Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Conditions + definitions > Endocrine - diabetes > Flashcards

Endocrine - diabetes Flashcards

1
Q

What are the types of insulin available?

A 
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
Continuous sub-cutaneous insulin infusion (insulin pump)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the regimes available for insulin therapy?

A

Twice daily
Three times daily
Four times daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do you take the twice daily regime?

A 
Rapid acting mixed with intermediate acting 
Before breakfast (BB) and evening meal (BT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the three times daily regime?

A

Rapid acting mixed with intermediate acting Before breakfast
Rapid acting Before dinner
intermediate acting at bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the four times daily insulin regime?

A

Short acting Before breakfast, lunch and dinner

Intermediate BBed or long acting insulin at a fixed time once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the basal bolus therapy and who is it good for?

A

Long acting insulin in the background
Rapid acting insulin calculated before meals
Very good for shift workers who don’t know when they will eat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the cautions with insulin pumps?

A

No background insulin

Must check blood glucose themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the glucose needed to drive?

A

5 to drive (greater than 5mmoles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the lowest blood glucose a diabetic should ever go to?

A

4s the floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main causes of hypoglycaemia?

A

Food (too little./wrong type)
Activity
Insulin (too much or taken poorly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of hypogylcaemia?

A 
Sweating
Palpitations
Shaking
Hunger
Confusion
Drowsiness
Speech difficulty
Incoordinatio
Nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the symptoms of a DKA?

A 
Polyuria
Polydipsia
Weakness
Weight loss
Nausea
Abdominal pain
Breathlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the signs of a DKA?

A 
Dry mucus membranes
Sunken eyes
Tachycardia
Hypotension
Ketotic breath
Altered mental state
Hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the complications of DKA?

A 
Hyper and hypokalaemia
Hypoglycaemia
>Rebound ketosis
>Arrhythmias
>Acute brain injury
Cerebral oedema
>Children more susceptible
>70-80% diabetes related deaths in children <12
Aspiration pneumonia
Arterial and venous thromboembolism
ARDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat a DKA?

A

Measure glucose / U and E’s / ketones / bicarbonate / arterial blood gas
Give iv saline (5 l in 24 hours)
Give iv insulin (drives glucose and potassium into cells)
Give iv potassium in saline
May need antibiotics
Consider heparin, NG tube
Mortality Rate 2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which drugs improve the action of insulin?

A

Biguanides

Thiazolidiones

17
Q

What drugs improve the excretion of glucose?

A

SGLT2 inhibitors

18
Q

Which drugs improve insulin release?

A

Sulphonylureas
Metglinides
Incretin mimics
DPPIV inhibitors

19
Q

What is metformin?

A

A biguinide
>therefore improves insulin sensnitivity
Has half life of 6 hours

20
Q

How does metformin improve the sensitivity of insulin?

A

Affects glucose production, decrease fatty acid synthesis
Improves receptor function
Inhibits gluconeogenic pathways

21
Q

What are the advantages of metformin?

A 
Improves cardiovascular outcomes and mortality in obese T2 DM
Cheap  
Efficaceous
Normally well tolerated
Not associated with weight gain
HbA1c by 12 – 17% reduction 
Also used in pregnancy now
22
Q

What are the disadvantages of metformin?

A 
Risk of lactic acidosis by inhibiting lactic acid uptake by liver especially in
>Hypoxia
>Renal failure (CI if creat<150)
>Hepatic failure
>Alcohol abuse
GI side effects 20 – 30 %
Risk vitamin B12 malabsorption
23
Q

What is the mechanism of action of sulphonylureas?

A

Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta-cells.
Binding closes the linked ATP-sensitive potassium channels
Decreased potassium influx depolarization of the beta-cell membrane.
Voltage-dependent calcium channels open and result in an influx of calcium
Translocation and exocytosis of secretory granules of insulin to the cell surface

24
Q

What are the advantages of sulphoylnureas?

