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Gen Med (Endocrine) > Diabetes - Treatment > Flashcards

Diabetes - Treatment Flashcards

1
Q

What type of insulin (i.e. human or analogue) is most commonly used by type 1 diabetics and why?

A

Analogue, because it has a lower risk of hypoglycaemia

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2
Q

What is an example of a short-acting human insulin?

A

Actrapid

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3
Q

What is an example of a long-acting human insulin?

A

Insulatard

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4
Q

What are 2 examples of short-acting analogue insulins?

A

Novorapid (insulin aspart) and Humalog (insulin lispro)

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5
Q

What are 2 examples of long-acting analogue insulins?

A

Lantus (insulin glargine) and Levemir (insulin determir)

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6
Q

Which has a shorter duration of action- human or analogue insulin?

A

Analogue

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7
Q

Patients with type 1 diabetes should be given an insulin to carbohydrate ratio and should be educated to match their prandial insulin dose to what 3 things?

A

Carbohydrate intake, pre-meal glucose and anticipated exercise

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8
Q

Do fingerprick blood glucose levels taken before meals inform about the long or short acting insulin dose?

A

Long-acting

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9
Q

Do fingerprick blood glucose levels taken after meals inform about the long or short acting insulin dose?

A

Short-acting

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10
Q

Explain what is meant by the basal bolus regimen of giving insulin?

A

A long-acting insulin is given before bed, and short-acting insulin doses are given with each meal

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11
Q

In a bi-daily insulin regimen, what type of insulin is given at the two daily doses?

A

A mixture of short and intermediate acting insulin

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12
Q

How fast acting is isophane insulin?

A

Intermediate-acting

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13
Q

What type of insulin is given in a once daily insulin regimen? When should this dose be given?

A

An intermediate-long acting insulin is given before breakfast

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14
Q

When is a once daily insulin regimen used?

A

In type 2 diabetics, in conjunction with oral hypoglycaemic agents

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15
Q

Explain what is meant by continuous SC insulin infusion?

A

A rapid acting insulin is infused continuously, boluses are given with meals

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16
Q

When is IV insulin used?

A

In acute illness and fasting patients

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17
Q

If a patient is being given IV insulin and their blood glucose is > 12mmol/L, what should be checked?

A

Ketones

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18
Q

What effect does insulin therapy have on weight?

A

Weight gain

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19
Q

What is the name for a lump of fat which accumulates under the skin at the site of many SC injections of insulin? How can this complication be avoided?

A

Lipohypertrophy, this can be avoided by regularly changing the injection site and using new needles daily

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20
Q

What is the major potential risk of insulin treatment?

A

Hypoglycaemia

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21
Q

What gets replaced in a pancreas transplant for type 1 diabetes?

A

Pancreatic islet cells

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22
Q

Which oral hypoglycaemic agent has the following mechanism of action: helps to increase insulin sensitivity and decrease hepatic gluconeogenesis?

A

Metformin

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23
Q

Metformin is the first line pharmacological treatment for type 2 diabetes because it does not cause what two things?

A

Weight gain and hypoglycaemia

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24
Q

What is the most common side effect of metformin?

A

Gastrointestinal upset

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25
Q

Which oral hypoglycaemic agent can cause a metallic taste in the mouth as a side effect?

A

Metformin

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26
Q

Why should metformin be avoided in those with severe liver disease or renal failure?

A

Risk of lactic acidosis

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27
Q

What are the contraindications to the use of metformin?

A

CKD, and periods of time where there is tissue hypoxia (e.g. post-MI)

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28
Q

It is recommended that metformin should be stopped if the creatinine is greater than what, or the eGFR is less than what?

A

Creatinine > 150 / eGFR < 30

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29
Q

Is metformin safe to use during pregnancy and breastfeeding?

A

Yes

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30
Q

When should metformin be taken in relation to food?

A

After food

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31
Q

Gliclazide and glibenclamide are examples of which class of oral hypoglycaemic agents?

