Diabetes mellitus Flashcards
difference between type 1 and type 2 diabetes?
type 1: insulin deficiency
type 2: insulin resistance
what are the symptoms of diabetes ?
polyphagia ( hunger) polydipsia ( thirst) polyuria ( myzimas) weight loss fatigue blurred vision poor wound healing
are statins given in diabetes ?
yes high intensity statin atorva 20 mg in type 1 diabetes and type 2 diabetes with CV risk of 10% or more as primary prevention
what are microvascular complications of diabetes ?
retinopathy ( important to treat hypertension) and nephropathy
In which pregnancy trimester does insulin requirements increase ?
second and third
women who are pregnant and have diabetes which supplement they should take and why ?
folic acid 5 mg because there is a high risk of neural tube defects
Women who have diabetes and are pregnant what is the target of hba1C and why ?
target must be below 48mmol/mol (6.5%)
which type of insulin is a first choice in pregnancy ?
longer acting : isophane insulin
(may be appropriate to continue using long-acting analogues : glargine or detemir if good glycaemic control before pregnancy
what should be done to insulin regime after giving birth and why ?
reduce insulin immediately after birth, because increased risk of hypoglycaemia postnatal period. monitor bg to establish dose
what counselling should you provide to all pregnant women treated with insulin ?
hypoglycaemic risk in all pregnant women, especially in first trimester.
carry fact acting glucose: dextrose/ glucose drink
for type 1 prescribe glucagon
for women who are type 2 diabetic and are pregnant what changes should be made to their oral anti diabetic drugs ?
stop all of them apart from metformin can add insulin or just metformin alone
which sulfonylurea can be given in pregnancy from 11 weeks ?
glibenclamide
pregnant women fasting BG is less than 7 mmol/L, what would be the first and second line treatment ?
1st line: dietary and exercise measures
Second line: metformin if BG target not met in 1-2 weeks , alternative is insulin, also can be added to metformin
pregnant women fasting BG is more than 7 mmol/L, what would be the first line treatment ?
insulin with or without metformin
if pregnant women presents with fasting blood glucose of 6-6.9 mmol/l with hydramnios or macrosomia, what treatment should be given ?
insulin with or without metformin
what are precipitating factors for diabetic ketoacidosis?
Infection (for example pneumonia or a urinary tract infection).
Physiological stress (such as trauma or surgery).
Non-adherence to insulin treatment regimen or intentional insulin omission in order to lose weight (diabulimia).
Other medical conditions (such as hypothyroidism or pancreatitis).
Drug treatment (such as corticosteroids, diuretics, and sympathomimetic drugs [for example salbutamol]).
hyperglycaemia associated with hypokalaemia or hyperkalaemia ?
hypokalaemia
how diabetic ketoacidosis treated ?
IV infusion of soluble insulin, fluids (saline), potassium ( not if anuria)
continue established long acting insulin e.g. detemir or glargine
add glucose to infusion when blood glucose concentration fall below 14mmol
Continue insulin infusion until blood-ketone concentration is below 0.3 mmol/litre, blood pH is above 7.3 and the patient is able to eat and drink; ideally give subcutaneous fast-acting insulin and a meal, and stop the insulin infusion 1 hour later.
what are rapid acting analogue insulins ?
Humalog (insulin lispro) and Novorapid (insulin aspart)
glulisine (apridra)
what is onset of action and duration of action of insulin lispro and insulin aspart?
onset 15 min
duration 2-5 hours
name examples of short acting insulins ?
actrapid and humulin S
what is onset of action and duration of actrapid and humulin S?
onset of action of 30–60 minutes and a duration of action of up to 8 hours.
name intermediate acting insulins?
isophane, Humulin I®, Insuman Basal®, and Insulatard®
what is onset of action and duration of intermediate acting insulins ?
onset of action of approximately 1–2 hours, maximal effects between 3–12 hours, and a duration of action of 11–24 hours.
name all long-acting insulins ?
Lantus® (insulin glargine), Levemir® (insulin detemir), and Tresiba® (insulin degludec).
what is onset of action and duration of long-acting insulins ?
long-acting insulins have a duration of action of up to 24 hours; steady-state level achieved after 2–4 days to produce a constant level of insulin.
under what circumstances insulin requirements would be increased ?
infection or intercurrent illness
stress or acidental or surgical trauma
puberty
pregnant 2 and 3 trimester
under what circumstances insulin requirements would be decreased ?
endocrine disorders: Addisons disease, hypotuitarism coeliac disease ( gluten intolerance )
Patient asks you how to administer insulin ?
SC injection into buttocks, upper arm, abdomen or thigh
describe biphasic mixtures insulin regimen ?
short/rapid acting insulin PRE_MIXED with intermediate/long-acting insulin OD/BD before meals
This regime suitable for patients who have difficulty with multiple regime, but not suitable for acutely ill patients as insulin requirements change
Which insulin regimen is recommended for adults with type 1 diabetes ?
Offer multiple daily injection basal-bolus insulin regimens as the first-line choice to all adults with type 1 diabetes.
Offer twice-daily insulin detemir as the long-acting basal insulin therapy.
Offer a rapid-acting insulin analogue injected before meals for mealtime insulin replacement (rather than rapid-acting soluble human or animal insulins)
for which patients groups is continuous subcutaneous infusion pump is recommended ?
type 1 diabetics who:
suffer recurrent unpredictable hypoglycaemia
glycemic control more than 8.5% despite optimised MIR
children under 12 where MIR is not practical
which drugs enhance hypoglycaemic effect of insulin ?
ace inhibitors ( hyperkalaemia and hypoglycaemia linked)
BB mask symptoms of hypoglycaemia
alcohol
which drugs antagonise hypoglycaemic effects of insulin ?
corticosteroids, oral contraceptives, loop/thiazide diuretics
patient is dehydrated, has vomiting and diarrhoea, fever and has been advised to stop metformin, why is that ?
risk of lactic acidosis
why would gliflozins would need to be stopped if patient is dehydrated ?
they cause volume depletion
what is second line treatment of t2d ?
if initial treatment with metformin did not work consider dual therapy with one of the followings:
metformin and a DPP‑4 inhibitor or
metformin and pioglitazone or
metformin and a sulfonylurea