CPT > Diabtes Mellitus > Flashcards

Diabtes Mellitus Flashcards

(48 cards)

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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

Study These Flashcards
A

Rotate site of administration around abdomen

21
Q

What is Diabulimia?

Study These Flashcards
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?

Study These Flashcards
A

Hypoglycaemic drugs (e.g metformin)

23
Q

List 6 Hypoglycaemic agents used to manage Type 2 DM

Study These Flashcards
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?

Study These Flashcards
A

Biguanide

  • Inhibit gluconeogenesis, thus reducing hepatic glucose production
  • Suppress appetite> LIMIT weight gain
25
Can Biguanides cause hypoglycaemia? How are they administered? How are they incorporated into a prescription?
- No - Orally - 1st line, can be taken with other hypoglycaemic agents
26
List an ADR and contraindication of using Biguanides
- GI upset (nausea, vomit, diarrhoea) | - Alcohol intoxication, eGFR<30 (excreted without being metabolised)
27
List important DDIs of Biguanides
- Don’t use with drugs that can impair renal function (ACEi, Diuretics, NSAIDs) - Loop & thiazide diuretics increase glucose so can reduce action
28
What drug class is Glicazide How do these drugs work? How do they affect weight?
- Sulphonylureas - Stimulate pancreatic insulin secretion - Due to anabolic effects of insulin-> Increased
29
Can Sulphonylureas (SU) cause hypoglycaemia? How are they administered? How are they incorporated into a prescription?
- Yes - Orally - 1st line if Metformin is contraindicated, can be taken with other hypoglycaemic agents
30
List an ADR and contraindication of using SU drugs
- GI Upset | - Hepatic or renal disease
31
List important DDIs of SU drugs
Loop and thiazide diuretics can reduce SU action
32
What drug class is Pioglitazone/ Rosiglitazone? How do these drugs work? How do they affect weight?
- Glitazone/ Thiazolidinedione Enhanced; - Insulin sensitivity - Glucose utilisation - Cause fat cell differentiation-> Increased
33
Can Glitazones cause hypoglycaemia? How are they administered? How often are they incorporated into a prescription?
- Yes - Orally - Used much less frequently than other agents (due to chance of bladder cancer and fracture)
34
List ADRs and a contraindication of using Glitazones
- GI Upset - Fluid retention - Fracture risk - Bladder cancer - Heart failure due to fluid retention
35
What drug class is Canagliflozin/ Dapagliflozin How do these drugs work? How do they affect weight?
- SLGT2 Inhibitor/ Gliflozin - Reduced glucose reabsorption - Cause weight loss
36
Can Gliflozins cause hypoglycaemia? How are they administered? How are they incorporated into a prescription?
- No - Orally - In addition to Insulin in Type 1, add on in Type 2
37
List 4 ADRs of Gliflozins
- UTI and genital infection - Thirst and Polyuria - Risk of DKA in Type 1 DM - Possible hypotension
38
List important DDIs of Gliflozins
- Antihypertensives (as they can cause hypotension)
39
What drug class is Saxagliptin/ Sitagliptin? How do these drugs work? How do they affect weight?
- DDP4 Inhibitor/ Gliptin - Prevent incretin degradation - Suppress appetite-> Weight neutral (These drugs are glucose dependant, so mainly after eating?)
40
Can Gliptins cause hypoglycaemia? How are they administered?
- No | - Orally
41
List 2 ADRs and contraindications of Gliptins
- GI upset - Small risk of pancreatitis - Pregnancy - History of pancreatitis
42
List important DDIs of Gliptins
Thiazides and loop diuretics can reduce action
43
DPP4 normally degrades GLP-1. Does it degrade GLP-1 Receptor Agonists?
No
45
Can Incretin Mimetics cause hypoglycaemia? How are they administered? How are they incorporated into a prescription?
- No - Subcutaneously - Add on if triple therapy is ineffective
46
List 2 ADRs and a contraindication of Incretin Mimetics
- GI upset - Reduced appetite-> weight loss - Renal impairment
47
What drug class is Exenatide/ liraglutide? How do these drugs work? How do they affect weight?
- GLP-1 Receptor Agonist/ Incretin Mimetic - Increased glucose-dependent insulin synthesis - Promote satiety (possible weight loss?)
48
For Glitazones, is half life related to duration of action? Why? How long does it take to get a benefit?
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
What are 2 side effects of Metformin? What is 1 good thing about this drug?
- GI Upset - Lactic acidosis (Inhibits gluconeogenesis so Pyruvate accumulates-> Lactic acid) - Doesn’t cause hypoglycaemia
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