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ENDOCRINE > Diabetes clinical > Flashcards

Diabetes clinical Flashcards

1
Q

rapid acting insulin?

A
  • novorapid
  • humalog (lispro)
  • apidra
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2
Q

short acting insulin?

A
  • actrapid

- Humulin S

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3
Q

when is rapid acting insulin taken?

A

at the start of a meal

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4
Q

when is short-acting insulin taken

A

15-30 minutes before a meal

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5
Q

intermediate acting insulin?

A
  • humulin I
  • insulatard
  • insuman basal
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6
Q

long acting insulin?

A
  • lantus (glargine)
  • Levemir
  • tresiba
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7
Q

when is intermediate acting insulin given?

A

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

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8
Q

when is long acting insulin given?

A

usually once daily

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9
Q

a mixture of intermediate and short insulin is given when?

A

30 mins before breakfast and dinner

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10
Q

a mixture of intermediate and rapid insulin is given when?

A

at the start of breakfast and dinner

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11
Q

what type of insulin regimens are there?

A
  • basal bolus regimen
  • twice daily pre-mixed regimen
  • OD morning/evening
  • twice daily intermediate
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12
Q

describe a basal bolus regimen?

A
  • 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.
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13
Q

describe a twice daily pre-mixed regimen?

A

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.

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14
Q

capillary glucose monitoring is usually performed when?

A

before meals

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15
Q

in what conditions should insulin be reduced?

A
  • if eating less.
  • reduced renal function.
  • when drinking alcohol.
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16
Q

when should insulin be increased?

A
  • DKA/HHS
  • sepsis
  • steroid use
  • pancreatitis
  • dehydration
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17
Q

what does HHS stand for?

A

hyperosmolar hyperglycaemic state

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18
Q

what is HHS?

A

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

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19
Q

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

A

increase evening long acting insulin

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20
Q

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

A

decrease evening long acting insulin

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21
Q

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

A

increase the evening insulin dose

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22
Q

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

A

reduce the evening insulin dose

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23
Q

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

A

increase morning insulin

24
Q

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

A

decrease morning insulin

25
Q

insulin doses are adjusted by approx.?

A

10%

26
Q

how do insulin pumps work?

A

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

27
Q

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

A

continue basal rate but NOT give any boluses

+ can give 5% dextrose infusion and adjust basal rate accordingly

28
Q

what types of devices are used for insulin administration?

A
  • disposable pen
  • vial
  • pen cartridge
  • pump
29
Q

initial management of T2DM?

A

diet

30
Q

what is the next management step in T2DM after diet?

A

metformin.
OR
if thin - give them a sulfonylurea.

31
Q

examples of sulfonylureas?

A
  • glibenclamide
  • gliclazide
  • tolbutamide
32
Q

sulfonylureas work by?

A

increasing insulin secretion (must be at mealtimes)

33
Q

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

A

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

34
Q

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

A

try triple therapy or add in insulin.

35
Q

metformin is what class of drug?

A

biguanide

36
Q

metformin works by?

A

increasing insulin sensitivity and suppressing gluconeogenesis

37
Q

metformin side effects?

A
  • GI disturbance
  • weight loss
  • lactic acidosis
  • metallic taste
38
Q

when is metformin contra-indicated?

A
  • low BMI

- creatinine >150 or GFR <30

39
Q

side effects of sulfonylureas?

A

hypoglycaemia and weight gain.

40
Q

when are sulfonylureas contra-indicated?

A

if severe hepatic/renal impairment.

41
Q

example of thiazolidinediones?

A

glitazones e.g. pioglitazone

42
Q

how do thiazolidinediones work?

A

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

43
Q

S/E of thiazolidinediones?

A

fluid retention

  • fractures (glitazones and broken bones!)
  • hepatotoxic
  • weight gain
44
Q

thiazolidinediones are contra-indicated in?

A

heart failure and those with a history of bladder cancer.

45
Q

example of DPP4-inhibitors?

A

sitagliptin

46
Q

mechanism of DPP4-inhibitors?

A

inhibition of DPP4 (breaks down GLP-1).

-> Allows higher GLP-1 concentrations which allow higher levels of insulin secretion after food intake.

47
Q

S/E of DPP4-inhibitors?

A

pancreatitis

48
Q

Example of GLP-1 agonist?

A

exenatide

49
Q

mechanism of GLP-1 agonist?

A

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

50
Q

s/e of GLP-1 agonist?

A
  • GI disturbance and indigestion?
  • pancreatitis
  • weight loss
51
Q

contraindications of GLP-1 agonists?

A
  • GFR <50
  • history of pancreatitis
  • severe GI disease
52
Q

examples of SGLT2-inhibitors?

A
  • dapagliflozin
53
Q

mechanism of SGLT2-inhibitors?

A

increases urinary glucose excretion

54
Q

s/e of SGLT2-inhibitors?

A

UTIs and ketoacidosis

55
Q

contraindications of SGLT2-inhibitors?

A

GFR <30

56
Q

which oral hypoglycaemics are safe in pregnancy?

A

only metformin and insulin

ENDOCRINE (12 decks)

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