Diabetes Flashcards
Which diabetic patients must inform the DVLA
- all insulin patients (unless temp treatment)
What advice does the DVLA recommend for diabetic drivers
- 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
What should a diabetic driver do if their BM <4mmol/L whilst driving?
- stop driving
- switch off enginge
- eat/drink sugar
- wait 45 mins after BM normal before driving
Why is alcohol an issue for diabetic patients
It can mask hypoglycaemia and cause delayed hypoglycaemia
Symptoms of diabetes
Poldipsia, Polyuria, weight loss, fatigue, blurred vision, poor wound healing
Long term complications of diabetes
Macrovascular: CVD
Microvascualr: retinopathy, nephropathy, peripheral neuropathy
What medication can be offered to diabetic patients to prevent risk of CVD
Atorvastatin 20mg
How often should T1DM patients have HbA1C test taken?
every 3 to 6 months
How often should T2DM patients have HbA1C test taken?
Every 3 to 6 months when stable 6 monthly
What is the glucose level aim on waking?
5-7mmol/L
What is the glucose level aim before meals other than breakfast?
4-7mmol/L
What is the glucose level aim >90mins after eating?
5-9mmol/L
What is the glucose level aim when driving?
> 5mmol/L
In T1DM what is the HbA1C aim?
<48mmol/L
In T2DM what is the HbA1c aim?
- Diet controlled/no hypo meds: 48mmol/L (6.5%)
- Hypo meds / >2 AD meds: 53mmol/L (7%)
Which diabetes is due to an absolute deficiency in insulin?
Type 1
How often should glucose levels be monitored in T1DM patients?
at least QDS
What is a basal bolus regime?
long acting insulin + short acting bolus given at meals times
Levemir BD + Novorapid is an example of what time of insulin regime
Basal bolus
Tresiba OD + Fiasp at mealtimes is an exmaple of what insulin regime?
Basal bolus
Advantages of a basal bolus regime
Good glucose control, allows for mealtime flexibility
Disadvantages of basal bolus regime
Multiple daily injections
First line insulin regime in T1DM
Basal bolus
What is the concept behind a Continuous SC insulin infusion and what patients can it be used in?
- Insulin pump
- regular amounts of insulin delivered by a preprogrammed pump
- for T1DM only
What is a biphasic insulin regime?
Short acting insulin mixed wiht intermediate acting that can be given as up to 3 injections a day
Humulin M3 and Novomix 30 are used in what type of insulin regime
Biphasic
Advantages of Biphasic regimes
Fewer injections compared to basal bolus
Disadvantages of Biphasic regime
Does not allow for mealtime flexibility
Intermediate acting/basal only regimes can only be used in which type of diabetes
T2DM
If a T1DM patient has a HbA1C of 69mmol/L or suffers from diabling hypoglycaemia what insulin regime can they be offered
insulin pump
What is a side effect associated with continuous inejection of insulin to the same area?
Lipodystrophy
Short acting insulin examples
Actrapid + Humulin S
Which insulin type takes 30mins for onset?
Short acting
How long do short acting insulins last for?
6-8 hours
When are short acting insulins adminsitered?
15-30 mins before food
Novorapid, Humalog and Apidra are examples of what type of insulin?
Rapid acting
When are rapid acting insulins adminsitered?
Immediately before meals
Onset of action of rapid acting insulins
5 - 15 mins
Peak onset of rapid acting insulins
0.5-1.5 houts
Which insulin type has a duration of 3-5 hours
Rapid acting insulins
What insulin is classed as ULTRA rapid fast acting
Fiasp - within 2 mins
Examples of intermediate acting insulins
Humulin I, Insuman and Insultard
Onset of action of intermediate acting insulins
2-4 hours
Duration of action of intermediate acting insulins
14-16 hours
Lantus, Levemir, Abasaglar and Toujeo are examples of what type of insulin?
Long acting
Long acting insulin duration of action
up to 36 hours
Lantus, Abasaglar and Toujeo are all examples of what insulin?
