Diabetes Pt2 (medications) Flashcards
What are the aims of Pharmacotherapy in diabetes?
- Maintain blood glucose control
- Keep HbA1c below 6.5-70%
- Prevent early mortality
- Decrease symptoms of hyperglycaemia (poly’s)
- Control other comorbidities
- Exercise and diet
What does exogenous insulin aim to achieve?
Mimic endogenous insulin
What are the types of insulin?
Rapid or short acting
Intermediate or long acting
If i was to have a meal in 20 minutes, what would be the most appropriate insulin to take?
Rapid acting insulin
Onset: 1-20 minutes
Peak: 1-2 hours
Duration: 3-5 hours
If i were to have a meal in 40 minutes, what would be the most appropriate insulin to take?
Short-acting insulin
Onset: 30 minutes
Peak: 2-4 hours
Duration: 6-8 hours
If i were to have a meal in 2 hours, what would be the most appropriate insulin to take?
Intermediate acting insulin
Onset: 90 minutes
Peak: 4-12 hours
Duration: 16-24 hours
If i were to have a meal in 4 hours, what would be the most appropriate insulin to take?
Long-acting insulin or just wait until closer time and take short or intermediate
Onset: 90-120 minutes
Peak: not pronounced
Duration: up to 24 hours
What are the combinations of mixed insulin?
Rapid + long
Rapid + intermediate
Short + intermediate
What are the three types of insulin administration
- Syringe
- Pen
- Pump
Where is the best spot to administer insulin?
Abdomen, however it can be done in the buttocks, arm or thigh
Are there any complications from insulin, if so what are they?
Yes, insulin antibodies, lipohypertrophy, lipoatrophy, hypoglycaemia, fluid retention, weight gain
List the most common forms of medication for diabetes, their class, and brief explanation in 1 line
Biguanides: (Met), immediate or long acting, increases uptake of glucose and decrease hepatic glucose
Sulphonylureas: (Gli), long or short, stimulates release of insulin by provoking B-cells
Thiazolidinediones: (glitazones), reduces circulating FFA, helps GLUT4
Alpha Glucosidase inhibitors: (Acarbose), slows down disaccharides to monosaccarides
DPP-4 inhibitors: (liptin), reduces breakdown of incretin hormones, helping insulin
GLP-1 receptor agonists: (tide), incretin mimetics, induces fullness and appetite
SGLT2 inhibitors: (gliflozins), prevents kidneys from reabsoribing glucose in the blood and is flushed out
Where is the best spot to check blood glucose?
On the side of the fingertip
When are some times blood glucose needs to be checked more often?
- Being more active or less active, changes in routine
- Sick or stressed
- Experiencing hypo, hyper
- Night sweats
- Pregnancy
- Surgical procedure
- Post dentist
What are two other forms of blood glucose testing?
Continuous monitoring via a wearable device
Flash glucose monitoring via scanning a sensory
What are blood glucose guidelines for T1DM, T2DM and GDM
T1DM Fasting: 4-6mmol/L Post feed: <10mmol/L T2DM Fasting: 6-8mmol/L Post feed: <10mmol/L GDM Fasting: 4-5.5mmol/L Post feed: <8mmol/L (1h), <7mmol (2h)
True or false, 90% of T2DM can be prevented
True
True or false, 150 minutes of brisk walking a week can reduce chance of getting diabetes by 45-55%
False, 59-69%
What are some benefits of exercise on T2DM?
- Improved insulin sensitivity up to 48 hours
- Improved GLUT4 translocation
- Increase mitochondria density/ efficiency
- Increase fuel oxidation and ATP production
- Improve endothelial function
What does the evidence suggest about aerobic training intensities?
Training between 40-85% VO2max can help blood pressure, and the health benefits, but above 85% may cause hyperglycaemia through catecholamine release
What are some benefits of exercise for T1DM?
- Insulin sensitivity
- Lower HbA1c %
- Blood glucose control
- Decrease comorbidities
When should a graded exercise test be performed?
- > 35 years
- TD2M >10 years
- T1DM >15 years
- Risk factors of CAD
- Microvascular disease
- Autonomic neuropathy
Why is exercise testing harder in diabetic populations?
-Fatigue quicker, lower VO2max, might miss information, decreased workload
Why are ketones bad?
They are made from fat breakdown when their isnt enough insulin to breakdown glucose. This makes the blood more acidic
Using the FITT principle, describe diabetes
Frequency - 3-5 days aerobic, 2 days resistance
Intensity - 40-85% VO2max, 50-70% 1RM
Time: 150 mins (mod) or 60 mins (vig)
Type: low impact exercise, resistance machines, free weights
What is hypoglycaemia?
- BGL <4mmol/L
- Dizziness, faint, headache, hunger, irritability, nervousness, low BP
What is the hypoglycaemia action plan?
Step 1: have 15 grams of fast acting carb
Step 2: wait 15 minutes and re-check BGL, if not changed repeat step 1, if above 4mmol/L have a snack with longer acting carbs, hydration
What is hyperglycaemia?
High blood sugar, usually above 7-8mmol/L
-Fix with insulin
What is Diabetic ketoacidosis?
Ketones in the blood, insulin insufficiency causing excessive lipolysis
What are the most common signs of diabetic ketoacidosis?
Acetone breath, poly’s, tachycardia
What are the three types of retinopathy?
Non-proliferated: least severe, dot blot haemorrhages
Pre-proliferated: retinal ischemia, non-perfusion
Prolifered: angiogensis
What should people with non/proliferated diabetic retinopathy avoid in exercise?
- Valsalva
- Pounding
- Increase in systolic BP over 170mmHg
What is diabetic kidney disease? (diabetic nephropathy)
A progressive increase in urine albumin excretion, accompanied by a rising BP and decline in eGFR
What is Diabetic Neuropathy?
A degenerative peripheral nerve disorder related to diabetes
-Vascular ischemia, direct toxicity from hyperglycaemia, cell damage
What are the four types of diabetic neuropathy?
Chronic distal polyneuropathy
Autonomic neuropathy
Diabetic proximal neuropathy
Multiple mononeuropathies
What are the most common consequences of diabetic neuropathies?
Diabetic foot, ulceration, loss of sensation
What is Charcot neuroarthropathy?
Non infection progression of joint structure leading to subluxations and dislocations
