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PPI > Diabetes Medical Management > Flashcards

Diabetes Medical Management Flashcards

1
Q

According to the DCTT study, what is the best management of T1D for reducing issues with the eye (50-60%) and neurological issues (40-50%)?

A

DCTT study best T1D management: Insulin 3x a day + background insulin.
Leads to: 50-60% reduction in eye issues
40-50% reduction in neurological issues

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2
Q

What are the aims of treatment for T1D?

A

T1D treatment aims:
- Relief of symptoms
- Prevention/minimisation of micro/macro vascular complications
- Attainment of a near normal life expectancy

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3
Q

What are people living with T1D given for treatment?

A

People living with T1D are given insulin for treatment.

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4
Q

Hypoglycaemic blood measurement

A

Hypoglycaemic blood measurement = <4.0mmol/l

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5
Q

Hyperglycaemic blood measurement

A

Hyperglycaemic blood measurement= Persistently >12.0mmol/l

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6
Q

What does hyperglycaemia increase the risk of?

A

Hyperglycaemia increases the risk of atherosclerosis

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7
Q

If blood glucose is >15.0mmol what needs to happen?

A

If blood glucose is >15.0 mmol/l the urine needs to be tested for ketones and medical staff need to be informed if the test is positive.

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8
Q

Which type of diet can be dangerous for T1D?

A

The ketogenic diet could be dangerous for T1D.

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9
Q

If the fasting glucose is above 7 a person is considered to be what?

A

If the fasting glucose is above 7 a person is considered to be diabetic.

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10
Q

Self-Monitoring T1D Interpretation of results
-Before meals/upon waking:
- Hypoglycaemia:
-Hyperglycaemia:
- Test for ketones if:

A

Self-Monitoring T1D Interpretation of results
-Before meals/upon waking:
- Hypoglycaemia: <4.0mmol/l
-Hyperglycaemia: Persistently >12.0mmol/l
- Test for ketones in urine if: Blood glucose >15.0mmol/l

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11
Q

What does QDS mean?

A

QDS= 4 times per day

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12
Q

Government guidance for monitoring diabetes

A

Government guidance for monitoring diabetes
Tight blood glucose control:
- Type 1 HbA1c <48mmol/mol (6.5%)
- Type 2 HbA1c 48-53mmol/mol (6.5-7%)
Blood glucose should be monitored:
- Type 1: 4x per day (before breakfast, lunch, dinner and bed)
- Type 2: Once per day

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13
Q

What blood component is measured for monitoring diabetes?

A

HbA1c glycated haemoglobin is measured to monitor diabetes

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14
Q

Which population may find it difficult to keep to monitoring targets for diabetes?

A

The elderly may find it difficult to stay within targets for monitoring diabetes.

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15
Q

For the management of T1D when must insulin be administered?

A

For T1D management insulin mus be administered at specific times to mimic the natural insulin response.

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16
Q

What are the different types of insulin treatments?

A

Different insulin treatment types:
- Rapid acting recombinant human insulin analogues
- Short acting
-Intermediate acting
- Long acting human insulin analogues
- Biphasic insulin

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17
Q

What is the ideal insulin administration frequency in T1D?

A

Ideal insulin administration frequency in T1D:
- 4 times per day:
X 1 basal and x 3 meals

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18
Q

When is there a rapid rise in plasma insulin, what is the purpose?

A

Following a meal there is a rapid rise in plasma insulin to limit postprandial glycaemia via stimulating peripheral glucose uptake and suppression of endogenous glucose production.

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19
Q

When are low steady levels of insulin usually released?

A

Low steady levels of insulin are usually released overnight and between meals to maintain normoglycaemia

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20
Q

What is basal secretion of insulin, how can it be mimicked?

A

Basal insulin secretion is a constant low level secretion of insulin. It can be mimicked by a 24 hour injection.

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21
Q

What are the problems of achieving normoglycaemia with insulin administration?

