HD46-7 Diabetes Flashcards
Why is blood glucose raised in type 1 diabetes?
• Due to autoimmune destruction of beta cells= insulin
Why is blood glucose raised in type 2 diabetes?
• Due to combination of insulin resistance and relative insulin lack
what are the types of diabetes?
1, 2 , gestational, or secondary to other condition
Uses of measurements of glycated Haemoglobin:
Diagnosis can also be made by HbA1c level of over 48mmol/mol
This test is also used over a few weeks to measure success of tx.
Does this raise or lower blood glucose?
food
raise
Does this raise or lower blood glucose?
starvation
lower
Does this raise or lower blood glucose?
glucagon
raise
Does this raise or lower blood glucose?
adrenaline
raise
Does this raise or lower blood glucose?
cortisol
raise
Does this raise or lower blood glucose?
growth hormone
raise
Does this raise or lower blood glucose?
Insulin
lowers
Does this raise or lower blood glucose?
anti-diabetic drugs
lowers
Does this raise or lower blood glucose?
illness
raises
Does this raise or lower blood glucose?
stress
raises
Does this raise or lower blood glucose?
excersize
lowers
Which 4 hormones increase glucose levels?
- Glucagon – made by a alpha cell of islets of Langerhann in pancreas = make
- Adrenaline
- GH
- Cortisol – hydrocortisone steroid hormone
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sulphoylureas
secretagogue
can cause hypoglycaemia and weight gain
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
gliclazide
secretagogue
(a type of sulphonyureas )
(can cause hypoglycaemia and weight gain)
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
DPP4 inhibitors
secretagogue (also described as having combined actions)
-liptin= DPP4 inhibitor
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sitagliptin
secretagogue (also described as having combined actions)
-liptin= DPP4 inhibitor
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
vildagliptin
secretagogue (also described as having combined actions)
-liptin= DPP4 inhibitor
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
GLP-1 binder
tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
exanetide
-tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
liraglutide
tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
biguanides
biguanides (metformin)
sensitiser
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
metformin
biguanides (metformin)
sensitiser
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
thiazolidines
thiozolidinediones (“glitazones”e.g. pioglitazone
sensitiser
is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
pioglitazone
thiozolidinediones (“glitazones”e.g. pioglitazone
sensitiser
it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
acarbose
- Delayed carbohydrate absorption:
Acarbose: alpha-glucosidase inhibitor (rarely used= wind)
it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
guar gum
delayed carb absorption
it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
alpha glucosidase inhibitors
- Delayed carbohydrate absorption:
Acarbose: alpha-glucosidase inhibitor (rarely used= wind)
Short acting types of insulin:
soluble e.g. actrapid, humulin S,
2) insulin aspart e.g. novorapid
3) insulin lispro e.g. humalog
intermediate / long acting types of insulin
1) isophane insulin e.f. humulin I, insulatard
2) insulin glargine e.g. lantus
3) insulin detemir e.g. levemir
Biphasic types :
1) biphasic isophane insulin
2) biphasic insulin aspart
3) biphasic lispro
concs of soluble in insulin to isophane in biphasic isophane insulin:
30% soluble, 70% isophane
mixtard 30 or Humulin M3
concs of insulin aspart to isophane in biphasic aspart insulin:
30% insulin aspart
70% aspart protamine
(novomix)
concs of insulin lispro to isophane in biphasic lispro insulin:
25% lispro
75% lispro protamine
2 ways of taking insulin injections other than the insulin pump:
1) basal-bolus (Can check insulin level before they eat and adjust the amount of insulin they need to inject in accordance with the amount of carbohydrate they are going to eat, take a intermediate action one in morning or night)
2) Twice daily (take soluble and isophane insulin twice so don’t have to inject at lunch)
group the following newer modified insulin into very long acting and very quick acting:
glulisine glargine,lispro, aspart, detimir
Newer modified insulins
• Very long acting – glargine, detimir
• Very quick acting – lispro, aspart, glulisine
what are the 3 acute complications of diabetes:
ketoacidosis (type 1)
• Hyperosmolar hyperglycaemic state (type 2)
• Hypoglycaemia – complication of treatment
what are the chronic complication of diabetes:
• Microvascular o Retinopathy o Neuropathy o Nephropathy • Macrovascular o Peripheral o Coronary o Cerebral • Neuropathy • Foot problems
true or false
Microvascular problems and foot problems are unique to diabetes
true
What is Diabetic cheiroarthropathy
limited joint mobility can’t flatten hands, occurs in those with diabetic neuropathy
Prevention of long-term complications
• Meticulous glucose control - difficult • Control of blood pressure • Avoidance/treatment of other risk factors o Smoking o Hyperlipidaemia o Obesity o Inactivity • Early detection and management - SCREENING
How is the following complication of diabetes treated:• Retinopathy
laser photocoagulation (burns out bits of ischemic retina)
How is the following complication of diabetes treated: Nephropathy
ACE inhibition, dialysis & transplantation
How is the following complication of diabetes treated: Neuropathy
advice about foot care = amputation if necessary
How is the following complication of diabetes treated: PVD
peripheral vascular disease (ache in leg)– bypass surgery, angioplasty with stents or amputation
How is the following complication of diabetes :
foot ulcers
chiropody, protection from pressure, good footwear & surgery
What hospital procedures require diabetics to fast?
.e. endoscopy
• For short procedures ‘fast and check’
for short procedures in hospital operations for diabetics, how are they carried out different to normal?
- Omit morning insulin/tablets and breakfast
- Do procedure first on list
- Give treatment and breakfast immediately afterwards
for major/longer procedures in hospital operations for diabetics, how are they carried out different to normal?
• Intravenous treatment with drip and insulin
• GKI – glucose, potassium, insulin infusion
o Monitor glucose hourly – adjust insulin content of bag to keep between 6 and 12
GKI is given IV during major operations, All recipes contain:
2) glucose is monitored hourly, what is the range of gluc conc that is considered fine?
glucose , insulin and potassium
2) 4-10
what is the folloowing a recipe for: • 10% dextrose 500ml • 10mmol KCl • 16u soluble (short-acting) insulin • Rate 100ml/hour
GKI
in a major hospital op a pt is recieving GKI via IV, there blood glucose falls to bellow 6 and is falling after 2 hours into the operation. What is the response?
2) what is the infusion rate at the start of the operation and after replacing the GKI
replace GKI with one containing 4 less units of insulin. , diet diabetic may not need insulin but stress and illness may alter glucose levels so monitor glucose
2)2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour
in a major hospital op a pt is recieving GKI via IV, there blood glucose is above to and rising after 2 hours into the operation. What is the response?
2) what is the infusion rate at the start of the operation and after replacing the GKI?
replace bag with one containing 4 more units of insulin
2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour
