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MBChB IV Endocrinology > Diabetes mellitus type II > Flashcards

Diabetes mellitus type II Flashcards

1
Q

What is the most common endocrine disorder worldwide?

A

DMII

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2
Q

What is the 2nd most common cause of death in South Africa?

A

DMII

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3
Q

Diagnostic criteria for diabetes mellitus type II

A 
Fasting plasma glucose (FPG) ≥ 7.0mmol/l
OR
2hr plasma glucose (2PG) during OGTT ≥ 11.1mmol/l
OR
HbA1c ≥ 6.5%
OR 
Random plasma glucose (RPG) ≥11.1mmol/l
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4
Q

OGTT stands for?

A

Oral glucose tolerance test

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5
Q

FPG stands for?

A

Fasting plasma glucose

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6
Q

2PG stands for?

A

2hr plasma glucose

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7
Q

When is a random plasma glucose test performed?

A
  1. Patient has classic symptoms

2. Hyperglycemic crisis

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8
Q

RPG stands for and why?

A

Random plasma glucose

Any time of day w/o regard to time of last meal

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9
Q

How long must a patient be fasting for a fasting plasma glucose?

A

> 8hr

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10
Q

How many times must the diagnostic measurements for DMII criteria be performed in an asymptomatic patient?

A

Same test repeated on another day

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11
Q

What are the classic symptoms of diabetes?

A

Polyuria
Polydipsia
Weight loss

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12
Q

How is fasting defined?

A

No caloric intake for at least 8hr

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13
Q

How is an OGTT performed?

A

As described by the WHO using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in 250ml water ingested over 5 minutes
1.75g/kg glucose in children
Collect blood samples 2hr after
Collect in sodium fluoride tube if test not performed immediately with sample

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14
Q

Which test can one do to diagnose for DMII at any time of the day?

A

Random plasma glucose

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15
Q

Name presentations of hyperglycemic crisis?

A

Diabetic ketoacidosis

Hyperosmolar non-ketotic hyperglycemia

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16
Q

Which type of diabetes has destruction of beta cells and absolute insulin deficiency?

A

Type I

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17
Q

All patients w/ late onset of diabetes have type II diabetes

True or false?

A

False

Latent autoimmune diabetes of adulthood (LADA)

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18
Q

Name causes of beta cell destruction?

A 
Autoimmune
- islet cell autoantigen (ICA)
- anti-GAD
- anti-insulin
Idiopathic
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19
Q

Anti-GAD stands for?

A

Antibodies on glutamic acid decarboxylase

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20
Q

ICA stands for?

A

Islet cell autoantigen

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21
Q

Which type of diabetes has variable degrees of insulin deficiency and resistance?

A

Type II

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22
Q

There is a specific test for type II diabetes

True or false?

A

False

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23
Q

Ketoacidosis excludes type II diabetes

A

False

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24
Q

Name causes of diabetes

A 
Genetic defects
- beta cell function
- insulin action
Pancreatic disease
- common in EtOH use
Endocrinopathies
- counter-regulatory hormone production eg GH, cortisol
Drug induced
- glucocorticoids
Infections
- severe stressors induce DM
Genetic syndromes
-T21
Gestational
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25
What type of diabetes do patients with trisomy 21 present with?
Mature onset diabetes of the young (MODY)
26
What does MODY stand for?
Mature onset diabetes of the young
27
What is the pathogenesis of diabetes mellitus type II?
"Famine theory" Insulin resistance -> reduced beta cell mass/glucose toxicity/islet amyloid -> injured beta cells -> glucose intolerance -> type II DM -> beta cell failure -> type I DM-like syndrome
28
Early use of combination therapy may be advantageous in DMII | True or false?
True
29
Even if initial response to monotherapy is good in DMII, combination therapy and/or exogenous insulin is frequently required True or false?
True
30
What trend does glycaemic control typically show in DMII?
Gradual deterioration
31
Genetics of DMII
Polygenetic Strong interplay between genetics and environment Strong assoc w/ obesity Familial clustering = strong genetic component Monozygotic twins have 60-90% concordance Risk of developing in siblings is 10-33% vs normal 5% of population Women with DMII offspring have 2-3x higher DMII risk than man with DMII offspring
32
Name the abnormalities seen in insulin resistance syndrome
``` Hyperinsulinemia Impaired glucose tolerance Hypertension Incr plasma triglycerides Decreased HDL Truncal obesity ```
33
Give other names for insulin resistance syndrome
Syndrome X Reaven's syndrome Metabolic syndrome
34
What risk for insulin resistance syndrome indicate?
DMII | Atherosclerotic disease
35
The risk of DMII in a patient with acanthosis nigricans increases with the presence of what other abnormality?
Skin tags
36
What are acanthosis nigricans a sign of?
Insulin dependence
37
Why is obesity strongly assoc with diabetes mellitus type II?
Leads to a deficiency in post-receptors
38
Name causes of increased insulin resistance
``` Obesity Sedentary lifestyle Aging Genetics Glucotoxicity Increased FFA levels ```
39
Name causes of decreased beta cell function
Genetics Glucotoxicity Increased FFA levels
40
Which laboratory tests are performed to assess glycemic control?
HbA1c (preferred) RPG Fructosamine
41
Indications for OGTT
Diagnosis when equivocal blood glucose values Diagnosis during pregnancy Epidemiological setting
42
Precautions for OGTT
Preceding 3 days of unrestricted diet and usual exercise Overnight fast 8-14hr NO smoking
43
Which tube should you collect an OGTT sample in if the test won't be performed immediately?
Sodium fluoride
44
Indications for RPG
Self monitoring of blood glucose (SMBG) | Clinics
45
Indications for urine test
Replaced by SMBG Acutely ill patients Patient w/ blood glucose consistently > 16.7mmol/l
46
Which factors influence HbA1Cc?
``` Erythropoesis Altered haemoglobin Glycation Erythrocyte destruction Assays ```
47
Give examples where erythropoesis increases HbA1c?
Iron deficiency Vitamin B12 deficiency Decreased erythropoeisis
48
Give examples where erythropoesis decreases HbA1c?
``` Administration of iron Administration of B12 Administration of erythropoeitin Reticulocytosis Chronic liver disease ```
49
Give examples of genetic/chemical alterations in haemoglobin
Haemoglobinopathies HbF Methaemoglobin
50
Give examples where glycation increases HbA1c?
Alcoholism Chronic renal failure Decreased intraerythrocyte pH
51
Give examples where glycation decreases HbA1c?
``` Aspirin Vitamin C Vitamin E Certain haemoglobinopathies Increased intraerythrocyte pH ```
52
Give examples where glycation results in variable HbA1c?
Genetic determinants
53
Give examples where erythrocyte destruction increases HbA1c?
Increased erythrocyte life span | Splenectomy
54
Give examples where erythrocyte destruction decreases HbA1c?
``` Decreased erythrocyte life span Haemoglobinopathies Splenomegaly Rheumatoid arthritis ARVs Ribavirin Dapsone ```
55
Give examples of assays that are associated with increased HbA1c?
``` Hyperbilirubinaemia Carbamylated haemoglobin Alcoholism Aspirin in large doses Chronic opiate use ```
56
Give examples of assays that are associated with decreased HbA1c?
Hypertriglyceridaemia
57
Give examples of assays that are associated with variable HbA1c?
Haemoglobinopathies
58
HbA1c gives indications of fine hour to hour control | True or false?
False | Only shows average glucose control
59
Interpreting HbA1c to assess glycaemic control
``` <7% = good control 7-10% = fair control 13-17% = poor control ```
60
HbA1c and the assoc with complications
When mean annual HbA1c <1.1 x ULN -> renal and retinal complications are rare When mean annual HbA1c >1,7 x ULN, >70% of cases have complications
61
Repeating the HbA1c test
May rise within 1 week with high glucose on 1st reading Make take 2-4 weeks to fall with controlled glucose 30days before test contributed 50% of the glycated Hb 90-120days before test contribute 10% glycated Hb Not good test to repeat
62
A 1% change of HbA1c correlates with what change in average blood glucose?
1.6mmol/l
63
Which test is the best to perform and repeat?
OGTT
64
What factor do HbA1c targets have an effect on?
``` Risk of hypoglycemia Risk of drug interactions Disease duration Life expectancy Major comorbidities Established MV disease Patient attitude Resources and support ```
65
Target HbA1c, FPG and PPG?
4.0-7.0mmol/l FPG <6.5% HbA1c <8mmol/l PPG <7% HbA1c <10mmol/l <8% HbA1c <12mmol/l
66
Combining drugs in diabetic pharmacological treatment is usually less effective than stopping one agent and introducing another True or false?
False
67
Adding a second agent in diabetic pharmacological treatment is usually better than increasing the dosage of one that is already near its maximum dosage True or false?
True
68
Secondary failure of 2 drug combinations is a negative outcome in diabetic management
False | Should be expected eventually as it is a progressive disease
69
When does pharmacological diabetic treatment call for the use of insulin?
Failure of 2/3 oral combinations | - use insulin alone or in combination w/ oral agents
70
When is insulin started in a patient with severe hyperglycaemia?
From the beginning until glucotoxicity resolves -> reduce/withdraw
71
What factors should you consider when choosing oral glucose drugs?
``` Glycaemic targets Glycaemic efficacy Hypoglycaemic risk Weight gain Adverse effects Treatment complexity Patient factors ```
72
Alpha glycosidase inhibitors are best for which patients? How much does it reduce the HbA1c?
High postprandial glucose | 0.5-1%
73
Metformin (buiganide) is best for which patients? How much does it reduce the HbA1c?
Obese patients | 1-2%
74
Meglinitides are best for which patients? How much does it reduce the HbA1c?
High postprandial glucose | 1-2%
75
Sulphonylureas are best for which patients? How much does it reduce the HbA1c?
Recently diagnosed DMII | 1-2%
76
Thiazolinediones are best for which patients? How much does it reduce the HbA1c?
Obese/insulin resistant patients | 0.8-1.0%
77
DPP4 inhibitors are best for which patients? How much does it reduce the HbA1c?
Add on therapy | 0.7%
78
GLP1 receptor agonists are best for which patients? How much does it reduce the HbA1c?
Add on therapy | 0.8-1.2%
79
SGLT2 inhibitors are best for which patients? How much does it reduce the HbA1c?
Add on therapy | 0.8-1.2%
80
Which pharmacological drug is the best option for a patient with high postprandial glucose?
Alpha glycosidase inhibitors | Meglinitides
81
Which pharmacological drug is the best option for a patient with obesity?
Metformin | Thiazolinediones (+insulin resistance)
82
Which pharmacological drug is the best option for a patient with recently diagnosed DMII?
Sulphonylureas
83
What is the treatment strategy for DM according the the EDL?
Metformin -> metformin + sulphonylurea -> metformin + sulphonylurea + basal insulin -> metformin + intensified insulin
84
Why do you stop the sulphonylurea in the 3rd step of the EDL management of diabetes?
Works on beta cells and no longer effective "flogging a dead horse"
85
Why do you start metformin at a low dose and go slow?
GIT side effects affects patient compliance
86
Why do we no longer use the sulphonylurea benclamide and what is its better alternative?
Prolonged hypoglycemia | Glimperide instead
87
Why do they consider the extended release tablet of metformin in private?
Less side effects
88
Which DM treatment strategy caters for private sector?
SEMDSA 2017 strategy
89
Which drugs are insulin secretagogues and what is their mechanism of action?
Sulphonylureas Meglitinides Increase secretion of endogenous insulin by binding to SUR and increasing insulin exocytosis as long as there is pancreatic beta cell function remaining
90
What are the 8 classes of available DM drugs?
``` Sulphonylureas Meglitinides Biguanides Thiazolinediones Alpha glucosidase inhibitors GL1 analogues DPP4 inhibitors SGLT2 inhibitors ```
91
What is Diamicron?
