Endocrine - Diabetes Flashcards by Abigail A

What is Type 1 Diabetes

Insulin deficiency
Pancreatic Beta Islet Cells are destroyed
Meaning there is little to no insulin secretion
An autoimmune disease

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What is Type 2 Diabetes?

insulin resistance which means you can’t easily take up glucose from your blood
and insufficient pancreatic insulin production

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Does diabetes cause persistent HYPO or HYPER-Glycaemia

Persistent HYPERGLYCAEMIA

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What is the target Hb1Ac level

ideal HbA1c level is 48mmol/mol (6.5%) or below for both type 1 and 2 diabetes

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What causes an exception to Hb1Ac levels? (2)

Patients prescribed a single drug associated with HYPOGLYCAEMIA (such as a sulfonylurea) should usually aim for an HbA1c level of 53 mmol/mol (7.0%)

Drug treatment intensifies after single drug controls poorly aim for 58 mmol/mol (7.5%)

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What are presenting symptoms of T1D? [5]

Ketosis.
Rapid weight loss.
Age of onset younger than 50 years.
Body mass index (BMI) below 25 kg/m2. (Don’t rule out if more than 25)
Personal and/or family history of autoimmune disease.

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What are presenting symptoms of T2D? (9)

Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
Polyuria (excessive urination)
Weight Loss
Fatigue
Blurred Vision
Recurrent Infection
Poor Wound Healing
Acanthosis Nigricans (Darken skin folds)

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What is HYPOGLYCAEMIA and SYMPTOMS? (8)

Low blood sugar

Drowsiness
cOnfusion
irRitability
Munchies
Anxiety & palpitations
SweatiNg
Tingling lips/Tremor

DORMANT

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What is HYPERGLYCAEMIA?

High blood sugar

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A patient has come in showing signs of HYPOglycaemia with a blood-glucose concentration GREATER than 4 mmol/litre. How would you treat them?

A small carbohydrate snack such as:
a slice of bread
OR a normal meal, if due.

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A patient has come in showing signs of HYPOglycaemia with a blood-glucose concentration of LESS than 4 mmol/litre. How would you treat them? (2 + 7)

Give 10-20g for fast acting carbohydrate
- for children and young people, approximately 0.3 g/kg of fast-acting carbohydrate
And repeat after 15mins

e.g.
3-6 GLUCOSE tablets
1-2 Dextrogel tubes
90-180ml Fizzy Drink
2-4 spoonfuls of sugar in water
4 large jelly babies
7 large jelly beans
50-100ml Lucazde energy

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A patient with Type 1 Diabetes comes into your pharmacy confused after her meeting with the diabetic nurse. She wants to know what her levels should be when driving, she wakes up, before and after food?

5 - 7 = waking up in HEAVEN
4 - 7 = beFORE food
5 - 9 = after dinner TIME
5 = before you drive

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If a patient is severe hypoglycaemic and unconscious what should you give them? (3)

If younger than 8 years old or below 25kg:
give IM Glucagon 500mcg

everyone else:
give IM Glucagon 1mg

call 999 if IM Glucagon is unavailable

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How often should a person with Type 1 diabetes test themselves

recommended 4 times daily

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What advice would you give to a diabetic person who drives? (3)

Test levels 2hrs before and immediately before driving

Levels need to be 5mmol/L or more driving
if it is below, treat by eating and test again

When levels are suitable for driving, test levels every 2hrs

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What advice would you give to a patient who drives a group 1 or 2 vehicle using Insulin and why would you give it? (1 +4)

Risk of HYPOGLYCAEMIA

If you experience a hypo
- STOP diving
- Tell the DVLA
- Reapply in 3 months if hypo free

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What advice would you give to a patient who drives a group 1 vehicle using Insulin Temporarily? (3)

Stop driving
don’t need to tell DVLA
but seek help

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What advice would you give to a patient who drives a group 2 vehicle using Insulin Temporarily? (4)

Get a restricted license last 1 year
STOP diving
Tell the DVLA
To renew license needs 3 months of BG readings

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What advice would you give to a patient who drives a group 1 vehicle using Sulphonylureas? (2)

ONLY tell DVLA if experienced a severe HYPO

and check with a healthcare professional if you need to check BG for driving

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Complications due to uncontrolled diabetes can occur. What are the two categories?

MACROvascular - severe cardiac complications
and
MICROvascular - severe complications elsewhere

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What diabetic complications occur in Macrovascular (5)

Coronary Heart Disease
Cardiomyopathy
Cerebrovascular Disease
Arrhythmias
Peripheral Artery Disease

What diabetic complications occur in Microvascular + Examples? (5)

RETINOPATHY: visual disability / blindness
NEUROPATHY: peripheral / autonomic
NEPHROPATHY: renal failure
FOOT PROBLEM: diabetic foot
METABOLISM: dyslipidaemia, ketoacidosis, hyperosmolar hyperglycaemic state (HHS)

METFORMIN
- aka
- MOA

aka Biguanide

Lowers both basal and postprandial [BG]
and Doesn’t stimulate insulin secretion (so no hypo risk)

SULFONYLUREA’S
- Examples
- MOA

end in ‘-ide’
e.g. Glicazide, Glipizide, Tolbutamide
Long acting: Glimepride, Glibenclamide

They increase insulin secretion AND have extrapancreatic action

DPP-4 inhbitors - examples - MOA

End in '-gliptin' e.g. Alogliptin, Linagliptin, Sitagliptin, Saxagliptin, Vildagliptin Inhibits DPP-4 to increase insulin secretion and decreases glucagon secretion

THIAZOLIDINEDIONE - examples - MOA

e.g. Pioglitazone They reduce peripheral insulin resistance and decrease blood glucose concentration

SGLT-2 - examples - MOA

end in '-flozin' e.g. canagliflozin, dapagliflozin, emapagliflozin, ertugliflozin reversibly inhibits SGLT-2 in renal PCT to decrease glucose reabsorption and increase urine glucose excretion

GLP-1 - examples - MOA

end in '-tide' e.g. dulaglutide, exenatide, liraglutide, lixisenatide They increase glucose-dependant insulin secretion and slows gastric emptying so you feel fuller for longer

Meglitinides - examples - MOA

e.g. repaglinide, Work by directly stimulating the release of insulin from pancreatic beta cells and thereby lower blood glucose concentrations; rapid onset and shorter duration

Metformin monitoring requirements

Renal function before treatment and annually (twice year in moderate renal impairment or elderly)

Pioglitazone monitoring req

monitor liver function before and periodically after can cause liver toxicity

DPP-4 monitor requireme

DPP-4 monitor requirements

renal function before treatment and periodically thereafter

SGLT-2 monitoring requirements

renal function before treatment and at least annually thereafter, and before initiation of concomitant drugs that reduce renal function and periodically thereafter

Metformin side effects

Diarrhoea & GI disturbance (switch to M/R) GI - abdominal pain, appetite decreased, nausea and vomiting, taste disturbance Lactic acidosis Vitamin B12 deficiency Skin reaction Hepitis

DPP-4 inhibitors

Pancreatitis - seek urgent help with signs of jaundice, nausea, vomiting, dark urine, abdominal pain GI - constipation, diarrhoea, reflux Hepatic - Hepatitis and liver failure Renal - acute renal failure Nervous - headache, dizziness and tremor Skin - swollen ankles, itching/rash MSK - back pain etc.. increased risk of infection and cough Hypersensitivity

Pioglitazone

WEIGHT GAIN increased risk of infection Bone fracture Bladder cancer Jaundice - stop and seek urgent help Numbness Visual impairment Heart failure

Sulfonylurea's side effects

HYPOGLYCAEMIA WEIGHT GAIN GI upset Skin reaction/hypersensitivity Hepatic impairment Blood abnormalities Nervous system Hyponatraemia

SGLT-2 side effects

DKA GI upset UTI/Renal impairment HYPOGLYCAEMIA (in combination) Dehydration/Dry mouth Hypotension Dizziness Gangrene, (Fournier's)

GLP-1 side effects

WEIGHT LOSS PANCREATITIS Decreased appetite GI upset Skin reaction Renal impairment

When it metformin contraindicated?

Metabolic acidosis e.g. Lactice acidosis and DKA

What risk are associated with diabetes in pregnancy? (4)

Pre-eclampsia rapidly worsening retinopathy Miscarriage risk to the developing fetus - malformatiion, stillbirth, neonatal death (death in first 28 days of life)

What are women with pre-esisting diabetes advised to take?

Folic acid

What treatment should be avoided in pregnancy

All oral anti-diabetic drugs (except metformin - benefit>harm)

What treatment should be avoided during breast feeding in a woman with diabetes

all oral antidiabetic drugs except insulin

What is first line treatment in pregnant diabetic women? (2)

Isophane Insulin (continue long acting if [BG] controlled prior pregnancy)

What advice would you give a diabetic woman who has just given birth

She is at higher risk of hypoglycaemia so reduce insulin immediately

What would you reccommend a diabetic woman who is not achieving diabetic control (w/o disabling hypoglycaemia)

Insulin pump therapy

What treatment would you recomend with Gestational Diabetes? (4) - fasting [BG] <7mmol/L

- Change diet and lifestyle If not met within 1-2 weeks - prescribe metformin - Insulin may prescribe if contraindicated or as an adjuvant if metformin alone is ineffective