Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Life Maintenance > Diabetes Treatment > Flashcards

Diabetes Treatment Flashcards

1
Q

What are the different types of DM?

A 
T1DM (beta cell destruction)
T2DM (insulin resistance, beta cell dysfunction) 
Gestational DM
T3c DM (pancreatic insufficiency)
Steroid induced Diabetes
MODY
NDM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is DM diagnosed in the PRESENCE of Sx?

A 
Random plasma glucose < 11mol/L 
OR
Fasting blood glucose > 7mmol/L
OR
2hr plasma glucose >11mmol/L, 2hr after 75g OGTT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What Sx usually present for DM?

A

polyuria
polydipsia
weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is DM diagnosed in the ABSENCE of Sx?

A

Dx should NOT be based on one sample

2 samples on separate dates, of either: fasting, random, 2hr post-load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which Dx criteria are often used for DM?

A

ADA 1997 diagnostic criteria

table that can be referred to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In the insulin deficient state, what metabolic compounds change?

A
  • increased glucose
  • increased FFAs (used as energy)
  • increased lipase
  • increased acetoacetic acid, cholesterol and TGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the aim of insulin therapy?

A
  • aim to normalise BMs
  • prevent DM complications
  • restore normal QoL

CAVEAT: can lead to hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the relationship between hypoglycaemia and retinopathy risk? What does this mean?

A

inverse:
lower the risk of (severe) hypoglycaemia, the higher the risk of retinopathy

means that good glycemic control is NEEDED to minimise risk of retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are exogenous insulin doses given to mimic endogenous secretion?

A

Basal level maintained with bolus (low, steady release of active insulin)

pre-prandial doses given, that are short-lived and rapidly acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the normal endogenous insulin signalling patterns?

A

Biphasic insulin secretion

Two key elements:

  1. short-lived, rapidly generated peaks post-prandially
  2. Low/basal level of insulin to control glucose between meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the short acting type of Insulin?

A

Actrapid

Humulin S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different types of human insulin preparations?

A
  • short acting
  • rapid acting analogue
  • medium and long acting insulin
  • mixed insulins- long acting analogue mixture
  • analogue mixture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of rapid-acting insulin in the UK?

A
  • Novorapid (takes effect 10-20 mins after injection)
  • Humalog (15-30’)
  • Apidra (10-20’)

New Gen.
Fiasp. (~5’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of basal insulins?

A
  • Type 1 (Lantus, Levemir, Trojeo)
  • Type 2 (intermediate acting (Humulin I, Insulatard)
  • Gestational DM (intermediate acting, Humulin I)
  • New generation (Degludec, Toujeo)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 types of BD pre-mixed insulin regimes?

A
  • once-daily basal insulin
  • twice-daily mix-insulin
  • basal-bolus therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main types of error when administering insulin?

A
  • prescribing errors
  • delivery errors (of insulin in syringe to patient)
  • dispensing error
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the devices used for insulin delivery?

A
  • insulin syringes
  • cartridges for infusion pens
  • pre-filled insulin pens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the side effects of using the same site for injection of SC insulin?

A

lipohypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the acute metabolic complication of insulin deficiency (T1DM)

A

DKA

  • hyperglycaemia
  • osmotic diuresis
  • dehydration
  • circulatory collapse

Caused by ketosis resulting in ketone body release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the ‘sick day rules’ for DM Mx?

A
  • never stop insulin and check for ketones
  • measure MBs 4x a day
  • if BM < 11mol/L continues normal insulin
    If BM 11-17 mol/L, add extra 4 units with meal
  • if BM >17mmol/L add extra 6 units with meals
  • if nausea and vomiting and BM > 17mmol/L, call Dr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the benefits of using a intradermal continuous BM sensor?

A
  • portable
  • continuous monitoring
  • Dr can monitor and discuss results with patients
22
Q

What are common causes of hypoglycaemia?

A
  • missed/delayed meals
  • OD or mis-timed insulin or SU
  • weight loss or frailty
  • increased physical activity
  • poor injection technique
  • renal/hepatic impairment
  • heat, EtOH, resolving infection
23
Q

What are the autonomic signs of hypoglycaemia?

A
  • hunger
  • confusion
  • sweating
  • shaking
  • dizziness
  • tachycardia

Caused by adrenaline and GcG release

24
Q

What are the neuroglycopaenic signs of hypoglycaemia?

A
  • confusion
  • drowsiness
  • reduced coordination
  • slurred speech
  • atypical behaviour
  • SEVERE: low GCS, coma, convulsions
25
Q

When does impaired cerebral function usually present for hypo?

A

[glucose] < 3.5mmol/L

26
Q

What is the immediate Rx for hypo?