A

Sulfonylureas

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32
Q

When may sulfonylureas be used as a first line treatment for type 2 diabetes?

A

In patients who are intolerant of metformin, or those who are significantly underweight

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33
Q

Which oral hypoglycaemic agent has the following mechanism of action: increases pancreatic insulin secretion by binding to an ATP-dependent potassium channel on the cell membrane of pancreatic beta cells?

A

Sulfonylureas

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34
Q

What are the two major adverse effects of sulfonylureas?

A

Hypoglycaemia and weight gain

35
Q

Due to the risk of hypoglycaemia, sulfonylureas should be avoided/given with caution in who?

A

The elderly/frail

36
Q

Sulfonylureas may cause which electrolyte abnormality?

A

Hyponatraemia (secondary to SIADH)

37
Q

Bone marrow suppression, hepatotoxicity and peripheral neuropathy are all relatively rare side effects of which oral hypoglycaemic agent?

A

Sulfonylureas

38
Q

Are sulfonylureas safe to use in pregnancy and breastfeeding?

A

No

39
Q

Exenatide and liraglutide are examples of which class of drug?

A

GLP-1 analogues

40
Q

What effect do GLP-1 analogue drugs have on weight?

A

Weight loss

41
Q

Which oral hypoglycaemic agents cause weight gain?

A

Sulfonylureas and thiazolidinediones

42
Q

Which oral hypoglycaemic agents risk hypoglycaemia?

A

Sulfonylureas and thiazolidinediones

43
Q

Which oral hypoglycaemic agent has the following mechanism of action: agonist to the PPAR-gamma receptor, working by reducing peripheral insulin resistance?

A

Thiazolidinediones

44
Q

Pioglitazone is an example of what class of oral hypoglycaemic agent?

A

Thiazolidinediones

45
Q

What blood test should be monitored regularly in those taking thiazolidinediones?

A

LFTs

46
Q

What is the major contraindication to the use of thiazolidinediones and why?

A

Heart failure - due to the adverse effect of fluid retention

47
Q

How and when should exenatide (a GLP-1 analogue) be given?

A

As SC injection, 60 minutes before the morning and evening meals

48
Q

What is the main advantage of liraglutide over exenatide?

A

It is only given once daily

49
Q

What is the main adverse effect of GLP-1 analogue drugs?

A

Nausea/vomiting (usually resolves by 6-8 weeks)

50
Q

Which class of type 2 diabetes drug comes with an increased risk of developing pancreatitis and pancreatic cancer?

A

GLP-1 analogues

51
Q

Vildagliptin and sitagliptin are examples of which class of oral hypoglycaemic agent?

A

DDP-4 inhibitors (Gliptins)

52
Q

What effect do DDP-4 inhibitors (gliptins) have on weight?

A

Weight neutral

53
Q

Canagliflozin and dapagliflozin are examples of which class of oral hypoglycaemic agent?

A

SGLT-2 inhibitors

54
Q

Which oral hypoglycaemic agent has the following mechanism of action: works in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion?

A

SGLT-2 inhibitors

55
Q

What effect do SGLT-2 inhibitors have on weight?

A

Weight loss

56
Q

What is the major adverse effect of SGLT-2 inhibitors?

A

Urinary and genital infections

57
Q

SGLT-2 inhibitors will be of no use in individuals with an eGFR of less than what?

A

60ml/min

58
Q

How often should HbA1c be monitored in type 1 diabetics?

A

Every 3-6 months

59
Q

How often, and when, should self-monitored testing of blood glucose be done in type 1 diabetics?

A

At least 4 times a day, including before each meal and before bed

60
Q

On average, for type 1 diabetics, what should their blood glucose target be when monitoring it throughout the day?

A

4 - 8mmol/L

61
Q

What is the insulin regimen of choice for all adult type 1 diabetics?

A

Multiple daily injection basal bolus regimen

62
Q

What is the basal insulin regimen of choice for all adult type 1 diabetics?