Insulin Glargine
Insulin detemir brand namw
Levemir
Onset of action of Long acting insulin
0-2 hours
Insulin degludec is what type of insulin
Ultra long acting (tresiba)
Humulin M3, Novomix, Humalog mix and Insuman Comb are what type of insulin?
Mixed insulin - mixture of intermediate and rapiding acting or a soluble insulin
Xultophy contains what?
Insulin degludec + Liraglutide
Is a patient is ill, should they continue to use their insulin?
Yes - as per sick day rules. Dose may need to be altered according to BG levels
Target BP for diabetic patients with CKD
130/80
Diabetes characterised by insulin resistance
T2DM
First line drug treatment for T2DM
Metformin
Which antidiabetic drug lowers basal and postprandial blood glucose concentrations therefore not causing hypos?
Metformin
Gliclazide, Glimepiride, Glipizide and Glibenclamide are examples of what drug class
Sulphonylureas
What side effect is associted with Sulphonylureas
Hypos + weight gain
What is Glibenclamide?
Long acting sulphonylurea
If HbA1c rises >58 despite metformin, what can be started?
Dual therapy with either a SU, DPP4 inhibitor, SGLT2 inhibitor, GLP1 or pioglitozone
Common side effects of metformin
GI disturbances, Lactic acidosis (if renally impaired), decreased absorption of B12
How do sulphonylureas work?
Stimulate insulins secretion therefore take with or after food
What EGFR is metformin contraindicated?
<30
What can interact with metformin during surgery?
Contrast media - increased risk of AKI
What condition are Meglitinides used for?
T2DM
Which antidiabetic drug is a PPAR agonsit and increases insulin sensitivity and reduces hepatic glucose output?
pioglitazone
Side effects of pioglitazone
Weight gain, Bladder cancer, HF, increased risk of bone fracture
Alogliptan, Linagliptan, sitagliptan and saxogliptan are examples of?
DPP4 inhibitors
Which oral antidiabetic drugs increase GLP! and thus stimulate insulin secretion?
DPP4 inhibitors
What is a side effect to be aware of with DPP4 (gliptans)
pancreatitis
Which oral antidiabetic drugs have excellent evidence for reducing HF and CVD?
SGLT2 inhibitors
Canaglifozin, Dapagliflozin and Empagliflozin are examples of?
SGLT2 inhibitors
What risk do SGLT2 inhibitors carry?
Risk of DKA
GLP1 agonist examples
Liraglutide, Dulaglutide, Semaglutide, Exenatide, Lixisenatide
Why can GLP1 agonsits help with weight loss?
They delay gastric emptying
Side effect of GLP1 agonsits
Pancreatitis, GI side effects
Other than diabetes, what can metformin be used to treat?
PCOS
What criteria is needed for GLP1 agonist intiated?
Third line intensification
BMI >35 AND psychological/medical problems with obesity OR BMI<35 and occupational issues with insulin therapy
In diabetic nephropathy, what medication should be started?
ACEI
In autonomic diabetic neuropathy, diabetic diarrhoea can be managed wiht ehat?
Tetracycline or codein
How is DKA managed?
- Fixed rate IV insulin (supress ketogenesis + reduce BG) + Long acting background
- Fluid replacement (Nacl and K+)
- IV glucose
In DKA, what do we aim to get ketones below?
<0.3
When can the VRII be stopped if a patient has started their Sc fast acting insulin and has eaten?
1 hour after
At what BG level is a person having a hypo?
<4mmol/L
How is a hypo treated?
- fast acting glucose (fruit juice/jelly babies/gluco gel)
OR if unconscious IM glucagon or 20% IV glucose 100mL over 15 mins - Once >4 mmol, give long acting carb (bread)
The Gold or Clarke score measures for what?
Hypoglycaemia awareness
What should women with preexisiting diabetes who are planning on becoming pregnant take?
Folic acid 5mg
Can oral antidiabetic drugs be used in pregnancy?
All should be switched to insulin except metformin
What insulin is first choice in pregnancy?
Isophane
What antidiabetic drughas an increased risk of lower limb amputations?
canagliflozin (SGLT2)
What antidiabetic class has an increased fourniers gangrene?
SGLT2 inhibitors
