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Chronic and complex conditions > Diabetes Pt2 (medications) > Flashcards

Diabetes Pt2 (medications) Flashcards

1
Q

What are the aims of Pharmacotherapy in diabetes?

A
  • 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
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2
Q

What does exogenous insulin aim to achieve?

A

Mimic endogenous insulin

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3
Q

What are the types of insulin?

A

Rapid or short acting

Intermediate or long acting

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4
Q

If i was to have a meal in 20 minutes, what would be the most appropriate insulin to take?

A

Rapid acting insulin
Onset: 1-20 minutes
Peak: 1-2 hours
Duration: 3-5 hours

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5
Q

If i were to have a meal in 40 minutes, what would be the most appropriate insulin to take?

A

Short-acting insulin
Onset: 30 minutes
Peak: 2-4 hours
Duration: 6-8 hours

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6
Q

If i were to have a meal in 2 hours, what would be the most appropriate insulin to take?

A

Intermediate acting insulin
Onset: 90 minutes
Peak: 4-12 hours
Duration: 16-24 hours

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7
Q

If i were to have a meal in 4 hours, what would be the most appropriate insulin to take?

A

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

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8
Q

What are the combinations of mixed insulin?

A

Rapid + long
Rapid + intermediate
Short + intermediate

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9
Q

What are the three types of insulin administration

A
  • Syringe
  • Pen
  • Pump
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10
Q

Where is the best spot to administer insulin?

A

Abdomen, however it can be done in the buttocks, arm or thigh

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11
Q

Are there any complications from insulin, if so what are they?

A

Yes, insulin antibodies, lipohypertrophy, lipoatrophy, hypoglycaemia, fluid retention, weight gain

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12
Q

List the most common forms of medication for diabetes, their class, and brief explanation in 1 line

A

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

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13
Q

Where is the best spot to check blood glucose?

A

On the side of the fingertip

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14
Q

When are some times blood glucose needs to be checked more often?

A
  • Being more active or less active, changes in routine
  • Sick or stressed
  • Experiencing hypo, hyper
  • Night sweats
  • Pregnancy
  • Surgical procedure
  • Post dentist
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15
Q

What are two other forms of blood glucose testing?

A

Continuous monitoring via a wearable device

Flash glucose monitoring via scanning a sensory

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16
Q

What are blood glucose guidelines for T1DM, T2DM and GDM

A 
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)
17
Q

True or false, 90% of T2DM can be prevented

A

True

18
Q

True or false, 150 minutes of brisk walking a week can reduce chance of getting diabetes by 45-55%

A

False, 59-69%

19
Q

What are some benefits of exercise on T2DM?

A
  • Improved insulin sensitivity up to 48 hours
  • Improved GLUT4 translocation
  • Increase mitochondria density/ efficiency
  • Increase fuel oxidation and ATP production
  • Improve endothelial function
20
Q

What does the evidence suggest about aerobic training intensities?

A

Training between 40-85% VO2max can help blood pressure, and the health benefits, but above 85% may cause hyperglycaemia through catecholamine release

21
Q

What are some benefits of exercise for T1DM?

A
  • Insulin sensitivity
  • Lower HbA1c %
  • Blood glucose control
  • Decrease comorbidities
22
Q

When should a graded exercise test be performed?

A
  • > 35 years
  • TD2M >10 years
  • T1DM >15 years
  • Risk factors of CAD
  • Microvascular disease
  • Autonomic neuropathy
23
Q

Why is exercise testing harder in diabetic populations?

A

-Fatigue quicker, lower VO2max, might miss information, decreased workload

24
Q

Why are ketones bad?

A

They are made from fat breakdown when their isnt enough insulin to breakdown glucose. This makes the blood more acidic

25
Q

Using the FITT principle, describe diabetes

A

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

26
Q

What is hypoglycaemia?

A
  • BGL <4mmol/L

- Dizziness, faint, headache, hunger, irritability, nervousness, low BP

27
Q

What is the hypoglycaemia action plan?

A

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

28
Q

What is hyperglycaemia?

A

High blood sugar, usually above 7-8mmol/L

-Fix with insulin

29
Q

What is Diabetic ketoacidosis?

A

Ketones in the blood, insulin insufficiency causing excessive lipolysis

30
Q

What are the most common signs of diabetic ketoacidosis?

A

Acetone breath, poly’s, tachycardia

31
Q

What are the three types of retinopathy?

A

Non-proliferated: least severe, dot blot haemorrhages
Pre-proliferated: retinal ischemia, non-perfusion
Prolifered: angiogensis

32
Q

What should people with non/proliferated diabetic retinopathy avoid in exercise?

A
  • Valsalva
  • Pounding
  • Increase in systolic BP over 170mmHg
33
Q

What is diabetic kidney disease? (diabetic nephropathy)

A

A progressive increase in urine albumin excretion, accompanied by a rising BP and decline in eGFR

34
Q

What is Diabetic Neuropathy?

A

A degenerative peripheral nerve disorder related to diabetes

-Vascular ischemia, direct toxicity from hyperglycaemia, cell damage

35
Q

What are the four types of diabetic neuropathy?

A

Chronic distal polyneuropathy
Autonomic neuropathy
Diabetic proximal neuropathy
Multiple mononeuropathies

36
Q

What are the most common consequences of diabetic neuropathies?

A

Diabetic foot, ulceration, loss of sensation

37
Q

What is Charcot neuroarthropathy?

A

Non infection progression of joint structure leading to subluxations and dislocations

Chronic and complex conditions (19 decks)

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