Extended release Gliclazide
92
Which sulphonylureas are available?
Glipizide (Minidiab) Gliclazide (Diamicron) Glimperide (Amaryl) Glibenclamide (Daonil)
93
We still use Daonil sulphnylurea in practice | True or false?
False
94
What is the drug name of Minidiab?
Glipizide
95
What is the drug name of Diamicron?
Gliclazide
96
What is the drug name of Amaryl?
Glimperide
97
What is the drug name of Daonil?
Glibenclamide
98
What is the retail name of Glipizide?
Minidiab
99
What is the retail name of Gliclazide?
Diamicron
100
What is the retail name of Glimperide?
Amaryl
101
What is the retail name of Gibenclamide?
Daonil
102
Which meglitinides are available?
Repaglinide | Nataglinide
103
What is the drug name of Novonorm?
Repaglinide
104
What is the drug name of Starlix?
Nataglinide
105
What is the retail name of Repaglinide?
Novonorm
106
What is the retail name of Nataglinide?
Starlix
107
What are important competitive inhibitors of sulphonylurea metabolism and what does this entail?
Alcohol H2 blockers Less metabolism -> longer duration -> more side effects
108
What is the most important side effect of sulphonylurea use?
Hypoglycemia
109
Pancreatic vs cardiac SUR argument
Gliclazide only acts on the pancreatic SUR while the other sulphonylureas work on cardiac SUR -> theorised to increase infart size
110
What is the benefit of meglitinides in relation to cardiovascular mortality?
Meglitinides are given at meal times and mimic the physiological insulin response Postprandial hyperglycemia is linked to incidence of cardiovascular mortality Therefore meglitinides have significant benefit
111
Which studies assessed the benefit of meglitinides in relation to cardiovascular mortality?
Honolulu heart study Chicago study DECODE study DIAS study
112
Which drugs are insulin sensitizing agents?
Biguanides (metformin) | Thiazolinediones (pioglitazone)
113
What is the mechanism of action of biguanides?
``` Liver - decrease gluconeogenesis - decrease glycogeneolysis - decrease FA oxidation Muscle - increase insulin mediated uptake and oxidation - increase glycogenesis Increased splanchnic glucose utilisaion Activate insulin receptors Activate GLUT4 ```
114
What are the advantages of biguanides?
``` Weight loss (mild anorexic effect) No hypoglycemia Decrease in thombotic risk Beneficial effect on lipid profile Safe in pregnancy ```
115
Why did people write off metformin at a stage?
Fenformin, a biguanide, was linked to causing lactic acidotic death
116
How does metformin decrease thrombotic risk?
Decreased platelet aggregation | Decreased PAI-1 levels
117
How does metformin affect the lipid profile?
Incr HDL Decr LDL Decr triglycerides
118
What is the starting dose of metformin?
500mg/day
119
What is the maximum dose of metformin?
850mg td
120
What is the maximum daily dose of metformin in a patient with eGFR 30-50ml/min
1g metformin | Avoid if <30ml/min
121
Common side effects of metformin?
Diarrhoea | Abdominal cramps
122
Why do you avoid metformin in a patient with low eGFR?
Likelihood of lactic acidosis increased in renal + cardiovascular patients
123
What is the mechanism of action of thiazolinediones?
PPARgamma nuclear receptor agonist that increases the transcription of proteins that augment post receptor action of insulin -> increase insulin sensitivity
124
What are the advantages of thiazolinediones?
``` Reduce CV risk Increase HDL Reduce triglycerides Reduce LDL Improve NASH Improve ovulation in PCOS ```
125
What are the adverse effects of thiazolinediones
Fluid retention Weight gain Increased fracture risk
126
Why do you need to be careful with thiazolinediones in women of childbearing age?
"Metformin babies" | PCOS improved -> fertile
127
What is the drug name of Glucobay?
Acarbose
128
What is the retail name of acarbose?
Glucobay
129
What is the mechanism of action of alpha glucosidase inhibitors and give an example of one?
Acarbose Slow starch, sucrose digestion -> delayed absorption Slow post meal rise in glucose
130
Side effects of alpha glucosidase inhibitors?
Flatulence Abdominal discomfort Diarrhoea Hypoglycemia when used w/ other medications
131
Alpha glucosidase inhibitors cause hypoglycemia as monotherapy True or false?
False | Only with other medicines
132
What are contraindications for alpha glucosidase inhibitors?
Intestinal diseases e.g Crohn's | Autonomic neuropathy affecting the GIT
133
When must alpha glucosidase inhibitors be taken to have any effect?
Just before a meal
134
Which is more effective, oral glucose or intravenous glucose, and why?
Oral glucose as beta cells are stimulated by the release of incretins by L cells in the small bowel while IV glucose has a delayed effect
135
The release of which substances due to food in the GIT leads to increased insulin secretion and decreased glucagon secretion?
Glucagon like peptide 1 (GLP1) | Glucose dependent insulinotropic polypeptide (GIP)
136
Which substance breaks down GLP1 and GIP?
Dipeptidylpeptide-4
137
Name GLP1 analogues
Exenatide bd Liraglutide 1/d Albiglutide Lixisenatide
138
What method are GLP1 analogues administered via?
Injectables
139
What method are DPP4 inhibitors administered via?
Oral
140
What is the retail name of exenatide?
Bayetta
141
What is the retail name of liraglutide?
Victoza
142
What is the drug name of Bayetta?
Exenatide
143
What is the drug name of Victoza?
Liraglutide
144
Name DPP4 drugs
Vildagliptin Saxagliptin Stigaliptin Linagliptin
145
What is the drug name of Galvus?
Vildagliptin
146
What are the drugs in Galvusmet?
Vildagliptin + metformin
147
What is the retail name of Vildagliptin?
Galvus
148
What is the retail name of Vildagliptin and metformin?
Galvusmet
149
What is the drug name of Onglyza?
Saxagliptin
150
What is the retail name of Saxagliptin?
Onglyza
151
What is the drug name of Januvia?
Sitagliptin
152
What is the retail name of Sitagliptin?
Januvia
153
What drugs are in Janumet?
Sitagliptin and metformin
154
What is the retail name for sitgaliptin + metformin?
Janumet
155
What is the drug name for Trajenta?
Linagliptin
156
What is the retail name for Linagliptin?
Trajenta
157
Why do GP1 analogues have decreased compliance?
Injectables | Increased complexity
158
What is the mechanism of action of GLP1 analogues?
Improve beta cell responsiveness to increasing glucose levels Decrease glucagon secretion Delayed gastric emptying Decreased appetite w/ reduction in food intake due to central effects Reduce HbA1c by 1%
159
How are GLP1 analogues injected?
Subcutaneously
160
What are the side effects of GLP1 analogues?
``` Nausea Weight loss Diarrhoea Risk of hyplogycemia w/ sulphonylurea Acute pancreatitis ```
161
What are contraindications for GLP1 analogues?
ESKD Renal impairment Pregnancy Severe gastrointestinal disease
162
What is the mechanism of action of DPP4 inhibitors?
Reduce plasma DPP4 activity up to 90% | Lower HbA1c by 0.5-0.8%
163
Name SGLT2 inhibitors
Dapagliflozin Empagliflozin Canagliflozin
164
What is the drug name of Invokana?
Canagliflozin
165
What is the retail name of Canagliflozin?
Invokana
166
What is the drug name of Farxiga?
Dapagliflozin
167
What is the retail name of dapagliflozin?
Farxiga
168
What is the drug name of Jardiance?
Empagliflozin
169
What is the retail name of empagliflozin?
Jardiance
170
What are the advantages of SGLT2 inhibitors?
Reduced in CV death and hospitalisation Only risk for hypoglycemia in combiantion with SUs or insulin Weight loss BP reduction
171
What are the side effects of SGLT2 inhibitors?
``` Mycotic genital infections UTIs Dehydration + hypotension in at risk patients eGFR declines initially -> then recovers Lower limb fractures w/ canagliflozin ```
172
Why do patients on SGLT2 inhibitors have reduced BP?
Water loss via urine
173
Why do patients on SGLT2 inhibitors have weight loss?
Losing all their calories in the urine
174
Which SGLT2 inhibitor has risk for lower limb fractures?
Canagliflozin
175
Which patients are at risk for dehydration and hypotension with SGLT2 inhibitor use?
Cardiac disease Loop diuretics Elderly
176
Why are patients with SGLT2 at increased risk for genital and UTIs?
Bacteria thrive on the glucose being excreted via the urinary tract
177
At what HbA1c do you consider insulin?
HbA1c >7%
178
How often should HbA1c be monitored with a patient on insulin?
3 monthly
179
Insulin combination has increased weight gain versus insulin alone True or false?
False | Less weight gain
180
What are the indications for insulin in DMII?
Persistent hyperglycemia despite oral agents Uncontrolled weight loss Oral agent C/I - Advanced renal disease - Advanced hepatic disease - Allergic reactions to oral agents Intercurrent events (MI, CVA, acute illness, surgery)
181
Why do chronic DMII patients get uncontrolled weight loss at a later stage?
Insulin is an anabolic hormone No insulin = lose mm and fat Patient becomes emaciated
182
Why do we start insulin early?
Beta cell decline is inevitable | Fewer years of poor control
183
What daily insulin dosage do most patients require?
0.5-1.0U/kg daily
184
Obese patients and those leading a sedentary lifestyle generally require less insulin than athletes and patients near their ideal weight True or false?
False | Require more insulin
185
What are the two styles of insulin regimens?
Traditional 1/2 daily | Flexible
186
When is the traditional 1/2 daily injection of insulin appropriate?
