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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
Q

What type of diabetes do patients with trisomy 21 present with?

A

Mature onset diabetes of the young (MODY)

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26
Q

What does MODY stand for?

A

Mature onset diabetes of the young

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27
Q

What is the pathogenesis of diabetes mellitus type II?

A

“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

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28
Q

Early use of combination therapy may be advantageous in DMII

True or false?

A

True

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29
Q

Even if initial response to monotherapy is good in DMII, combination therapy and/or exogenous insulin is frequently required
True or false?

A

True

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30
Q

What trend does glycaemic control typically show in DMII?

A

Gradual deterioration

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31
Q

Genetics of DMII

A

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

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32
Q

Name the abnormalities seen in insulin resistance syndrome

A 
Hyperinsulinemia
Impaired glucose tolerance
Hypertension
Incr plasma triglycerides
Decreased HDL
Truncal obesity
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33
Q

Give other names for insulin resistance syndrome

A

Syndrome X
Reaven’s syndrome
Metabolic syndrome

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34
Q

What risk for insulin resistance syndrome indicate?

A

DMII

Atherosclerotic disease

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35
Q

The risk of DMII in a patient with acanthosis nigricans increases with the presence of what other abnormality?

A

Skin tags

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36
Q

What are acanthosis nigricans a sign of?

A

Insulin dependence

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37
Q

Why is obesity strongly assoc with diabetes mellitus type II?

A

Leads to a deficiency in post-receptors

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38
Q

Name causes of increased insulin resistance

A 
Obesity
Sedentary lifestyle
Aging
Genetics
Glucotoxicity
Increased FFA levels
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39
Q

Name causes of decreased beta cell function

A

Genetics
Glucotoxicity
Increased FFA levels

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40
Q

Which laboratory tests are performed to assess glycemic control?

A

HbA1c (preferred)
RPG
Fructosamine

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41
Q

Indications for OGTT

A

Diagnosis when equivocal blood glucose values
Diagnosis during pregnancy
Epidemiological setting

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42
Q

Precautions for OGTT

A

Preceding 3 days of unrestricted diet and usual exercise
Overnight fast 8-14hr
NO smoking

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43
Q

Which tube should you collect an OGTT sample in if the test won’t be performed immediately?

A

Sodium fluoride

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44
Q

Indications for RPG

A

Self monitoring of blood glucose (SMBG)

Clinics

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45
Q

Indications for urine test

A

Replaced by SMBG
Acutely ill patients
Patient w/ blood glucose consistently > 16.7mmol/l

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46
Q

Which factors influence HbA1Cc?

A 
Erythropoesis
Altered haemoglobin
Glycation
Erythrocyte destruction
Assays
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47
Q

Give examples where erythropoesis increases HbA1c?

A

Iron deficiency
Vitamin B12 deficiency
Decreased erythropoeisis

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48
Q

Give examples where erythropoesis decreases HbA1c?

A 
Administration of iron
Administration of B12
Administration of erythropoeitin
Reticulocytosis
Chronic liver disease
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49
Q

Give examples of genetic/chemical alterations in haemoglobin

A

Haemoglobinopathies
HbF
Methaemoglobin

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50
Q

Give examples where glycation increases HbA1c?

A

Alcoholism
Chronic renal failure
Decreased intraerythrocyte pH

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51
Q

Give examples where glycation decreases HbA1c?

A 
Aspirin
Vitamin C
Vitamin E
Certain haemoglobinopathies
Increased intraerythrocyte pH
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52
Q

Give examples where glycation results in variable HbA1c?

A

Genetic determinants

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53
Q

Give examples where erythrocyte destruction increases HbA1c?

A

Increased erythrocyte life span

Splenectomy

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54
Q

Give examples where erythrocyte destruction decreases HbA1c?

A 
Decreased erythrocyte life span
Haemoglobinopathies
Splenomegaly
Rheumatoid arthritis
ARVs
Ribavirin
Dapsone
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55
Q

Give examples of assays that are associated with increased HbA1c?

A 
Hyperbilirubinaemia
Carbamylated haemoglobin
Alcoholism
Aspirin in large doses
Chronic opiate use
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56
Q

Give examples of assays that are associated with decreased HbA1c?

A

Hypertriglyceridaemia

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57
Q

Give examples of assays that are associated with variable HbA1c?

A

Haemoglobinopathies

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58
Q

HbA1c gives indications of fine hour to hour control

True or false?

A

False

Only shows average glucose control

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59
Q

Interpreting HbA1c to assess glycaemic control

A 
<7% = good control
7-10% = fair control
13-17% = poor control
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60
Q

HbA1c and the assoc with complications

A

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

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61
Q

Repeating the HbA1c test

A

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

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62
Q

A 1% change of HbA1c correlates with what change in average blood glucose?

A

1.6mmol/l

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63
Q

Which test is the best to perform and repeat?

A

OGTT

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64
Q

What factor do HbA1c targets have an effect on?

A 
Risk of hypoglycemia
Risk of drug interactions
Disease duration
Life expectancy
Major comorbidities
Established MV disease
Patient attitude
Resources and support
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65
Q

Target HbA1c, FPG and PPG?

A

4.0-7.0mmol/l FPG
<6.5% HbA1c <8mmol/l PPG
<7% HbA1c <10mmol/l
<8% HbA1c <12mmol/l

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66
Q

Combining drugs in diabetic pharmacological treatment is usually less effective than stopping one agent and introducing another
True or false?

A

False

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67
Q

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?

A

True

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68
Q

Secondary failure of 2 drug combinations is a negative outcome in diabetic management

A

False

Should be expected eventually as it is a progressive disease

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69
Q

When does pharmacological diabetic treatment call for the use of insulin?

A

Failure of 2/3 oral combinations

- use insulin alone or in combination w/ oral agents

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70
Q

When is insulin started in a patient with severe hyperglycaemia?

A

From the beginning until glucotoxicity resolves -> reduce/withdraw

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71
Q

What factors should you consider when choosing oral glucose drugs?

A 
Glycaemic targets
Glycaemic efficacy
Hypoglycaemic risk
Weight gain
Adverse effects
Treatment complexity
Patient factors
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72
Q

Alpha glycosidase inhibitors are best for which patients? How much does it reduce the HbA1c?

A

High postprandial glucose

0.5-1%

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73
Q

Metformin (buiganide) is best for which patients? How much does it reduce the HbA1c?

A

Obese patients

1-2%

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74
Q

Meglinitides are best for which patients? How much does it reduce the HbA1c?

A

High postprandial glucose

1-2%

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75
Q

Sulphonylureas are best for which patients? How much does it reduce the HbA1c?

A

Recently diagnosed DMII

1-2%

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76
Q

Thiazolinediones are best for which patients? How much does it reduce the HbA1c?

A

Obese/insulin resistant patients

0.8-1.0%

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77
Q

DPP4 inhibitors are best for which patients? How much does it reduce the HbA1c?

A

Add on therapy

0.7%

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78
Q

GLP1 receptor agonists are best for which patients? How much does it reduce the HbA1c?

A

Add on therapy

0.8-1.2%

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79
Q

SGLT2 inhibitors are best for which patients? How much does it reduce the HbA1c?

A

Add on therapy

0.8-1.2%

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80
Q

Which pharmacological drug is the best option for a patient with high postprandial glucose?

A

Alpha glycosidase inhibitors

Meglinitides

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81
Q

Which pharmacological drug is the best option for a patient with obesity?

A

Metformin

Thiazolinediones (+insulin resistance)

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82
Q

Which pharmacological drug is the best option for a patient with recently diagnosed DMII?

A

Sulphonylureas

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83
Q

What is the treatment strategy for DM according the the EDL?

A

Metformin -> metformin + sulphonylurea -> metformin + sulphonylurea + basal insulin -> metformin + intensified insulin

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84
Q

Why do you stop the sulphonylurea in the 3rd step of the EDL management of diabetes?

