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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
Phase 2 insulins?
Phase 2 insulins for slow steady sustained release: - Intermediate acting - Long acting human insulin analogues
26
**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
**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
What are rapid acting recombinant human insulin analogues?
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
Long acting human insulin analogues
**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
**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:
**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
What are biphasic insulins?
Biphasic insulins are insulins that cover phase 1 and phase 2. They contain a mix of rapid and slow (intermediate) acting insulin
31
What should be considered when prescribing biphasic insulin?
An individual’s lifestyle, preferences, patterns of glycaemic control should be considered when prescribing biphasic insulin
32
Biphasic insulin: Humalog mix 25: Humalog mix 50 Novomix 30: Insuman comb 15: Insuman comb 25: Insuman comb 50 Humulin M3:
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
Where are the appropriate sites for insulin administration?
Appropriate insulin administration sites: Buttocks, tummy, pocket line, thighs, upper arms
34
Insulin pumps
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
How much insulin per 10g of CHO should there be to begin with?
To begin, there should be 1 unit of insulin per 10g of CHO
36
Why do hypos happen?
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
If someone is more active, do they need more or less insulin?
Someone that is more active needs LESS insulin
38
Hypoglycaemia symptoms of BG 3.9-2.0 mmol
Hypoglycaemia symptoms of BG 3.9-2.0 mmol - Headache - Trembling - Sweating - Restlessness - Tingling lips/tongue - Pallor - Hunger - Feeling shaky
39
Why do hypoglycaemic symptoms of BG 3.9-2.0 mmol occur?
• Symptoms occur due to adrenal glands and pancreas hormones (adrenaline and glucagon) attempt to release glycogen from liver to increase blood glucose (BG)
40
Hypoglycaemia Symptoms with BG below 2.0mmol
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
What do symptoms of hypoglycaemia below 2.0 mmol indicate?
These signs indicate the brain is not supplied with enough glucose
42
What is the treatment for hypoglycaemia?
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
Hyperglycaemia Definition? Causes? Major concern? Diagnosis? Aim to avoid? Symptoms?
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
Diabetic Keto acidosis
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
What are the diet and lifestyle modifications for T2D?
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
Which anti-diabetic medications are used for T2D?
Anti-diabetic medications for T2D: - Biguandes - Sulphonylureas - Meglitinide analogues • Thiazolidinediones (glitazones) • a-Glucosidase inhibitors • Incretin mimics • DPP-4 inhibitor • Sodium-glucose co-transporter
47
Which anti-diabetic medications increase insulin secretion in T2D?
T2D anti-diabetic medications that increase insulin secretion: [SIM] - Sulphonylureas - Meglitinide analogues - Incretin mimics
48
Which anti-diabetic medications reduce insulin resistance in T2D?
T2D anti-diabetic medications that reduce insulin resistance: (TB or GB) - Thiazolidinediones (glitazones) - Biguandes
49
Which anti-diabetic medications affect some kind of absorption in T2D?
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
What is metformin?
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
What is the first line choice for antidiabetic medication in T2D?
Metformin is the first line choice for antidiabetic medication in T2D.
52
Metformin (Glucophage) - Action - Side-effects - Where use should be avoided - Blood test measurements where use should be reduced/ stopped - Use - Dosage
**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
Long term Metformin use is associated with malabsorption of which vitamin?
Long term Metformin use is associated with Vitamin B12 malabsorption
54
What is the 2nd option of treatment if Metformin doesn’t work in T2D?
Sulphonylureas are the 2nd option of treatment if Metformin doesn’t work in T2D
55
When aren’t sulphonylureas used in T2D?
Sulphonylureas aren’t used in the late stages of T2D as it requires there to be some functioning beta cells to be effective
56
Sulphonylureas (SUR) - Action - Side-effects - Where use should be avoided - Blood test measurements where use should be reduced/ stopped - Use - Dosage
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
Meglitinides - Action - Side-effects - Where use should be avoided - Blood test measurements where use should be reduced/ stopped - Use - Dosage
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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