A

Problems of achieving normoglycaemia with insulin administration:

  • Insulin is injected subcutaneously and absorbed in the peripheral bloodstream instead of portal which can affect absorption.
  • Some short acting insulins are absorbed slowly and should be injected 30 minutes prior to eating
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22
Q

Which type of insulin is rarely used in T1D?

A

Short acting insulin is rarely used for T1D

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23
Q

Rapid acting recombinant human insulin analogues
- Work quickly to minimise blood sugar rise following a meal.
Beta chain with 1 amino acid chain modified
- Starts working:
- Peak:
- Duration:
- Examples:
- Administration:

A

Rapid acting recombinant human insulin analogues
- Starts working: 5-15 minutes
- Peak: 50-90 minutes
- Duration: 3-5 hours
- Examples: Novorapid, Humalog, Apidra, Fiasp
- Administration: Shortly before or after meal

24
Q

Short acting insulin
Normally taken before meals. Also known as regular/neutral insulin. Rarely used now
- Starts working:
- Peak:
- Duration:
- Examples:
- Administration:

A

Short acting insulin
- Starts working: 30-60 minutes
- Peak: 2-4 hours
- Duration: 5-8 hours
- Examples: Human based: Actrapid, Humulin, Insuman, Rapid
Pork based: Hyperion Porcine Neutral
- Administration: 15-30 minute before a meal

25
Q

Phase 2 insulins?

A

Phase 2 insulins for slow steady sustained release:
- Intermediate acting
- Long acting human insulin analogues

26
Q

Intermediate acting insulin
Often taken with short acting but may be taken alone. Rarely used but used for people who don’t want to inject 4x daily.
Isophane insulin: insulin suspension combine with protamine
Must have small meals throughout day
Milder peak
- Starts working:
- Peak:
- Duration:
- Examples:
Human:
- Administration: Twice daily injections

A

Intermediate acting insulin
Often taken with short acting but may be taken alone. Rarely used but used for people who don’t want to inject 4x daily.
Isophane insulin: insulin suspension combine with protamine
Must have small meals throughout day
Milder peak
- Starts working: 1-3 HOURS
- Peak: 8 hours
- Duration: 12-16 hours
- Examples:
Human: Insulatard, humulin, insuman basal,
Porcine: Hypurin porcine isophane
- Administration: Twice daily injections

27
Q

What are rapid acting recombinant human insulin analogues?

A

Rapid acting recombinant human insulin analogues are rapid acting insulins where one or two amino acids on the beta chain are switched via genetic engineering

28
Q

Long acting human insulin analogues

A

Intermediate acting insulin
Often taken with short acting but may be taken alone. Rarely used but used for people who don’t want to inject 4x daily.
Isophane insulin: insulin suspension combine with protamine
Must have small meals throughout day
Milder peak
- Starts working: 1-3 HOURS
- Peak: 8 hours
- Duration: 12-16 hours
- Examples:
Human: Insulatard, humulin, insuman basal,
Porcine: Hypurin porcine isophane
- Administration: Twice daily injections

29
Q

Long acting human insulin analogues
Basal insulin. Less likely to cause low blood sugar. Can be used or alone or with rapid/short insulins. No pronounced peaks
- Starts working:
- Peak:
- Duration:
- Examples:
- Administration:

A

Long acting human insulin analogues
- Starts working: 1 hour
- Peak: Peakless
- Duration: 24 hours
- Examples: Levemir, Lantus, Abasalagar
- Administration:

Starts working: 30-90 minutes
- Peak: Peakless
- Duration: >24 hours
- Examples: Degludec 100 units/ml, degludec 100 units/ml, touted 300 units/ml
- Administration:

30
Q

What are biphasic insulins?

A

Biphasic insulins are insulins that cover phase 1 and phase 2. They contain a mix of rapid and slow (intermediate) acting insulin

31
Q

What should be considered when prescribing biphasic insulin?

