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November resit > Endocrine - Diabetes > Flashcards

Endocrine - Diabetes Flashcards

1
Q

What is Type 1 Diabetes

A

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

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2
Q

What is Type 2 Diabetes?

A

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

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3
Q

Does diabetes cause persistent HYPO or HYPER-Glycaemia

A

Persistent HYPERGLYCAEMIA

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4
Q

What is the target Hb1Ac level

A

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

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5
Q

What causes an exception to Hb1Ac levels? (2)

A

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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6
Q

What are presenting symptoms of T1D? [5]

A

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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7
Q

What are presenting symptoms of T2D? (9)

A

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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8
Q

What is HYPOGLYCAEMIA and SYMPTOMS? (8)

A

Low blood sugar

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

DORMANT

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9
Q

What is HYPERGLYCAEMIA?

A

High blood sugar

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10
Q

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

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

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11
Q

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)

A

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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12
Q

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?

A

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

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13
Q

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

A

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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14
Q

How often should a person with Type 1 diabetes test themselves

A

recommended 4 times daily

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15
Q

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

A

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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16
Q

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)

A

Risk of HYPOGLYCAEMIA

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

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17
Q

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

A

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

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18
Q

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

A
  • 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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19
Q

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

A

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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20
Q

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

A

MACROvascular - severe cardiac complications
and
MICROvascular - severe complications elsewhere

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21
Q

What diabetic complications occur in Macrovascular (5)

A

Coronary Heart Disease
Cardiomyopathy
Cerebrovascular Disease
Arrhythmias
Peripheral Artery Disease

22
Q

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

A

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

23
Q

METFORMIN
- aka
- MOA

A

aka Biguanide

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

24
Q

SULFONYLUREA’S
- Examples
- MOA

A

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

They increase insulin secretion AND have extrapancreatic action

25
Q

DPP-4 inhbitors
- examples
- MOA

A

End in ‘-gliptin’
e.g. Alogliptin, Linagliptin, Sitagliptin, Saxagliptin, Vildagliptin

Inhibits DPP-4 to increase insulin secretion and decreases glucagon secretion

26
Q

THIAZOLIDINEDIONE
- examples
- MOA

A

e.g. Pioglitazone

They reduce peripheral insulin resistance and decrease blood glucose concentration

27
Q

SGLT-2
- examples
- MOA

A

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

28
Q

GLP-1
- examples
- MOA

A

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

29
Q

Meglitinides
- examples
- MOA

A

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

30
Q

Metformin monitoring requirements

A

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

31
Q

Pioglitazone monitoring req

A

monitor liver function before and periodically after can cause liver toxicity

32
Q

DPP-4 monitor requireme

A
33
Q

DPP-4 monitor requireme

A
34
Q

DPP-4 monitor requirements

A

renal function before treatment and periodically thereafter

35
Q

SGLT-2 monitoring requirements

A

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

36
Q

Metformin side effects

A

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

37
Q

DPP-4 inhibitors

A

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

38
Q

Pioglitazone

A

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

39
Q

Sulfonylurea’s side effects

A

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

40
Q

SGLT-2 side effects

A

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

41
Q

GLP-1 side effects

A

WEIGHT LOSS
PANCREATITIS
Decreased appetite
GI upset
Skin reaction
Renal impairment

42
Q

When it metformin contraindicated?

A

Metabolic acidosis e.g.
Lactice acidosis and DKA

43
Q

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

A

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

44
Q

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

A

Folic acid

45
Q

What treatment should be avoided in pregnancy

A

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

46
Q

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

A

all oral antidiabetic drugs except insulin

47
Q

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

A

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

48
Q

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

A

She is at higher risk of hypoglycaemia so reduce insulin immediately

49
Q

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

A

Insulin pump therapy

50
Q

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

A
  • 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

November resit (10 decks)

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