A

Twice daily Levemir (insulin determir)

63
Q

NICE recommends the addition of what drug in type 1 diabetics with a BMI of 25 or more?

A

Metformin

64
Q

How often should HbA1c be checked in type 2 diabetics?

A

Every 3-6 months until stable, 6 monthly after that

65
Q

Complete the blanks: in type 2 diabetics, you can titrate up metformin and encourage lifestyle changes to aim for an HbA1c of (X), but should only add a second drug if the HbA1c rises to (Y)

A

X = 48mmol/mol, Y = 58mmol/mol

66
Q

What is the HbA1c target for type 2 diabetics on lifestyle, or lifestyle + metformin management?

A

48mmol/mol

67
Q

What is the target HbA1c for type 2 diabetics who are taking any drug that comes with a risk of hypoglycaemia?

A

53mmol/mol

68
Q

What is the first line pharmacological treatment for type 2 diabetes and when should it be offered?

A

Metformin: offer when HbA1c 48mmol/mol+ on lifestyle intervention only

69
Q

A second drug should be added to metformin in type 2 diabetic patients if their HbA1c has risen above what?

A

58mmol/mol

70
Q

What are the 4 options of second line drug class that can be offered to patients as second line therapy in addition to metformin, if HbA1c is 58mmol/mol or more?

A

Sulfonylureas, thiazolidinediones, DDP-4 inhibitors, SGLT-2 inhibitors

71
Q

What are the two treatment options that can be considered for type 2 diabetic patients who are on metformin plus one other oral hypoglycaemic agent yet still have an HbA1c of 58mmol/mol or more?

A

Add one more drug (triple therapy) or start insulin

72
Q

In those type 2 diabetic patients who can tolerate metformin, if triple therapy is not effective, not tolerated or contraindicated for any reason AND the patient has a BMI of > 35, a combination of what three drugs can be tried?

A

Metformin, sulfonylurea and GLP-1 analogue

73
Q

What targets must be met for treatment with a GLP-1 analogue to be continued in type 2 diabetic patients?

A

Reduction in HbA1c of 11mmol/mol and weight loss of at least 3%, both in 6 months

74
Q

In those type 2 diabetic patients who cannot tolerate metformin, if the HbA1c rises to 48mmol/mol on lifestyle interventions alone, one of what 3 drug classes can be considered as first line treatment?

A

Sulfonylurea, thiazolidinedione, DDP-4 inhibitor

75
Q

In those type 2 diabetic patients who cannot tolerate metformin, if one drug is started but the HbA1c remains at 58mmol/mol or more, what should be done?

A

Combine two drugs (sulfonylurea, thiazolidinedione, DDP-4 inhibitor)

76
Q

In those type 2 diabetic patients who cannot tolerate metformin, if two drugs are started in combination but the HbA1c remains at 58mmol/mol or more, what should be done?

A

Start insulin therapy

77
Q

What drug should always be continued alongside insulin therapy for type 2 diabetes (if the patient is already on the drug)?

A

Metformin

78
Q

What is the recommended insulin regime for type 2 diabetics starting insulin treatment?

A

Intermediate acting human insulin (isophane insulin) given once or twice daily

79
Q

If treatment for hypertension is required in a diabetic patient, what is the drug of choice?

A

ACE inhibitor or ARB

80
Q

Should anti-platelets be offered routinely to diabetic patients?

A

No

81
Q

What drug is typically used as primary prevention against hyperlipidaemia in diabetic patients?

A

Atorvastatin 20mg

82
Q

When should atorvastatin 20mg be given to type 1 diabetic patients?

A

This is started in most adult type 1 diabetics

83
Q

When should atorvastatin 20mg be given to type 2 diabetic patients?

A

If they have a 10 year CV risk > 10%

84
Q

How many units of insulin are usually found within 1ml?

A

100 units

Gen Med (Endocrine) (12 decks)

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