Insulin and oral hypoglycaemics Flashcards
what is the 1st line treatment of type 1 diabetes in children?
basal bolus injection regimes (one or more specific long/ intermediate acting insulin analogue as basal insulin, along side rapid acting insulin (bolus) before mealtimes).
What is the 2nd line treatment for type 1 diabetes in children?
if basal-bolus not appropriate, consider continuous subcutaneous insulin infusion (pump)
What is the 1st line treatment for type 2 diabetes in children?
metformin.
What is the 1st line treatment for type 2 diabetes in adults?
standard release metformin.
What is the 2nd line treatment for type 2 diabetes in adults?
If metformin is contraindicated/ not tolerated, consider initial treatment with either a dipeptdyl peptidase-4 (DPP-4), or piogutazone or a sulfonylurea.
what is metformin?
Biguanide. Decreases insulin resistance by stimulating receptors on muscle, fat and liver cells.
What is the 1st line treatment for type 1 diabetes in adults?
basal-bolus insulin regimes. One or more intermediate/ long acting insulin for basal insulin and multiple bolus injections of short acting insulin (rapid acting is recommended).
What should insulin determir be offered for? What is its duration, onset and peak?
Long acting, basal insulin. Onset 4-8 hours, Peak 10-30 hours and duration 36+ hours).
What should a rapid acting insulin analogue be used for? What is its onset, peak and duration?
bolus insulin. Onset- 15 mins. Peak 1-3 hours. Duration 3-5 hours.
What is the 2nd line treatment for type 1 diabetes be in adults?
If a multiple daily injection basal-bolus regime not possible, a twice daily mixed insulin regime should be considered if it is preferred.
what is the name of the NICE guideline on type 1 diabetes in adults?
NICE guideline (NG17): Type 1 diabetes in adults: diagnosis and management (2015).
What is the name of the NICE guideline on type 2 diabetes in adults?
NICE guideline (NG28): Type 2 diabetes in adults: management (2015).
What is the name of the NICE guidelines on diabetes in children?
NICE guidelines (NG18): Diabetes (Type 1 and 2) in children and young people: diagnosis and management.
What are the monitoring requirements for all insulins?
Monitor patient parameters. Many patients now monitor their own blood glucose concentrations; all carers and children need to be trained to do this.
In adults: patients should maintain a blood glucose concentration of between 4-9 mmol/l. 4-7 before meals and below 9 after.
In children: 4-10 mmol/l. 4-8 before meals and below 10 after.
What is a big unwanted side effect of insulin therapy?
Hypoglycaemia. Patients must be educated on how to avoid it; involves appropriate adjustment of insulin dose, type and frequency with suitable timing and quantity of meals and snacks.
