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CPT > Diabtes Mellitus > Flashcards

Diabtes Mellitus Flashcards

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1
Q

Which hormones promote insulin release after eating?

State the half life of insulin

A
  • Incretins (GLP-1, GIP)

- 5mins

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2
Q

Why is Insulin secreted into blood even during fasting?

A

To prevent receptor downregulation

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3
Q

List the 3 characteristic features of Type 1 DM

List 3 others

A
  • Weight loss
  • Polydipsia
  • Polyuria
  • Fatigue/ lethargy
  • General weakness
  • Blurred vision
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4
Q

What are the 2 plasma glucose requirements for classification of hyperglycaemia

A

Fasting plasma glucose: 6.9mM or higher
Random plasma glucose: 11mM or higher

(HbA1c: 6.5% or higher)

(Can’t diagnose diabetes with a single raised plasma glucose reading WITHOUT symptoms)

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5
Q

How do Glucose and HbA1c readings differ?

A

Glucose: Immediate measure of glucose in blood

HbA1c: % of RBCs with a ‘sugar coating’, reflects average blood sugar over last 10-12 weeks

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6
Q

Diabetic Ketoacidosis is a triad of what 3 signs?

More common in Type 1 DM

A
  • Hyperglycaemia (may not be present)
  • Ketonaemia (Urine or Blood)
  • Acidosis
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7
Q

How do you treat DKA?

A

IV fluids with K+, then IV insulin

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8
Q

Why can’t Insulin be given Orally?

How is it given routinely?

A

Is a protein, so would be digested in gut

Subcutaneous (IV if in emergency)

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9
Q

List 3 possible preparations of Insulin

A
  • 100 units/ ml
  • 300 units/ ml
  • 500 units/ml

(Latter 2 were created due to obesity and insulin resistance)

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10
Q

State 2 types of Natural insulins

A
  • Bovine

- Porcine

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11
Q

What are 3 methods of slowing Insulin absorption?

A
  1. Addition of a Protamine/ Zinc complex with NATURAL insulins
  2. Use of Insulin analogues (a few amino acid changes, no change to Pharmcodyanmics)
  3. Use of Soluble/ Neutral insulin;
    - Forms hexamers, so delayed absorption
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12
Q

When is [plasma] greatest after giving Soluble Insulins?

When are they often prescribed?

A

After 2-3 hours

15-30 mins before meals

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13
Q

List 2 examples of Insulin Analogues

Compare their;

  • Onset of action
  • Duration
  • Class (rapid/ short/ long etc)
A

Insulin aspart;

  • OoA: 10-20 mins
  • D: 3-5hrs
  • Rapid

Insulin glargine;

  • OoA: 60-90 mins
  • D: 20-24 hrs
  • Long
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14
Q

For Soluble Insulin, list the;

  • Onset of Action
  • Duration
  • Class
A

OoA: 30-60 mins
D: 5-8 hrs
Class: Short

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15
Q

For NPH (Isophane insulin), list the;

  • Onset of Action
  • Duration
  • Class
A

OoA: 60-120 mins
D: 18-24 hrs
Class: Intermediate

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16
Q

Insulin can be made in mixtures of Long and Short acting, so combinations are often prescribed by Brand name.

Suggest and describe a dosing regimen that’s often used in young patients with Type 1 DM

A

Basal-Bolus dosing;

Mix of Rapid acting bolus and Long acting basal insulin throughout the day

E.g 3 Boluses before meals + 2 Basal injections

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17
Q

Suggest 2 ADRs of Insulin therapy

A
  • Hypoglycaemia

- Lipodystrophy (Lipohypertrophy or Lipoatrophy)

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18
Q

Suggest a contraindication of Insulin therapy

A

Renal impairment (risk of hypoglycaemia due to decreased Insulin clearance)

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19
Q

Suggest an important Drug-Drug Interaction (DDI) of Insulin

A

Dose needs increasing with systemic steroids (e.g cortisol)

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20
Q

How can Lipodystrophy be minimised during Insulin therapy

Can reduce adherence

A

Rotate site of administration around abdomen

21
Q

What is Diabulimia?

A

When a Type 1 DM patient stops/ reduces their insulin to control their weight

22
Q

Pharmacological treatment of Type 2 DM involves use of what drugs before insulin?

A

Hypoglycaemic drugs (e.g metformin)

23
Q

List 6 Hypoglycaemic agents used to manage Type 2 DM

A
  • Sulphonylureas
  • Biguanides
  • Thiazolidinediones/ Glitazones
  • DPP4 Inhibitors/ Gliptins
  • SGLT2 Inhibitors/ Gliflozins
  • GLP1 Receptor Agonists/ Incretin mimetics
24
Q

What drug class is Metformin

How do these drugs work?
How do they affect weight?

A

Biguanide

  • Inhibit gluconeogenesis, thus reducing hepatic glucose production
  • Suppress appetite> LIMIT weight gain
25
Q

Can Biguanides cause hypoglycaemia?

How are they administered?

How are they incorporated into a prescription?

A
  • No
  • Orally
  • 1st line, can be taken with other hypoglycaemic agents
26
Q

List an ADR and contraindication of using Biguanides

A
  • GI upset (nausea, vomit, diarrhoea)

- Alcohol intoxication, eGFR<30 (excreted without being metabolised)

27
Q

List important DDIs of Biguanides

A
  • Don’t use with drugs that can impair renal function (ACEi, Diuretics, NSAIDs)
  • Loop & thiazide diuretics increase glucose so can reduce action
28
Q

What drug class is Glicazide

How do these drugs work?
How do they affect weight?

A
  • Sulphonylureas
  • Stimulate pancreatic insulin secretion
  • Due to anabolic effects of insulin-> Increased
29
Q

Can Sulphonylureas (SU) cause hypoglycaemia?

How are they administered?

How are they incorporated into a prescription?

A
  • Yes
  • Orally
  • 1st line if Metformin is contraindicated, can be taken with other hypoglycaemic agents
30
Q

List an ADR and contraindication of using SU drugs

A
  • GI Upset

- Hepatic or renal disease

31
Q

List important DDIs of SU drugs

A

Loop and thiazide diuretics can reduce SU action

32
Q

What drug class is Pioglitazone/ Rosiglitazone?

How do these drugs work?
How do they affect weight?

A
  • Glitazone/ Thiazolidinedione

Enhanced;

  • Insulin sensitivity
  • Glucose utilisation
  • Cause fat cell differentiation-> Increased
33
Q

Can Glitazones cause hypoglycaemia?

How are they administered?

How often are they incorporated into a prescription?

A
  • Yes
  • Orally
  • Used much less frequently than other agents (due to chance of bladder cancer and fracture)
34
Q

List ADRs and a contraindication of using Glitazones

A
  • GI Upset
  • Fluid retention
  • Fracture risk
  • Bladder cancer
  • Heart failure due to fluid retention
35
Q

What drug class is Canagliflozin/ Dapagliflozin

How do these drugs work?
How do they affect weight?

A
  • SLGT2 Inhibitor/ Gliflozin
  • Reduced glucose reabsorption
  • Cause weight loss
36
Q

Can Gliflozins cause hypoglycaemia?

How are they administered?

How are they incorporated into a prescription?

A
  • No
  • Orally
  • In addition to Insulin in Type 1, add on in Type 2
37
Q

List 4 ADRs of Gliflozins

A
  • UTI and genital infection
  • Thirst and Polyuria
  • Risk of DKA in Type 1 DM
  • Possible hypotension
38
Q

List important DDIs of Gliflozins

A
  • Antihypertensives (as they can cause hypotension)
39
Q

What drug class is Saxagliptin/ Sitagliptin?

How do these drugs work?
How do they affect weight?

A
  • DDP4 Inhibitor/ Gliptin
  • Prevent incretin degradation
  • Suppress appetite-> Weight neutral

(These drugs are glucose dependant, so mainly after eating?)

40
Q

Can Gliptins cause hypoglycaemia?

How are they administered?

A
  • No

- Orally

41
Q

List 2 ADRs and contraindications of Gliptins

A
  • GI upset
  • Small risk of pancreatitis
  • Pregnancy
  • History of pancreatitis
42
Q

List important DDIs of Gliptins

A

Thiazides and loop diuretics can reduce action

43
Q

DPP4 normally degrades GLP-1.

Does it degrade GLP-1 Receptor Agonists?

A

No

45
Q

Can Incretin Mimetics cause hypoglycaemia?

How are they administered?

How are they incorporated into a prescription?

A
  • No
  • Subcutaneously
  • Add on if triple therapy is ineffective
46
Q

List 2 ADRs and a contraindication of Incretin Mimetics

A
  • GI upset
  • Reduced appetite-> weight loss
  • Renal impairment
47
Q

What drug class is Exenatide/ liraglutide?

How do these drugs work?
How do they affect weight?

A
  • GLP-1 Receptor Agonist/ Incretin Mimetic
  • Increased glucose-dependent insulin synthesis
  • Promote satiety (possible weight loss?)
48
Q

For Glitazones, is half life related to duration of action?

Why?

How long does it take to get a benefit?

A
  1. No
  2. Because it works by altering gene transcription, which takes time to develop (effects can even happen after the drug is no longer present)
  3. 6-8 weeks
49
Q

What are 2 side effects of Metformin?

What is 1 good thing about this drug?

A
  • GI Upset
  • Lactic acidosis (Inhibits gluconeogenesis so Pyruvate accumulates-> Lactic acid)
  • Doesn’t cause hypoglycaemia

CPT (19 decks)

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