Not ideal Initial therapy Patient with poor disease understanding
187
When is the flexible insulin injection therapy appropriate?
Intelligent, motivated patient
188
When is night time insulin used and what should you remember?
Never use as monotherapy Part of daytime sulphonylurea + nightime insulin regime when starting patient on insulin MUST have bedtime snack
189
Twice daily insulin regimen
2 in morning 1 in evening With 2/3 intermediate and 1/3 short acting
190
Flexible insulin regimen
``` Basal bolus - 40% daily dose - NPH/Lente/Glargine - 1-2times daily Meal bolus - 60% in 3 doses - Glulysine/Lispro/Aspart - w/ or <30min before meal ```
191
What is carbohydrate counting in insulin regimen?
Adjust insulin dose according to anticipated grams of carbohydrate 1U Lispro/Aspart per 15g CH Individualised - experiment
192
Name insulin injection sites?
Lateral forearm Lateral thigh Abdominal
193
Practical considerations to overcome fear of starting insulin
``` Get over needle fear Get needle through the skin Start injecting via abdomen Use pen devices Use demonstration solutions ```
194
What does a molecule of insulin consist of?
51 aa arranged in two chains - A chain of 21 aa - B chain of 30aa - linked by 2 disulphide bonds
195
What is regular insulin and give examples
Short acting insulin Actrapid Humulin R
196
Describe the pharmacodynamics of regular insulin
Onset 0.5-1hr Peak 2-4hr Duration 5-8hr Clear solution
197
What is NPH and give examples
Intermediate acting insulin Protophane Humulin N
198
Describe the pharmacodynamics of NPH
Onset 1-2hrs Peak 4-10hrs Duration >14hrs Cloudy solution
199
What is regular NPH mix 30/70 and give examples
Actraphane | Insuman 30/70
200
Describe the pharmacodynamics of regular NPH mix 30/70
Onset 0.5-1h Peak 3-5hr Duration >14hr Cloudy solution
201
Name basal (long acting) insulin analogues
Detemir (Levemir) Glargine (Lantus) Degludec
202
What is the drug name of Levemir?
Detemir
203
What is the trade name of Levemir?
Detemire
204
What is the drug name of Lantus?
Glargine
205
What is the trade name of Glargine?
Lantus
206
Describe the pharmacodynamics of Detemir (Levemir)
Onset 90min | Duration 16-24hr
207
Describe the pharmacodynamics of Glargine (Lantus)
Onset 90min | Duration 24hr
208
Describe the pharmacodynamics of Degludec
Onset 90min | Duratoin >24hr
209
Name bolus (rapid acting) insulin analogues
Asprart (Novorapid) Glulysine (Apidra) Lispro (Humalog)
210
What is the drug name of Novorapid?
Asprart
211
What is the drug name of Apidra?
Glulysine
212
What is the drug name of Humalog?
Lispro
213
What is the trade name of Asprart?
Novorapid
214
What is the trade name of Glulysine?
Apidra
215
What is the trade name of Lispro?
Humalog
216
Describe the pharmacodynamics of Asprart (Novorapid)
Onset 10-15min Peak 1-1.5hr Duration 3-5hr
217
Describe the pharmacodynamics of Glulysine (Apidra)
Onset 10-15min Peak 1-1.5hr Duration 3-5hr
218
Describe the pharmacodynamics of Lispro (Humalog)
Onset 10-15min Peak 1-2hr Duration 3.5-4.75hr
219
Give examples of premixed regular insulin (NPH)
30% regular/70% NPH (Humulin 30/70, Actraphane) 40% regular/60% NPH 50% regular/50% NPH
220
Give examples of premixed insulin analogues
``` NovoMix 30 - 30% aspart/70% aspart protamine Humalog Mix25 - 25% lispro/75% lispro protamine Humalog Mix50 - 50% lispro/50% lispro protamine ```
221
What factors influence the bioavailability of insulin?
``` Site of injection Depth of injection Insulin concentration Insulin dose Insulin mixing Heat application Massage Exercise ```
222
What is the purpose of self-monitoring of blood glucose in type I diabetes and what action can you take?
Monitor insulin management to adjust insulin dose
223
What is the purpose of self-monitoring of blood glucose in type II diabetes?
Monitor insulin management and glycemic control in order to change behaviour or adjust insulin dose
224
What is the purpose of self-monitoring of blood glucose in pattern testing?
Problem identification, education and engagement in order to change behaviour and adjust therapy
225
What is the purpose of self-monitoring of blood glucose in paired testing?
Education and engagement in order to change behaviour and adjust therapy
226
What is the purpose of self-monitoring of blood glucose in titration testing?
Therapy management for therapy adjustment
227
What is day profile pattern testing?
Patient tests 7 times per day over 3 days and records results on paper-based, easily understood form It is comprehensie and includes BG, meal size and feel good score

MBChB IV Endocrinology (8 decks)

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