Diabetic Pharmacology Flashcards
What does rapid acting insulin form a basal bolus of?
A basal bolus regime
What is short acting insulin used in?
Pumps
Sliding scale
What does biphasic insulin consist of?
Two phases
What is biphasic insulin a mix of?
Intermediate acting insulin
Short acting insulin
What do intermediate and long acting insulins provide?
All day cover
Intermediate vs Long acting
Intermediate there is a bit more of a peak than long acting and therefore risk of hypos
When does long acting insulin tend to be used and how often?
T1DM
Twice daily
When is biphasic insulin useful?
Elderly
Problems injecting
Sedentary lifestyle
What is the issue with biphasic insulin overnight?
Hypos overnight so will need a snack at bedtime
What does a basal bolus consist of?
50% short acting
50% something else
What does carb counting consist of?
Count how much CHO and adjust insulin
Check 2 hours later and adjust if need
What kind of control is the insulin pump good for and in what kind of people?
Erratic control
Good for athletic people
What do you still expect in T2DM?
Slight insulin production from the pancreas
What is the aim of treatment of T2DM?
Just need a bit of insulin to take the stress off their pancreas
What type of metformin is tolerated the best?
Slow release
What change in HbA1c does metformin give?
A decrease by 11mmol
What is metformins influence on weight?
Decrease / stays the same
Side effects of metformin
GI
Lactic acidosis
Does metformin give you hypos?
No
Can metformin be used in renal impairment?
Yes, but not when < 30ml
Is metformin cheap?
Yes
Why does metformin not make you put on weight?
As it does not produce insulin
Why does metformin not give you hypos?
As it does not produce insulin
How do sulphonyureas work?
Promote secretion of insulin in a non glucose dependent manner
What change in HbA1c does sulphonyureas give?`
Decrease by 11mmol
Effect of sulphonyureas on weight
Increases weight
Side effects of sulphonyureas
GI
Can sulphonyureas give you hypos?
Yes
Example of a sulphonyurea
Glycoside
Can sulphonyureas be used in renal impairment?
Yes but monitored
Is sulphonyureas cost effective?
Yes, they are cheap
How much does pigoglitazone decrease the HbA1c by?
A decrease by 11mmol
How does pigoglitazone work?
PRR receptor agonist
Makes more of the receptors by making more of a gene
How long does pigoglitazone take to work?
5 - 6 months to work as creating new receptors
Pigoglitazone effect on weight
Increases your weight
Side effects of pigoglitazone
Changes in metabolism leading to increased lipid upload into the cells Oedema Weight gain Fracture risk Cancer risk Congestive Heart failure effects
Does pigoglitazone give you hypos?
No
Can pigoglitazone be used in renal impairment?
Yes
How much does pigoglitazone cost per month?
£16 / month
How much do DPP4 inhibitors decrease your HbA1c by?
Decrease in 8-9mmol/l (not as good as the others)
DPP4 inhibitors effect on your weight?
A slight decrease in weight
Does DPP4 inhibitors give you hypos?
No
How much for DPP4 inhibitors cost per month?
£32 per month
What has DPP4 inhibitors been linked with?
CCF admissions
How is GLP1 given?
Injectable
Who is GLP1 good for?
Young people
How does GLP1 work?
Naturally occurs in gut - incretin
Produced when you eat and tells the pancreas to produce insulin - decreasing glucagon secretion and increasing satiety
Only does this in the presence of glucose (no hypos)
Blocks active GLP1 to inactive GLP1 and so more GLP1 is produced
Makes you lose weight as you feel full
What does GLP1 do to your weight?
Decreases it (big amount)
Side effects of GLP1
Nausea and vomiting
Does GLP1 cause hypos?
No
How much does GLP1 cost per month?
£72 per month
How much does GLP1 decrease your HbA1c by?
BIG decrease (11mmol)
How much does SGLT2 decrease your HbA1c by?
11mmol
Effect of SGLT2 on weight
Lose weight
Side effects of SGLT2
UTI
DKA (even in T2DM)
Genital tract infection
Does SGLT2 cause hypos?
No
Can SGLT2 be used in renal impairment?
No
How much does SGLT2 cost per month?
£36 / month
How does SGLT2 work?
Blocks the kidney from reabsorbing glucose which is also filtered so you are peeing out glucose
Why does SGLT2 give UTIs?
Sugary urine
Why cant SGLT2 be used in renal impairment?
As have to have filtering capacity
What occupations are especially a problem with T2DM and why?
Shift workers
Diet, convenience foods etc
What happens to patients with T2DM after 10 years diagnosis?
They loose their ability to make their own insulin
What is the target of HbA1c in the elderly compared to everyone else? Why is this?
Higher target
To reduce risk of hypos / falls
Protocol before adjusting insulin levels
Monitor BG at different times of the day
Look at the pattern
Adjust accordingly
What makes up metabolic syndrome?
HTN
Increased total cholesterol
Increased BG
Which of SGLT2 and DPP4 has a better weight loss?
SGLT2
If adjust the dose of a medication for example levothyroxine, when should the TFTs be checked?
6 - 8 weeks later
What is the volume distribution?
The volume in which a drug will dissociate
What needs to be done in respect to volume distribution if a patient loses weight?
Need to alter the dose of the drug as the concentration of the drug in the body would increase if lost weight
What is the goal of metformin?
To utilise the insulin they are producing
What is the first line GLP1?
Loragradtiade
What insulin does the insulin pump use? What does this consist of?
Novorapid
- short acting amounts over 24 hours
Who is eligible for an insulin pump?
T1DM
Carb counting
Proficient carb counting confirmed by the dietician
What does the libra monitoring system measure the blood glucose of?
The interstitial fluid
Why is the libra monitoring system only 80% accurate?
Delay behind the blood
What is a positive value for ketones?
> 1.0
What is a ketone value indicating some are present but more insulin is needed?
0.6 - 1.0
What value indicates that there is no ketones present?
< 0.6
What needs to be done to any insulin pen that is cloudy?
Mixing
