Diabetes Management

Question 1

What is the standard dose of insulin (U)?

Answer 1

U100

100 units per 1ml

Question 2

What other doses of insulin are available for those with insulin resistance or are just too fat?

Answer 2

U200, U300, U500

Question 3

What’s the difference between pocine and bovine insulin, recombinant insulin, and recombinant insulin analogue

Answer 3

Porcine and bovine insulines are extracted from animals.

Recombinant insulin is made from recombinant DNA technology. Different formulations can change the duration of action.

Insulin analogues are recombinant insulin, but with a few amino acids changes to make it rapid or long acting.

Question 4

Name a rapid-acting insulin, and describe its use

Answer 4

Novorapid.

Peak onset at 60mins, therefore can be injected just before a meal.

Lasts for 4-6hrs.

Question 5

Name a short-acting insulin, and describe its use

Answer 5

Actrapid, Humulin S.

Peaks at 2-3hrs, therefore need to inject 15-30mins before a meal.

Lasts for 8-10hrs.

Question 6

Name an intermediate-acting insulin, and describe its use

Answer 6

Isophane insulin, Insulatard.

Peaks at 4-8hrs, therefore used to keep glucose low overnight and between meals.

Question 7

Name a long-acting insulin, and describe its use

Answer 7

Glargine, Degludec.

Glargine lasts for around 24hrs, and plateaus in this time to act like normal-people insulin.

Degludec lasts for 50+hrs.

Question 8

What is a risk associated with short-acting insulins?

Answer 8

Slow to act, so can lead to postprandial hyperglycaemia.

Therefore need to inject 15-30mins before a meal

Question 9

What is a risk associated with injecting intermediate-acting insulin before bed?

Answer 9

Hypoglycaemia overnight

Question 10

Name three adverse effects of injecting insulin

Answer 10

Hypoglycaemia
Hyperglycaemia
Lypodystrophy (move injection sites to avoid changes to insulin absorption in these areas)
Allergies
Painful

Question 11

What is the target HbA1C in TI and TII DM patients?

Answer 11

<48mmol

<6.5%

Question 12

What is the target fasting blood glucose in TI and TII DM patients?

Answer 12

4-7mmol

Question 13

Describe the basal-bolus regime of administration of insulin

Answer 13

Inject a long-acting insulin (basal)

Inject a short-acting insulin before meals (bolus)

Question 14

Describe the BD regime of administration of insulin

Answer 14

One intermediate-acting injection in the morning, and one before dinner

Question 15

What is the DAFNE course?

Answer 15

Dose Adjustment For Normal Eating

Question 16

Which of the oral hypoglycaemic agents can cause hypoglycaemia?

Answer 16

Sulphonylureas

Question 17

Which of the oral hypoglycaemic agents can cause weight gain?

Answer 17

Sulphonylureas

Glitazones

Question 18

Which of the oral hypoglycaemic agents can cause weight loss?

Answer 18

SGLT-2 inhibitors

Metformin

Question 19

What are the three MoAs of metformin?

Answer 19

Makes cells more sensitive to insulin .·. ↑uptake and utilisation in target tissues

Reduces hepatic gluconeogenesis

Reduces intestinal absorption of glucose

Question 20

What are the benefits of metformin?

Answer 20

Reduced risk of hypos

Reduced risk of CVS events

Question 21

State three side effects of metformin

Answer 21

Gas
N+V
Diarrhoea
Lactic acidosis (more likely in kidney disease, but still rare)

Question 22

Name a gliptin/ DDP-4 inhibitor

Answer 22

Sitagliptin
Alogliptin
Linagliptin

Question 23

What is the mechanism of action of gliptins?

Answer 23

Inhibits the enzyme DDP-4, and in turn prevents the breakdown of GLP-1. This causes:

• Increased production of insulin
• Reduced release of glucagon

Question 24

State an adverse effect of gliptins

Answer 24

GI upset
?Pancreatitis .·. caution if pt’s have a risk
Cough
Limited reduction in HbA1C

Question 25

Name a sodium-glucose co-transporter 2 inhibitor

Answer 25

Canagliflozin
Dapagliflozin
Empagliflozin

Question 26

What is the MoA of SGLT-2 inhibitors?

Answer 26

Competative reversible inhibition of SGLT-2 in the PCT

Causes increased excretion of glucose in the urine

Low hypo risk and causes weight loss and reduced BP

Question 27

State two adverse reactions of SGLT-2 inhibitors

Answer 27

• Constipation
• Increased risk of UTIs and thrush
• Polyuria and polydipsia
• Euglycaemic ketoacidosis

Question 28

Name a glucagon-like peptide 1 (GLP-1) agonist

Answer 28

Exenatide

Liraglutide

Question 29

What is the MoA of GLP-1 agonists?

Answer 29

Bind to the GLP-1 receptor and cause:

• Increased insulin release
• Decreased production of glucagon
• Slower gastric emptying

Question 30

State two adverse effects of GLP-1 agonists

Answer 30

Constipation
Diarrhoea
Dizziness
Skin reactions from sub-cut injections

Question 31

Name a sulphonylurea

Answer 31

Gliclazide

Question 32

What is the MoA of sulphonylureas?

Answer 32

Binds to beta cells, and stimulates them to release insulin:

Antagonises ATP sensitive K+ channels, decreasing K+ efflux and increasing insulin release

Question 33

State two adverse effects of using sulphonylureas

Answer 33

Hypoglycaemia .·. self-monitoring of blood glucose
Weight gain
Abdo pain
Diarrhoea

Question 34

Name a thiazolidinedione/ glitazone

Answer 34

Pioglitazone
Rosiglitazone

Not used much

Question 35

What is the MoA of glitazones?

Answer 35

Increased sensitivity of muscle and adipose tissue to insulin

Question 36

State two risks of glitazones

Answer 36

Heart failure
Bladder cancer
Weight gain
fluid retention