Diabetes Pharmacological treatment Flashcards
which elements are present on the physical activity checklist to manage diabetes?
- minimum of 150min of moderate-to-vigorous intensity aerobic exercise per week (brisk walk)
- resistance exercise (strength training) > 2x/week (arms, chest, back, legs, abdomen)
- PA goals and involve multidisciplinary team
- minimize uninterrupted sedentary time
on which evidence does the PA checklist base itself?
- delay progression of disease itself and complication
- help in glycemic control and reducing medication for insulin resistance
why is a multidisciplinary team required when engaging in PA
when you start a new program of PA/exercise the whole treatment of diabetes will be affected -> medication and diet changes
which conditions must be assess before prescribing an exercise regimen
- neuropathy
- retinopathy
- coronary artery disease
- peripheral arterial disease
what are the ABCDES^3 of diabetes care and their targets
- A1c: optimal glycemic control (usually <7%)
- BP: optimal blood pressure control (<130/80)
- Cholesterol: LDL <2.0mmol/L or >50% reduction
- Drugs to protect the HEART
- Exercise/Healthy Eating
- Screening for complications
- Smoking cessation
- Self-management, stress and other barriers
which are the 2 insulin therapies for type 1 diabetes
- Basal [once a day] and bolus [at meals times] injection therapy
- continuous subcutaneous insulin infusion (insulin pump therapy)
why is insulin secretion so rapid?
when beta cells produce insulin, insulin is stored in vesicles which are ready to be released when there’s an increase in blood glucose
why is the blood glucose response at breakfast higher than at other meals?
during the overnight fasting period there are enzymatic reactions occurring promoting glucose anabolism (gluconeogenesis/glycogenolysis) which have to be stoped due to incoming glucose -> this switch takes time
what does basal insulin injection cover
the minimal amount on insulin circulating in blood - 50pm
used for overnight fasting period and in between meals
what are analogue types of insulin
human insulin produced by bacteria.
they are just formulated differently so that the release will be slower and cover only basal needs for basal injection or they can react faster with a higher peak and be removed from circulation more rapidly which reduces risks of hypo and hyperglycemia
what is the more conventional type of regiment for treating T1D compared to the intense regimen?
only 2 injections per day (vs. minimum of 3)
consistes of a premix which consists of rapid acting and intermediary acting insulin
NO BASAL
advantages and disadvantages of conventional type of regimen
advantage: doesn’t require education, good for someone who does not want to count their CHO or does not like to inject themselves
However, this is a last resort regimen because there is a risk of hyperglycemia at lunch time and hypoglycaemia after breakfast and dinner
=> more chronic hyperglycemia although controlled
+ FIXED insulin plan: it requires a strict meal plan in regards to CHO content, no skipping meals, as meal revolves around the insulin injection + physical activity could lea dot hypoglycemia
characteristics of Bolus types of insulin
- rapid acting has a short onset, peaks sooner, and lasts for a shorter amount of time
- short acting has a delayed onset, peaks later, but lasts for a longer time
characteristics of Basal types of insulin
- intermediate acting has a delayed onset with a peak much later ans lasts for 3/4 day
- long acting has a faster onset, no peak is observed and can last up to 24h => covers basal needs
both require only one injection per day
intensive insulin regimen is recommended for ____
better glycemic control
advantages of intensive insulin therapy
- more flexibility in timing and content of meals: insulin is adjusted according to CHO intake [must learn carb counting]
- insulin dose may be adjusted to exercise
- delays onset and slows progression of complications
what was observed during the follow-up of patients who underwent conventional vs intensive therapy
A1c levels maintained very high for conventional regimen (9%) where as goal is around 7% which was achieved by intensive therapy
+ there was a decrease in retinopathy, nephropathy, and neuropathy for those who followed intensive regimen+ significant reduction in MI, stroke, or CV death
insulin injection is done intravenously. True or false
FALSE, it is a subcutaneous injection: in the belly or button or leg by doing a simple pinch
what are the drugs called for management of type 2 diabetes?
antihyperglycemic agents