A

An individual’s lifestyle, preferences, patterns of glycaemic control should be considered when prescribing biphasic insulin

32
Q

Biphasic insulin:
Humalog mix 25:
Humalog mix 50
Novomix 30:
Insuman comb 15:
Insuman comb 25:
Insuman comb 50
Humulin M3:

A

Biphasic insulin:
Humalog mix 25: For people who have small meals throughout day.
Humalog mix 50: For people who have a lot of carbs
Novomix 30: For people who have small meals throughout day.
Insuman comb 15: For people who have light meals
Insuman comb 25: For people who have small meals throughout day.
Insuman comb 50: For people who have a lot of carbs
Humulin M3:

33
Q

Where are the appropriate sites for insulin administration?

A

Appropriate insulin administration sites:
Buttocks, tummy, pocket line, thighs, upper arms

34
Q

Insulin pumps

A

Insulin pumps:
- Takes 3 months to perfect
- Pumps fast acting insulin usuallly in 6 blocks
- Basal rates can be programmed per hour for 24 hours
- Additional insulin can be given for meals coinciding with amount of CHO eaten
- Carb counting is necessary

35
Q

How much insulin per 10g of CHO should there be to begin with?

A

To begin, there should be 1 unit of insulin per 10g of CHO

36
Q

Why do hypos happen?

A

Hypos happen when:
- Excess insulin
- Some medications
- Delayed or missed meal or snack
- Not enough carbs
- Unplanned physical activity
- Large quantities of alcohol
- Alcohol without foo

37
Q

If someone is more active, do they need more or less insulin?

A

Someone that is more active needs LESS insulin

38
Q

Hypoglycaemia symptoms of BG 3.9-2.0 mmol

A

Hypoglycaemia symptoms of BG 3.9-2.0 mmol
- Headache
- Trembling
- Sweating
- Restlessness
- Tingling lips/tongue
- Pallor
- Hunger
- Feeling shaky

39
Q

Why do hypoglycaemic symptoms of BG 3.9-2.0 mmol occur?

A

• Symptoms occur due to adrenal glands and pancreas
hormones (adrenaline and glucagon) attempt to release glycogen from liver to increase blood glucose (BG)

40
Q

Hypoglycaemia Symptoms with BG below 2.0mmol

A

Hypoglycaemia Symptoms with BG below 2.0mmols:
- Slower reaction times
- Altered behaviour (aggressive, depression, laughing)
- Difficulty with speech
– slurred
- Changes in vision
- Dizziness
- Feeling Disorientated

41
Q

What do symptoms of hypoglycaemia below 2.0 mmol indicate?

A

These signs indicate the brain is not supplied
with enough glucose

42
Q

What is the treatment for hypoglycaemia?

A

Hypoglycaemia treatment:
-15-20g quick acting CHO
- 150-200mls fruit juice/coke
- 100-120mls lucozade
- 5-6 glucose tablets
- 3-4 jelly babies
Then long acting CHO snack (if patient likely to be active)
• Glucose intravenous infusion 15% - 20%- 50% OR
• Glucagon – given intramuscular (if no IV access)

43
Q

Hyperglycaemia
Definition?
Causes?
Major concern?
Diagnosis?
Aim to avoid?
Symptoms?

A

BG above target range. Causes may be illness, stress,
missed insulin/medication, inadequate doses of medication/insulin, regular consumption of high GI carbs.
• Production of ketones major concern in Type 1 with
hyperglycaemia.
• Two consecutive readings above 15mmol/l patient should
test for urinary ketones.
• Aim to avoid Diabetic Ketoacidosis (DKA) • Symptoms include: Intense thirst, passing lots of urine,
nausea, vomiting, abdominal pain, shortness of breath. Can lead to coma and death if not treated.

44
Q

Diabetic Keto acidosis

A

Diabetic Ketoacidosis (DKA)
• Can occur in Type 1 patients, particularly in times of
illness. • Body switches to burning fatty acids and producing acidic
ketone bodies • Insulin and fluids and K+ * as treatment (hospital) (* if
Hypokalaemia) •

45
Q

What are the diet and lifestyle modifications for T2D?

A

Diet and lifestyle modifications for T2D
- Increased physical activity
- Stop smoking
- Reduce weight by 5-10% (improves insulin sensitivity)
- Improve glycaemic control
- Reduce CVD risk

46
Q

Which anti-diabetic medications are used for T2D?

A

Anti-diabetic medications for T2D:
- Biguandes
- Sulphonylureas
- Meglitinide analogues
• Thiazolidinediones (glitazones)
• a-Glucosidase inhibitors
• Incretin mimics
• DPP-4 inhibitor
• Sodium-glucose co-transporter

47
Q

Which anti-diabetic medications increase insulin secretion in T2D?

A

T2D anti-diabetic medications that increase insulin secretion: [SIM]
- Sulphonylureas
- Meglitinide analogues
- Incretin mimics

48
Q

Which anti-diabetic medications reduce insulin resistance in T2D?

A

T2D anti-diabetic medications that reduce insulin resistance: (TB or GB)
- Thiazolidinediones (glitazones)
- Biguandes

49
Q

Which anti-diabetic medications affect some kind of absorption in T2D?

A

T2D anti-diabetic medications that affect absorption:
- a-glucosidase inhibitors (slows down CHO absorption)
- sodium-glucose co-transporter 2 (reduces the re absorption of glucose into the plasma)

50
Q

What is metformin?

A

Metformin is an anti diabetic drug used to treat T2D. It is a biguande which reduces insulin resistance as well as hepatic glucose output.

51
Q

What is the first line choice for antidiabetic medication in T2D?

A

Metformin is the first line choice for antidiabetic medication in T2D.

52
Q

Metformin (Glucophage)
- Action
- Side-effects
- Where use should be avoided
- Blood test measurements where use should be reduced/ stopped
- Use
- Dosage

A

Metformin (Glucophage)
- Action: Deceases gluconeogenesis
Increases peripheral glucose uptake
Decreases glycogenolysis
Decreases fatty acid oxidation
Suppresses appetite
Doesn’t cause hypoglycaemia
- Side-effects: bloating, lactic acidosis, gastro intestinal side effects (reduced when taken with food), long term use associated with vit b12 malabsorption
- Where use should be avoided: renal disease, hepatic disease (lactic acidosis)
- Blood test measurements where use should be reduced/ stopped:
Reduced: eGFR 30- 60 ml/min,
Stopped: eGFR <30 ml/min or creatinine > 150 umol/l
- Use: After meals with dose increased gradually
- Dosage: Start with 1 tablet

53
Q

Long term Metformin use is associated with malabsorption of which vitamin?

A

Long term Metformin use is associated with Vitamin B12 malabsorption

54
Q

What is the 2nd option of treatment if Metformin doesn’t work in T2D?

A

Sulphonylureas are the 2nd option of treatment if Metformin doesn’t work in T2D

55
Q

When aren’t sulphonylureas used in T2D?

A

Sulphonylureas aren’t used in the late stages of T2D as it requires there to be some functioning beta cells to be effective

56
Q

Sulphonylureas (SUR)
- Action
- Side-effects
- Where use should be avoided
- Blood test measurements where use should be reduced/ stopped
- Use
- Dosage

A

Sulphonylureas (SUR)
AGONISTS
- Action: stimulate beta cells to secrete insulin (insulin secretagogues).
Bind to SUR-1 receptors on beta cell membrane
Leads to closure of ATP sensitive K+ channel which causes membrane depolarisation, influx of calcium and exocytosis of insulin (makes hypo more likely)
- Side-effects: increased appetite, weight gain, hypoglycaemia
- Benefits: Increased insulin sensitivity, cheap
- Disadvantages: Slow onset of action (3-4 hours)
- Where use should be avoided: Elderly
- Use: 30 minutes before meals
- Dosage

57
Q

Meglitinides

  • Action
  • Side-effects
  • Where use should be avoided
  • Blood test measurements where use should be reduced/ stopped
  • Use
  • Dosage
A

Meglitinides

  • Action: increase insulin secretion (insulin secretagogues)
  • Side-effects
  • Where use should be avoided
  • Blood test measurements where use should be reduced/ stopped
  • Use
  • Dosage

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