A

Works on beta cells and no longer effective “flogging a dead horse”

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85
Q

Why do you start metformin at a low dose and go slow?

A

GIT side effects affects patient compliance

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86
Q

Why do we no longer use the sulphonylurea benclamide and what is its better alternative?

A

Prolonged hypoglycemia

Glimperide instead

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87
Q

Why do they consider the extended release tablet of metformin in private?

A

Less side effects

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88
Q

Which DM treatment strategy caters for private sector?

A

SEMDSA 2017 strategy

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89
Q

Which drugs are insulin secretagogues and what is their mechanism of action?

A

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

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90
Q

What are the 8 classes of available DM drugs?

A 
Sulphonylureas
Meglitinides
Biguanides
Thiazolinediones
Alpha glucosidase inhibitors
GL1 analogues
DPP4 inhibitors
SGLT2 inhibitors
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91
Q

What is Diamicron?

A

Extended release Gliclazide

92
Q

Which sulphonylureas are available?

A

Glipizide (Minidiab)
Gliclazide (Diamicron)
Glimperide (Amaryl)
Glibenclamide (Daonil)

93
Q

We still use Daonil sulphnylurea in practice

True or false?

A

False

94
Q

What is the drug name of Minidiab?

A

Glipizide

95
Q

What is the drug name of Diamicron?

A

Gliclazide

96
Q

What is the drug name of Amaryl?

A

Glimperide

97
Q

What is the drug name of Daonil?

A

Glibenclamide

98
Q

What is the retail name of Glipizide?

A

Minidiab

99
Q

What is the retail name of Gliclazide?

A

Diamicron

100
Q

What is the retail name of Glimperide?

A

Amaryl

101
Q

What is the retail name of Gibenclamide?

A

Daonil

102
Q

Which meglitinides are available?

A

Repaglinide

Nataglinide

103
Q

What is the drug name of Novonorm?

A

Repaglinide

104
Q

What is the drug name of Starlix?

A

Nataglinide

105
Q

What is the retail name of Repaglinide?

A

Novonorm

106
Q

What is the retail name of Nataglinide?

A

Starlix

107
Q

What are important competitive inhibitors of sulphonylurea metabolism and what does this entail?

A

Alcohol
H2 blockers
Less metabolism -> longer duration -> more side effects

108
Q

What is the most important side effect of sulphonylurea use?

A

Hypoglycemia

109
Q

Pancreatic vs cardiac SUR argument

A

Gliclazide only acts on the pancreatic SUR while the other sulphonylureas work on cardiac SUR -> theorised to increase infart size

110
Q

What is the benefit of meglitinides in relation to cardiovascular mortality?

A

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
Q

Which studies assessed the benefit of meglitinides in relation to cardiovascular mortality?

A

Honolulu heart study
Chicago study
DECODE study
DIAS study

112
Q

Which drugs are insulin sensitizing agents?

A

Biguanides (metformin)

Thiazolinediones (pioglitazone)

113
Q

What is the mechanism of action of biguanides?

A 
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
Q

What are the advantages of biguanides?

A 
Weight loss (mild anorexic effect)
No hypoglycemia
Decrease in thombotic risk
Beneficial effect on lipid profile
Safe in pregnancy
115
Q

Why did people write off metformin at a stage?

A

Fenformin, a biguanide, was linked to causing lactic acidotic death

116
Q

How does metformin decrease thrombotic risk?

A

Decreased platelet aggregation

Decreased PAI-1 levels

117
Q

How does metformin affect the lipid profile?

A

Incr HDL
Decr LDL
Decr triglycerides

118
Q

What is the starting dose of metformin?

A

500mg/day

119
Q

What is the maximum dose of metformin?

A

850mg td

120
Q

What is the maximum daily dose of metformin in a patient with eGFR 30-50ml/min

A

1g metformin

Avoid if <30ml/min

121
Q

Common side effects of metformin?

A

Diarrhoea

Abdominal cramps

122
Q

Why do you avoid metformin in a patient with low eGFR?

