  • always carry glucose monitor
  • check glucose at least 2 hours before driving and every 2 hours of the drive
  • Blood glucose should always be >5 when driving
  • supply of fast acting carb always in the car
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3
Q

What should a diabetic driver do if their BM <4mmol/L whilst driving?

A
  • stop driving
  • switch off enginge
  • eat/drink sugar
  • wait 45 mins after BM normal before driving
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4
Q

Why is alcohol an issue for diabetic patients

A

It can mask hypoglycaemia and cause delayed hypoglycaemia

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5
Q

Symptoms of diabetes

A

Poldipsia, Polyuria, weight loss, fatigue, blurred vision, poor wound healing

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6
Q

Long term complications of diabetes

A

Macrovascular: CVD
Microvascualr: retinopathy, nephropathy, peripheral neuropathy

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7
Q

What medication can be offered to diabetic patients to prevent risk of CVD

A

Atorvastatin 20mg

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8
Q

How often should T1DM patients have HbA1C test taken?

A

every 3 to 6 months

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9
Q

How often should T2DM patients have HbA1C test taken?

A

Every 3 to 6 months when stable 6 monthly

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10
Q

What is the glucose level aim on waking?

A

5-7mmol/L

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11
Q

What is the glucose level aim before meals other than breakfast?

A

4-7mmol/L

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12
Q

What is the glucose level aim >90mins after eating?

A

5-9mmol/L

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13
Q

What is the glucose level aim when driving?

A

> 5mmol/L

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14
Q

In T1DM what is the HbA1C aim?

A

<48mmol/L

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15
Q

In T2DM what is the HbA1c aim?

A
  • Diet controlled/no hypo meds: 48mmol/L (6.5%)

- Hypo meds / >2 AD meds: 53mmol/L (7%)

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16
Q

Which diabetes is due to an absolute deficiency in insulin?

A

Type 1

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17
Q

How often should glucose levels be monitored in T1DM patients?

A

at least QDS

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18
Q

What is a basal bolus regime?

A

long acting insulin + short acting bolus given at meals times

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19
Q

Levemir BD + Novorapid is an example of what time of insulin regime

A

Basal bolus

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20
Q

Tresiba OD + Fiasp at mealtimes is an exmaple of what insulin regime?

A

Basal bolus

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21
Q

Advantages of a basal bolus regime

A

Good glucose control, allows for mealtime flexibility

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22
Q

Disadvantages of basal bolus regime

A

Multiple daily injections

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23
Q

First line insulin regime in T1DM

A

Basal bolus

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24
Q

What is the concept behind a Continuous SC insulin infusion and what patients can it be used in?

A
  • Insulin pump
  • regular amounts of insulin delivered by a preprogrammed pump
  • for T1DM only
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25
Q

What is a biphasic insulin regime?

A

Short acting insulin mixed wiht intermediate acting that can be given as up to 3 injections a day

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26
Q

Humulin M3 and Novomix 30 are used in what type of insulin regime

A

Biphasic

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27
Q

Advantages of Biphasic regimes

A

Fewer injections compared to basal bolus

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28
Q

Disadvantages of Biphasic regime

A

Does not allow for mealtime flexibility

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29
Q

Intermediate acting/basal only regimes can only be used in which type of diabetes

A

T2DM

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30
Q

If a T1DM patient has a HbA1C of 69mmol/L or suffers from diabling hypoglycaemia what insulin regime can they be offered

A

insulin pump

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31
Q

What is a side effect associated with continuous inejection of insulin to the same area?

A

Lipodystrophy

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32
Q

Short acting insulin examples

A

Actrapid + Humulin S

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33
Q

Which insulin type takes 30mins for onset?

A

Short acting

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34
Q

How long do short acting insulins last for?

A

6-8 hours

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35
Q

When are short acting insulins adminsitered?

A

15-30 mins before food

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36
Q

Novorapid, Humalog and Apidra are examples of what type of insulin?

A

Rapid acting

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37
Q

When are rapid acting insulins adminsitered?

A

Immediately before meals

38
Q

Onset of action of rapid acting insulins

A

5 - 15 mins

39
Q

Peak onset of rapid acting insulins

A

0.5-1.5 houts

40
Q

Which insulin type has a duration of 3-5 hours

A

Rapid acting insulins

41
Q

What insulin is classed as ULTRA rapid fast acting

A

Fiasp - within 2 mins

42
Q

Examples of intermediate acting insulins

A

Humulin I, Insuman and Insultard

43
Q

Onset of action of intermediate acting insulins

A

2-4 hours

44
Q

Duration of action of intermediate acting insulins

A

14-16 hours

45
Q

Lantus, Levemir, Abasaglar and Toujeo are examples of what type of insulin?

A

Long acting

46
Q

Long acting insulin duration of action

A

up to 36 hours

47
Q

Lantus, Abasaglar and Toujeo are all examples of what insulin?

A

Insulin Glargine

48
Q

Insulin detemir brand namw

A

Levemir

49
Q

Onset of action of Long acting insulin

A

0-2 hours

50
Q

Insulin degludec is what type of insulin

A

Ultra long acting (tresiba)

51
Q

Humulin M3, Novomix, Humalog mix and Insuman Comb are what type of insulin?

A

Mixed insulin - mixture of intermediate and rapiding acting or a soluble insulin

52
Q

Xultophy contains what?

A

Insulin degludec + Liraglutide

53
Q

Is a patient is ill, should they continue to use their insulin?

A

Yes - as per sick day rules. Dose may need to be altered according to BG levels

54
Q

Target BP for diabetic patients with CKD

A

130/80

55
Q

Diabetes characterised by insulin resistance

A

T2DM

56
Q

First line drug treatment for T2DM

A

Metformin

57
Q

Which antidiabetic drug lowers basal and postprandial blood glucose concentrations therefore not causing hypos?

A

Metformin

58
Q

Gliclazide, Glimepiride, Glipizide and Glibenclamide are examples of what drug class

A

Sulphonylureas

59
Q

What side effect is associted with Sulphonylureas

A

Hypos + weight gain

60
Q

What is Glibenclamide?

A

Long acting sulphonylurea

61
Q

If HbA1c rises >58 despite metformin, what can be started?

A

Dual therapy with either a SU, DPP4 inhibitor, SGLT2 inhibitor, GLP1 or pioglitozone

62
Q

Common side effects of metformin

A

GI disturbances, Lactic acidosis (if renally impaired), decreased absorption of B12

63
Q

How do sulphonylureas work?

A

Stimulate insulins secretion therefore take with or after food

64
Q

What EGFR is metformin contraindicated?

A

<30

65
Q

What can interact with metformin during surgery?

A

Contrast media - increased risk of AKI

66
Q

What condition are Meglitinides used for?

A

T2DM

67
Q

Which antidiabetic drug is a PPAR agonsit and increases insulin sensitivity and reduces hepatic glucose output?

A

pioglitazone

68
Q

Side effects of pioglitazone

A

Weight gain, Bladder cancer, HF, increased risk of bone fracture

69
Q

Alogliptan, Linagliptan, sitagliptan and saxogliptan are examples of?

A

DPP4 inhibitors

70
Q

Which oral antidiabetic drugs increase GLP! and thus stimulate insulin secretion?

A

DPP4 inhibitors

71
Q

What is a side effect to be aware of with DPP4 (gliptans)

A

pancreatitis

72
Q

Which oral antidiabetic drugs have excellent evidence for reducing HF and CVD?

A

SGLT2 inhibitors

73
Q

Canaglifozin, Dapagliflozin and Empagliflozin are examples of?

A

SGLT2 inhibitors

74
Q

What risk do SGLT2 inhibitors carry?

A

Risk of DKA

75
Q

GLP1 agonist examples

A

Liraglutide, Dulaglutide, Semaglutide, Exenatide, Lixisenatide

76
Q

Why can GLP1 agonsits help with weight loss?

A

They delay gastric emptying

77
Q

Side effect of GLP1 agonsits

A

Pancreatitis, GI side effects

78
Q

Other than diabetes, what can metformin be used to treat?

A

PCOS

79
Q

What criteria is needed for GLP1 agonist intiated?

A

Third line intensification

BMI >35 AND psychological/medical problems with obesity OR BMI<35 and occupational issues with insulin therapy

80
Q

In diabetic nephropathy, what medication should be started?

A

ACEI

81
Q

In autonomic diabetic neuropathy, diabetic diarrhoea can be managed wiht ehat?

A

Tetracycline or codein

82
Q

How is DKA managed?

A
  1. Fixed rate IV insulin (supress ketogenesis + reduce BG) + Long acting background
  2. Fluid replacement (Nacl and K+)
  3. IV glucose
83
Q

In DKA, what do we aim to get ketones below?

A

<0.3

84
Q

When can the VRII be stopped if a patient has started their Sc fast acting insulin and has eaten?

A

1 hour after

85
Q

At what BG level is a person having a hypo?

A

<4mmol/L

86
Q

How is a hypo treated?

A
  1. fast acting glucose (fruit juice/jelly babies/gluco gel)
    OR if unconscious IM glucagon or 20% IV glucose 100mL over 15 mins
  2. Once >4 mmol, give long acting carb (bread)
87
Q

The Gold or Clarke score measures for what?

A

Hypoglycaemia awareness

88
Q

What should women with preexisiting diabetes who are planning on becoming pregnant take?

A

Folic acid 5mg

89
Q

Can oral antidiabetic drugs be used in pregnancy?

A

All should be switched to insulin except metformin

90
Q

What insulin is first choice in pregnancy?

A

Isophane

91
Q

What antidiabetic drughas an increased risk of lower limb amputations?

A

canagliflozin (SGLT2)

92
Q

What antidiabetic class has an increased fourniers gangrene?

A

SGLT2 inhibitors

BNF Endocrine system (6 decks)

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