Diabetes clinical

Question 1

rapid acting insulin?

Answer 1

• novorapid
• humalog (lispro)
• apidra

Question 2

short acting insulin?

Answer 2

• actrapid

- Humulin S

Question 3

when is rapid acting insulin taken?

Answer 3

at the start of a meal

Question 4

when is short-acting insulin taken

Answer 4

15-30 minutes before a meal

Question 5

intermediate acting insulin?

Answer 5

• humulin I
• insulatard
• insuman basal

Question 6

long acting insulin?

Answer 6

• lantus (glargine)
• Levemir
• tresiba

Question 7

when is intermediate acting insulin given?

Answer 7

once/twice daily, usually as part of a mixture.

Question 8

when is long acting insulin given?

Answer 8

usually once daily

Question 9

a mixture of intermediate and short insulin is given when?

Answer 9

30 mins before breakfast and dinner

Question 10

a mixture of intermediate and rapid insulin is given when?

Answer 10

at the start of breakfast and dinner

Question 11

what type of insulin regimens are there?

Answer 11

• basal bolus regimen
• twice daily pre-mixed regimen
• OD morning/evening
• twice daily intermediate

Question 12

describe a basal bolus regimen?

Answer 12

• long acting basal insulin is taken at night.
  e. g. lantus, levemir.
• rapid acting insulin is taken at the start of every meal.
  e. g. novorapi, humalog (lispro) and apidra.

Question 13

describe a twice daily pre-mixed regimen?

Answer 13

a mixture of:
- intermediate
e.g. humulin I, insulatard and insuman basal.
+ short OR rapid acting insulin.
e.g. short: actrapid and humulin S.
e.g. rapid: novorapid, humalog (lispro), apidra.

Given two times a day before breakfast AND dinner.

Question 14

capillary glucose monitoring is usually performed when?

Answer 14

before meals

Question 15

in what conditions should insulin be reduced?

Answer 15

• if eating less.
• reduced renal function.
• when drinking alcohol.

Question 16

when should insulin be increased?

Answer 16

• DKA/HHS
• sepsis
• steroid use
• pancreatitis
• dehydration

Question 17

what does HHS stand for?

Answer 17

hyperosmolar hyperglycaemic state

Question 18

what is HHS?

Answer 18

severe dehydration as the body tried to rid itself of excess sugar - T2DM commonly.

Question 19

what should be done in a patient on a basal bolus insuling regimen with high glucose before breakfast/at night?

Answer 19

increase evening long acting insulin

Question 20

what should be done in a patient on a basal bolus insulin regimen with low glucose before breakfast/at night?

Answer 20

decrease evening long acting insulin

Question 21

what should be done in a patient on a pre-mixed/intermediate insulin regimen with high glucose before bed AND before breakfast?

Answer 21

increase the evening insulin dose

Question 22

what should be done in a patient on a pre-mixed/intermediate insulin regimen with low glucose before bed AND before breakfast?

Answer 22

reduce the evening insulin dose

Question 23

what should be done in a patient on a pre-mixed/intermediate insulin regimen with high glucose before lunch AND evening meal?

Answer 23

increase morning insulin

Question 24

what should be done in a patient on a pre-mixed/intermediate insulin regimen with low glucose before lunch AND evening meal?

Answer 24

decrease morning insulin

Question 25

insulin doses are adjusted by approx.?

Answer 25

10%

Question 26

how do insulin pumps work?

Answer 26

continuous infusion of a basal rate of rapid/short acting insulin subcutaneously.

Question 27

what should happen if a patient is nil by mouth on an insulin pump?

Answer 27

continue basal rate but NOT give any boluses | + can give 5% dextrose infusion and adjust basal rate accordingly

Question 28

what types of devices are used for insulin administration?

Answer 28

- disposable pen - vial - pen cartridge - pump

Question 29

initial management of T2DM?

Answer 29

diet

Question 30

what is the next management step in T2DM after diet?

Answer 30

metformin. OR if thin - give them a sulfonylurea.

Question 31

examples of sulfonylureas?

Answer 31

- glibenclamide - gliclazide - tolbutamide

Question 32

sulfonylureas work by?

Answer 32

increasing insulin secretion (must be at mealtimes)

Question 33

what is the next management step in T2DM after first stage drug intervention?

Answer 33

add sulfonylurea to the metformin. OR add thiazolidinedione. OR add DDP-4 inhibitor

Question 34

what should be initiated if T2DM is unresponsive to diet, metformin and a second line agent?

Answer 34

try triple therapy or add in insulin.

Question 35

metformin is what class of drug?

Answer 35

biguanide

Question 36

metformin works by?

Answer 36

increasing insulin sensitivity and suppressing gluconeogenesis

Question 37

metformin side effects?

Answer 37

- GI disturbance - weight loss - lactic acidosis - metallic taste

Question 38

when is metformin contra-indicated?

Answer 38

- low BMI | - creatinine >150 or GFR <30

Question 39

side effects of sulfonylureas?

Answer 39

hypoglycaemia and weight gain.

Question 40

when are sulfonylureas contra-indicated?

Answer 40

if severe hepatic/renal impairment.

Question 41

example of thiazolidinediones?

Answer 41

glitazones e.g. pioglitazone

Question 42

how do thiazolidinediones work?

Answer 42

PPAR(gamma) agonists which increase fat/muscle glucose uptake

Question 43

S/E of thiazolidinediones?

Answer 43

fluid retention - fractures (glitazones and broken bones!) - hepatotoxic - weight gain

Question 44

thiazolidinediones are contra-indicated in?

Answer 44

heart failure and those with a history of bladder cancer.

Question 45

example of DPP4-inhibitors?

Answer 45

sitagliptin

Question 46

mechanism of DPP4-inhibitors?

Answer 46

inhibition of DPP4 (breaks down GLP-1). | -> Allows higher GLP-1 concentrations which allow higher levels of insulin secretion after food intake.

Question 47

S/E of DPP4-inhibitors?

Answer 47

pancreatitis

Question 48

Example of GLP-1 agonist?

Answer 48

exenatide

Question 49

mechanism of GLP-1 agonist?

Answer 49

mimics GLP-1 (hormone released by gut) to increase insulin production after food.

Question 50

s/e of GLP-1 agonist?

Answer 50

- GI disturbance and indigestion? - pancreatitis - weight loss

Question 51

contraindications of GLP-1 agonists?

Answer 51

- GFR <50 - history of pancreatitis - severe GI disease

Question 52

examples of SGLT2-inhibitors?

Answer 52

- dapagliflozin

Question 53

mechanism of SGLT2-inhibitors?

Answer 53

increases urinary glucose excretion

Question 54

s/e of SGLT2-inhibitors?

Answer 54

UTIs and ketoacidosis

Question 55

contraindications of SGLT2-inhibitors?

Answer 55

GFR <30

Question 56

which oral hypoglycaemics are safe in pregnancy?

Answer 56

only metformin and insulin