A

Likelihood of lactic acidosis increased in renal + cardiovascular patients

123
Q

What is the mechanism of action of thiazolinediones?

A

PPARgamma nuclear receptor agonist that increases the transcription of proteins that augment post receptor action of insulin -> increase insulin sensitivity

124
Q

What are the advantages of thiazolinediones?

A 
Reduce CV risk
Increase HDL
Reduce triglycerides
Reduce LDL
Improve NASH
Improve ovulation in PCOS
125
Q

What are the adverse effects of thiazolinediones

A

Fluid retention
Weight gain
Increased fracture risk

126
Q

Why do you need to be careful with thiazolinediones in women of childbearing age?

A

“Metformin babies”

PCOS improved -> fertile

127
Q

What is the drug name of Glucobay?

A

Acarbose

128
Q

What is the retail name of acarbose?

A

Glucobay

129
Q

What is the mechanism of action of alpha glucosidase inhibitors and give an example of one?

A

Acarbose
Slow starch, sucrose digestion -> delayed absorption
Slow post meal rise in glucose

130
Q

Side effects of alpha glucosidase inhibitors?

A

Flatulence
Abdominal discomfort
Diarrhoea
Hypoglycemia when used w/ other medications

131
Q

Alpha glucosidase inhibitors cause hypoglycemia as monotherapy
True or false?

A

False

Only with other medicines

132
Q

What are contraindications for alpha glucosidase inhibitors?

A

Intestinal diseases e.g Crohn’s

Autonomic neuropathy affecting the GIT

133
Q

When must alpha glucosidase inhibitors be taken to have any effect?

A

Just before a meal

134
Q

Which is more effective, oral glucose or intravenous glucose, and why?

A

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
Q

The release of which substances due to food in the GIT leads to increased insulin secretion and decreased glucagon secretion?

A

Glucagon like peptide 1 (GLP1)

Glucose dependent insulinotropic polypeptide (GIP)

136
Q

Which substance breaks down GLP1 and GIP?

A

Dipeptidylpeptide-4

137
Q

Name GLP1 analogues

A

Exenatide bd
Liraglutide 1/d
Albiglutide
Lixisenatide

138
Q

What method are GLP1 analogues administered via?

A

Injectables

139
Q

What method are DPP4 inhibitors administered via?

A

Oral

140
Q

What is the retail name of exenatide?

A

Bayetta

141
Q

What is the retail name of liraglutide?

A

Victoza

142
Q

What is the drug name of Bayetta?

A

Exenatide

143
Q

What is the drug name of Victoza?

A

Liraglutide

144
Q

Name DPP4 drugs

A

Vildagliptin
Saxagliptin
Stigaliptin
Linagliptin

145
Q

What is the drug name of Galvus?

A

Vildagliptin

146
Q

What are the drugs in Galvusmet?

A

Vildagliptin + metformin

147
Q

What is the retail name of Vildagliptin?

A

Galvus

148
Q

What is the retail name of Vildagliptin and metformin?

A

Galvusmet

149
Q

What is the drug name of Onglyza?

A

Saxagliptin

150
Q

What is the retail name of Saxagliptin?

A

Onglyza

151
Q

What is the drug name of Januvia?

A

Sitagliptin

152
Q

What is the retail name of Sitagliptin?

A

Januvia

153
Q

What drugs are in Janumet?

A

Sitagliptin and metformin

154
Q

What is the retail name for sitgaliptin + metformin?

A

Janumet

155
Q

What is the drug name for Trajenta?

A

Linagliptin

156
Q

What is the retail name for Linagliptin?

A

Trajenta

157
Q

Why do GP1 analogues have decreased compliance?

A

Injectables

Increased complexity

158
Q

What is the mechanism of action of GLP1 analogues?

A

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
Q

How are GLP1 analogues injected?

A

Subcutaneously

160
Q

What are the side effects of GLP1 analogues?

A 
Nausea
Weight loss
Diarrhoea
Risk of hyplogycemia w/ sulphonylurea
Acute pancreatitis
161
Q

What are contraindications for GLP1 analogues?

A

ESKD
Renal impairment
Pregnancy
Severe gastrointestinal disease

162
Q

What is the mechanism of action of DPP4 inhibitors?

A

Reduce plasma DPP4 activity up to 90%

Lower HbA1c by 0.5-0.8%

163
Q

Name SGLT2 inhibitors

A

Dapagliflozin
Empagliflozin
Canagliflozin

164
Q

What is the drug name of Invokana?

A

Canagliflozin

165
Q

What is the retail name of Canagliflozin?

A

Invokana

166
Q

What is the drug name of Farxiga?

A

Dapagliflozin

167
Q

What is the retail name of dapagliflozin?

A

Farxiga

168
Q

What is the drug name of Jardiance?

A

Empagliflozin

169
Q

What is the retail name of empagliflozin?

A

Jardiance

170
Q

What are the advantages of SGLT2 inhibitors?

A

Reduced in CV death and hospitalisation
Only risk for hypoglycemia in combiantion with SUs or insulin
Weight loss
BP reduction

171
Q

What are the side effects of SGLT2 inhibitors?

A 
Mycotic genital infections
UTIs
Dehydration + hypotension in at risk patients
eGFR declines initially -> then recovers
Lower limb fractures w/ canagliflozin
172
Q

Why do patients on SGLT2 inhibitors have reduced BP?

A

Water loss via urine

173
Q

Why do patients on SGLT2 inhibitors have weight loss?

A

Losing all their calories in the urine

174
Q

Which SGLT2 inhibitor has risk for lower limb fractures?

A

Canagliflozin

175
Q

Which patients are at risk for dehydration and hypotension with SGLT2 inhibitor use?

A

Cardiac disease
Loop diuretics
Elderly

176
Q

Why are patients with SGLT2 at increased risk for genital and UTIs?

A

Bacteria thrive on the glucose being excreted via the urinary tract

177
Q

At what HbA1c do you consider insulin?

A

HbA1c >7%

178
Q

How often should HbA1c be monitored with a patient on insulin?

A

3 monthly

179
Q

Insulin combination has increased weight gain versus insulin alone
True or false?

A

False

Less weight gain

180
Q

What are the indications for insulin in DMII?

A

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
Q

Why do chronic DMII patients get uncontrolled weight loss at a later stage?

A

Insulin is an anabolic hormone
No insulin = lose mm and fat
Patient becomes emaciated

182
Q

Why do we start insulin early?

A

Beta cell decline is inevitable

Fewer years of poor control

183
Q

What daily insulin dosage do most patients require?

A

0.5-1.0U/kg daily

184
Q

Obese patients and those leading a sedentary lifestyle generally require less insulin than athletes and patients near their ideal weight
True or false?

A

False

Require more insulin

185
Q

What are the two styles of insulin regimens?

A

Traditional 1/2 daily

Flexible

186
Q

When is the traditional 1/2 daily injection of insulin appropriate?

A

Not ideal
Initial therapy
Patient with poor disease understanding

187
Q

When is the flexible insulin injection therapy appropriate?

A

Intelligent, motivated patient

188
Q

When is night time insulin used and what should you remember?

A

Never use as monotherapy
Part of daytime sulphonylurea + nightime insulin regime when starting patient on insulin
MUST have bedtime snack

189
Q

Twice daily insulin regimen

A

2 in morning
1 in evening
With 2/3 intermediate and 1/3 short acting

190
Q

Flexible insulin regimen

A 
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
Q

What is carbohydrate counting in insulin regimen?

A

Adjust insulin dose according to anticipated grams of carbohydrate
1U Lispro/Aspart per 15g CH
Individualised - experiment

192
Q

Name insulin injection sites?

A

Lateral forearm
Lateral thigh
Abdominal

193
Q

Practical considerations to overcome fear of starting insulin

A 
Get over needle fear
Get needle through the skin
Start injecting via abdomen
Use pen devices
Use demonstration solutions
194
Q

What does a molecule of insulin consist of?

A

51 aa arranged in two chains

  • A chain of 21 aa
  • B chain of 30aa
  • linked by 2 disulphide bonds
195
Q

What is regular insulin and give examples

A

Short acting insulin
Actrapid
Humulin R

196
Q

Describe the pharmacodynamics of regular insulin

A

Onset 0.5-1hr
Peak 2-4hr
Duration 5-8hr
Clear solution

197
Q

What is NPH and give examples

A

Intermediate acting insulin
Protophane
Humulin N

198
Q

Describe the pharmacodynamics of NPH

A

Onset 1-2hrs
Peak 4-10hrs
Duration >14hrs
Cloudy solution

199
Q

What is regular NPH mix 30/70 and give examples

A

Actraphane

Insuman 30/70

200
Q

Describe the pharmacodynamics of regular NPH mix 30/70

A

Onset 0.5-1h
Peak 3-5hr
Duration >14hr
Cloudy solution

201
Q

Name basal (long acting) insulin analogues

A

Detemir (Levemir)
Glargine (Lantus)
Degludec

202
Q

What is the drug name of Levemir?

A

Detemir

203
Q

What is the trade name of Levemir?

A

Detemire

204
Q

What is the drug name of Lantus?

A

Glargine

205
Q

What is the trade name of Glargine?

A

Lantus

206
Q

Describe the pharmacodynamics of Detemir (Levemir)

A

Onset 90min

Duration 16-24hr

207
Q

Describe the pharmacodynamics of Glargine (Lantus)

A

Onset 90min

Duration 24hr

208
Q

Describe the pharmacodynamics of Degludec

A

Onset 90min

Duratoin >24hr

209
Q

Name bolus (rapid acting) insulin analogues

A

Asprart (Novorapid)
Glulysine (Apidra)
Lispro (Humalog)

210
Q

What is the drug name of Novorapid?

A

Asprart

211
Q

What is the drug name of Apidra?

A

Glulysine

212
Q

What is the drug name of Humalog?

A

Lispro

213
Q

What is the trade name of Asprart?

A

Novorapid

214
Q

What is the trade name of Glulysine?

A

Apidra

215
Q

What is the trade name of Lispro?

A

Humalog

216
Q

Describe the pharmacodynamics of Asprart (Novorapid)

A

Onset 10-15min
Peak 1-1.5hr
Duration 3-5hr

217
Q

Describe the pharmacodynamics of Glulysine (Apidra)

A

Onset 10-15min
Peak 1-1.5hr
Duration 3-5hr

218
Q

Describe the pharmacodynamics of Lispro (Humalog)

A

Onset 10-15min
Peak 1-2hr
Duration 3.5-4.75hr

219
Q

Give examples of premixed regular insulin (NPH)

A

30% regular/70% NPH (Humulin 30/70, Actraphane)
40% regular/60% NPH
50% regular/50% NPH

220
Q

Give examples of premixed insulin analogues

A 
NovoMix 30
- 30% aspart/70% aspart protamine
Humalog Mix25
- 25% lispro/75% lispro protamine
Humalog Mix50
- 50% lispro/50% lispro protamine
221
Q

What factors influence the bioavailability of insulin?

A 
Site of injection
Depth of injection
Insulin concentration
Insulin dose
Insulin mixing
Heat application
Massage
Exercise
222
Q

What is the purpose of self-monitoring of blood glucose in type I diabetes and what action can you take?

A

Monitor insulin management to adjust insulin dose

223
Q

What is the purpose of self-monitoring of blood glucose in type II diabetes?

A

Monitor insulin management and glycemic control in order to change behaviour or adjust insulin dose

224
Q

What is the purpose of self-monitoring of blood glucose in pattern testing?

A

Problem identification, education and engagement in order to change behaviour and adjust therapy

225
Q

What is the purpose of self-monitoring of blood glucose in paired testing?

A

Education and engagement in order to change behaviour and adjust therapy

226
Q

What is the purpose of self-monitoring of blood glucose in titration testing?

A

Therapy management for therapy adjustment

227
Q

What is day profile pattern testing?

A

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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