A 
Used with metformin
Rapid improvement in control 
Rapid improvement if symptomatic
Rapid titration
Cheap 
Generally well tolerated
25
Q

What are the disadvantages of sulphonylureas?

A 
Risk of hypoglycaemia
Weight gain
Caution in renal and hepatic disease
CI in pregnancy and breastfeeding.
SE include
>Hypersensitivity and photosensitivity reactions
>Blood disorders
26
Q

What is the mechanism of action of thiazolidinediones?

A

selectively stimulates thenuclear receptorperoxisome proliferator-activated receptor gamma (PPAR-gamma) and to a lesser extentPPAR - alpha
modulates the transcription of theinsulin-sensitive genes involved in the control of glucose andlipid metabolismin themuscle,adipose tissue, and theliver.
reduces insulin resistancein the liver and peripheral tissues;
increases the expense of insulin-dependent glucose;
decreases withdrawal of glucose from the liver;
reduces quantity of glucose, insulin andglycated haemoglobinin the bloodstream.

27
Q

What are the advantages of pioglitazone?

A 
Good for people if insulin resistance significant
HbA1c by  0.6-1.3%
Cheap 
Cardiovascular safety established
(Contrast with rosiglitazone)
28
Q

What are the disadvantages of pioglitazone?

A 
Increase risk of bladder cancer
>Caution in those of increased risk bladder cancer (Age, industry etc)
Fluid retention - CCF
Weight gain
Fractures in females
>Small increased risk
>TZDs affect bone turnover
>Reduced BMD
>Initial report were of increased distal fractures in women
29
Q

What is the mechanism of action of gliptins (DDPV inhibitors)?

A

Inhibits DD4 enzyme which degrades incretins
Therefore increases active incretin levels
Results in increase in insulin release and decrease in glucagon

30
Q

What are the advantages of gliptins?

A 
Usually well tolerated
Can be used as 2nd or 3rd line agent
Can be used in renal impairment
No risk of hypoglycaemia
Weight neutral
31
Q

What are the disadvantages of gliptins?

A

Trial data shows relatively small effects on glycaemic control
CI in pregnancy and breastfeeding.
Possible increased risk of pancreatitis and pancreatic cancer
SE: nausea

32
Q

What is the mechanism of action of GLP-1 analogues?

A

Injectable analogues of GLP-1 resistant to enzymatic half life
Therefore greatly enhanced biological half life
Incretins stimulate the pancreas for longer
Results in more insulin release

33
Q

What are the advantages of GLP-1 analogues?

A

Weight loss
No risk of hypoglycaemia
3rd line agent
Can be used with basal insulin

34
Q

What are the disadvantages of GLP-1 analogues?

A 
Injection
		Very expensive
		Possible increased risk of pancreatitis and pancreatic cancer
		CI in pregnancy and breastfeeding.
		SE:
Nausea, vomiting
35
Q

What is the Mechanism of action of SGLT2 inhibitors (gliflozins)?

A

Prevent glucose reabsorption at proximal tubule

Results in a lot more urinary excretion of glucose

36
Q

What are the effects of SGLT2 inhibitors?

A 
Gets rid of glucose/more glycosuria
>Lowers HbA1C          
Gets rid of water/osmotic diuresis
>(POSTURAL) hypotension, dehydration
Gets rid of calories by wasting glucose
>Weight loss with same intake
Less uptake of sodium
>Lowers systolic blood pressure
Increases risk of urinary infection
>Cystisis + candidiasis
37
Q

What are the advantages of SGLT2 inhibitors?

A 
Weight loss
No risk of hypoglycaemia
Good effects on glycemic control
May have beneficial effect on cardiovascular morbidity &amp; mortality
2nd or 3rd line agent
Can add to insulin regimens in T2DM
38
Q

What are the disadvantages of SGLT2 inhibitors?

A 
Expensive
SE:
UTI, fungal infections, osmotic symptoms
Risk of digital amputation
Risk of DKA
CI in pregnancy and breastfeeding.
Cannot use in renal impairment

Conditions + definitions (68 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions