Diabetes Management Flashcards
Lifestyle modification?
- Maintain normal weight for adults (BMI 20-25 kg/m2)
- Reduce salt intake
- Stop alcohol intake
- Stop smoking
- Engage in regular physical exercise (eg brisk walking) for 30 minutes per day, on 5 days of per week
- Consume at least five portions/day of fresh fruit and /or vegetables
- Reduce the intake of total and saturated fat (animal fat)
Basic principles for recommended diet?
- Avoid short acting carbohydrate (sugar, sugary foods and drinks)
- Eat fruits one at a time( 2 if small) maximum 2 times/day
- Take regular meals of unrefined carbohydrate
Non insulin therapies for T2 DM?
- sulphonylureas - glibenclamide, glipizide
- biguanides - metformin
- gliptins
- SGLT2 inhibitor - dapagliflozin
- alpha glucosidase inhibitors (acarbose)
Salphonylureas?
- Stimulate the release of insulin from endogenous
- Low doses are initially indicated
Side effects of sulphonylureas?
- hypoglycaemia(common with glibenclamide)
- Use with caution in renal impairment
Glipizide?
stimulate first phase insulin release
Mechanism of action of biguanides?
increases peripheral insulin sensitivity promotes weight loss
Elimination of biguanides?
- Metformin is renally excreted
- CONTRAINDICATED if renal impairment (CKD Stage 3, 4 & above)
- Contraindicated if severe CCF or liver failure
Side effects of biguanides?
- diarrhea
- nausea
- Most serious risk of metformin
- LACTIC ACIDOSIS
Mechanism of action in Dapagliflozin?
Benefits of DAPA?
- used to reduce the risk of needing to be hospitalized for heart failure in adults who have TD2 along with heart and blood vessel disease or who have multiple risk factors for developing heart and blood vessel disease
- used to reduce the risk of worsening kidney disease
Types of insulin?
- rapid acting
- short acting
- intermediate
- long acting
Rapid acting insulin?
onset - 15 minutes
peak - 60-90 minutes
duration - 3-4 hours
Short acting insulin?
onset - 30 mins - 1 hr
peak - 2-3 hours
duration - 3-6 hours
Intermediate insulin?
onset - 2-4 hours
peak - 4-10 hours
duration - 10-16 hours
Long acting insulin?
onset - 1-2 hours
peak - no peak
duration - 24+ hrs
Insulin categories?
basal
bolus
biphasic
Basal insulin?
intermediate and long acting insulin
Bolus insulin?
rapid and short acting insulin
Biphasic insulin?
premixed combination of
rapid-acting + isophane
short acting + isophane
Insulin available in Malawi?
- protophane/cloudy/lente
- onset of action is 2-4hrs
- peak is 4-10hrs
- duration is 10-18hrs - soluble/clear/actrapid
– onset of action is 30-60min
- peak is 2-3hrs
- duration is 5-8hrs - Premixed insulin- short and intermediate
Side effect of insulin?
- hypoglycemia
- weight gain
Note: therefore in obese diabetics who need insulin, combine insulin+ metformin
Management of T1 DM?
- insulin for life
- diet to balance insulin
Management of T2 DM?
- endogenous insulin production slowly declines
- diet
- diet + metformin/suphonylurea
e.g. glibenclamide - diet + metformin + suphonylurea
e.g. glibenclamide - diet + insulin (20%) ± metformin