A
  • 15-20g glucose
  • recheck BM 10-15’ later
  • if BM < 4mmol/L, give glucose again
  • recheck BM and document
  • give slow acting carbs.
  • analyse cause of hypo and r/v Rx
  • Refer to DM specialist nurse
27
Q

How do insulin pumps work?

A

Canule is inserted subcutaneously to deliver insulin

Insulin pump is connected to cannula via flexible tubing delivers insulin from pump to the infusion site

Continuous monitoring of capillary blood BM

28
Q

What is the step-wise management for T2DM?

A
  • diet and exercise
  • oral monotherapy
  • oral combination
  • insulin ± oral agents
29
Q

What happens hen there is failure of oral therapy for T2DM management?

A

will have to start on exogenous insulin

30
Q

What are the hypoglycaemic agents used in T2DM Mx?

A
  • Metformin (biguanides)
  • sulphonylureas
  • glitazones
  • alpha-glucosidase inhibitors (e.g. acarbose)
  • GLP1- analogues (subcut)
  • DPPIV inhibitors
  • SGLT2 inhibitos
  • exogenous insulin
31
Q

What is the mechanism of action for metformin?

A

(MULTIFACTORIAL)

  • reduced hepatic gluconeogenesis
  • reduced fatty acid oxidation
  • increased kinase activity of INS receptor
  • Increased translocation of GLUT-4 transporter
  • increased glycogenesis
32
Q

What is the mechanism of action for sulphonylureas?

A
  • stimulates GSIS
  • Potent (risk of hypo)
  • Mediates closure of ATP-dependent K+ channels, promoting Ca2+ influx and GSIS
33
Q

What are some GLP1 analogues/agonists?

A
  • Exenatide
  • Liraglutide
  • Lixisenatide
34
Q

In which physiological test, is the incretin effect most apparent?

A

IVGTT (or IPGTT in murine)
and OGTT
(incretin effect only seen when there is an enteral load of carbohydrate via gut promoting secretion of incretins from small intestine

35
Q

What trend is seen for incretin response in T2DM patients?

A

reduced incretin response

compared to non-DM controls

36
Q

What are the systemic impact of incretin hormones?

A

Beta cell
Enhances GSIS

Alpha cell
Suppresses GCG secretion

Liver
Suppresses hepatic gluconeogenesis

Stomach
Slows rate of gastric emptying

Brain
Promotes satiety and reduces appetite

37
Q

What are Gliptins?

A

= DPP4 inhibitors

  • alogliptin
  • sitagliptin
  • liagliptin
  • saxagliptin
38
Q

What is the mechanism of action of DPP4i?

A

DPP4 usually catalyses breakdown of active GLP-1

by inhibiting this process, half life of GLP-1 (and its actions) are prolonged

39
Q

What are the longer term actions of GLP-1?

A
  • increases insulin biosynthesis

- promotes beta cell differentiation

40
Q

What are e.g. of SGLT2i?

A
  • dapaglifozin
  • canagliflozin
  • empagliflozin
41
Q

What is the mechanism of action for SGLT2i?

A

SGLT2 usually responsible for reabsorbing the majority of glucose in the PCT
By blocking this transporter, a larger proportion of glucose in blood is excreted renally

42
Q

What is the risk associated with SGLT2i for DM Mx?

A

increased risk of UTIs

Because the urine is much more glucose rich - good nutrient pool for bacteria (e.g. E. coli)

Also should consider for routine urine dipsticks

43
Q

Aside from T2DM, what else is metformin used to treat?

A
  • PCOS

- NAFLD

44
Q

What is the mechanism of action of metformin?

A
  • activation of AMPK
  • increases insulin sensitivity
  • reduced hepatic gluconeogenesis
  • reduces GI absorption of carbohydrates
45
Q

What are the adverse effects of metformin?

A
  • GI upsets (nausea, anorexia, diarrhoea)
  • reduced vitamin B12 absorption
  • lactic acidosis (can be with severe liver disease or renal failure)
46
Q

What are the contraindications for metformin use?

A
  • CKD
  • tissue hypoxia can lead to concomitant lactic acidosis e.g. post-MI
  • EtOH abuse
47
Q

What is the mechanism of action of sulphonylureas?

A
  • increasing insulin secretion

- decrease hepatic clearance of insulin

48
Q

What are common side effects of suphonylureas?

A
  • hypoglycaemia

- weight gain

49
Q

What are the rarer adverse effects of sulphonylureas?

A
  • hyponatraemia
  • BM suppression
  • hepatotoxicity
  • peripheral neuropathy
50
Q

What is the mechanism for developing hyponatraemia after taking sulphonylureas?

A

syndrome of inappropriate ADH secretion

Life Maintenance (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions