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Y3 Patient sem 1 > Intro to diabetes > Flashcards

Intro to diabetes Flashcards

1
Q

What are the 4 T’s in identifying type 1 diabetes in children?

A

Toilet
Thirsty
Tired
Thinner

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2
Q

What is Diabetic Ketoacidosis (DKA)?

A

The body completely switches to lipid metabolism - the body cannot process glucose so excretes in urine.
Glycogen is stored as fat - body starts burning fat - produces ketones and fatty acids

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3
Q

How does type 2 diabetes present?

A
  • Often not symptomatic
  • Like type 1 but slower onset and less extreme
  • Increased episode of genital thrush
  • Slow wound healing
  • Tends to be in older patients with larger BMI
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4
Q

What are the characteristics of type 1 diabetes?

A
  • No insulin produced
  • quickly life threatening
  • no diet restrictions (just careful monitoring)
  • no risk factors (slight genetic link)
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5
Q

What are the characteristics of type 2 diabetes?

A
  • Insulin is usually produced at the beginning
  • body doesn’t respond to insulin properly (controlled with diet and exercise)
  • rarely life threatening
  • insulin used as last option
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6
Q

What are the risk factors of type 2 diabetes?

A
  • ethnicity
  • age
  • obesity
  • genetics
  • smoking/alcohol
  • raised BP
  • PCOS - polycystic ovary
  • poor sleep
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7
Q

What drugs reduce hepatic glucose out put?

A
  • metformin
  • pioglitazone
  • DPP-4 inhibitors
  • GLP-1 agonists
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8
Q

What drugs reduce glucose re-uptake from glomerular filtrate?

A
  • SGLT-1 inhibitors
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9
Q

What drugs reduce peripheral insulin resistance ?

A
  • Pioglitazone
  • Metformin
  • improve effect of insulin at end point
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10
Q

What drugs enhance insulin secretions by affecting the pancreas?

A
  • Sulphonylureas

- Meglitanides

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11
Q

What drugs enhance the action of incretin?

A
  • GLP-1 agonists
  • DPP-4 inhibitors (ends in gliptin)
  • Increases insulin
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12
Q

What drugs delay carbohydrate absorption?

A
  • Acarbose
  • GLP-1 agonist
  • Carbs pass through untouched so glucose stays low, bad GI side effects, not usually used
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13
Q

What are the advantages and disadvantages of Metformin?

A 
Advantages;
 - cheap
 - weight neutral 
 - low risk of hypo
Disadvantages:
 - commonly causes GI side-effects
 - rare but serious side effect of lactic acidosis
 - short half life so TDS frequency
 - caution in egfr < 45
 - contraindicated in egfr < 30 
- takes 3 weeks to titrate up dose
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14
Q

What is the 1st line drug choice for all type 2 patients?

A

Metformin

used to be Sulfonylureas

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15
Q

What is the mode of action of metformin?

A
  • Makes muscles more sensitive to insulin, doesn’t produce MOEW.
  • Less likely to have a hypo*
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16
Q

What are the advantages and disadvantages of Sulfonylureas?

A 
Advantages:
 - Can be OD or BD
 - works quickly to lowers blood glucose levels so improves symptoms 
 - fewer GI side effects than metformin
Disadvantages:
 - can cause hypos 
 - can cause weight gain
 - need functional pancreas to work 
 - can be un-predictable in renal impairment and in the elderly
17
Q

What are the advantages and disadvantages of pioglitazone?

A 
Advantages: 
 - OD dosing 
 - low risk of hypo 
 - suitable in renal impairment
Disadvantages:
 - associated with heart failure
 - increased risk of bladder cancer and fractures 
 - causes weight gain
 - rarely causes liver toxicity 
 - can take 3-6 months to show benefit (not quick acting)
18
Q

What are the advantages and disadvantages of DPP-4 inhibitors?

A 
Advantages:
 - once a day 
 - no weight gain 
 - low risk of hypo
 - some can be used in renal impairment 
Disadvantages: 
 - commonly causes GI side-effects, rash ancf UTI
 - rarely causes inflammation
 - doesn't work as well, although well tolerated
19
Q

What are the advantages and disadvantages of SGLT-2 Inhibitors?

A

Advantages:
- Can cause weight loss
- can reduce BP
- Low risk of hypo
Disadvantages:
- Can cause thrush and UTIs especially on starting treatment (excess glucose urinated out instead of being reabsorbed - bacteria like sugar)
- Only effective if reasonable renal function
- Lower BP can increase fall risk
- risk of DKA
- risk of kidney injury and and foot ulcers?

20
Q

What are the advantages and disadvantages of GLP-1 agonists?

A

Advantages:
- weight loss
- once a day (or weekly with some preparations)
- rarely cause hypos
Disadvantages:
- injections
- severe GI side-effects are very common
- suitable in moderate renal impairment
- rarely causes pancreatitis
- expensive
- have to have BMI greater than 30 with complications (e.g. knee problems)

21
Q

What are the insulin treatments for type 1 diabetes?

A
  • Basal bolus: one (or two) long acting in evening (and morning). 3 doses of short/rapid acting during day before meals
  • Biphasic (insulin and a salt - free insulin works straight away on muscles) Two biphasic insulin doses, one in the morning and one at teatime. Dose split (breakfast/teatime) dependent on when biggest meals is eaten
22
Q

What are the 5 types of insulin?

A
  • rapid acting (Novorapid, Humalong, Apidra)
  • short acting (Actrapid, Humulin S, Insuman rapid)
  • intermediate acting (Insulatard, Humulin I, Insuman basal)
  • long acting (Lantus, Abaseglar)
  • super long acting (Toujeo, Tresiba)
23
Q

What is the first line therapy for type 1 diabetes in adults and children?

A

Basal bolus regime

24
Q

Describe the basal bolus regime?

A
  • Long-acting insulin analogue ONCE daily (night time)
    OR
  • Long-acting insulin analogue TWICE daily (breakfast and night time)
    AND
  • Rapid acting insulin analogue THREE times daily with meals: dose based on carb intake

*bolus preferred in people that like to snack throughout the day

25
Q

Describe short acting insulin + examples

A

Soluble

  • onset 1/2-1 hour
  • peak 2-3 hours
  • duration 8-10 hours

Human Actrapid®
Humulin S ®
Insuman Rapid®

26
Q

Describe rapid acting insulin analogues and examples?

A
  • onset 5-15 mins
  • peak 30-90 mins
  • duration 4-6 hrs
    Humalog = insulin lispro
    Novorapid = insulin aspart
    Apidra = insulin glulisine
27
Q

Describe Intermediate acting insulin and examples?

A

Isophane (Neutral Protamine Hagedorn=NPH)

  • onset 2 – 4 hours
  • peak 4 -10 hrs
  • duration 12-18 hours

Human insulatard
Humulin I
Insuman Basal

28
Q

Describe long acting insulin analogues and examples

A

Insulin Glargine (Lantus® or Abasaglar®) & Detemir (Levemir ®)

  • Once (Glargine) or twice (Detemir) daily
  • Flat insulin profile
  • Onset 2 – 4 hours with duration of 20-24hrs
  • No peak as mirrors basal Insulin output in non diabetics
  • Less nocturnal hypoglycaemia is the greatest benefit
29
Q

What are the NICE guidelines on ultra long acting insulin analogues?

A

NICE 3rd line regime with other long acting insulins have failed

30
Q

Describe Ultra long acting insulin and examples

A

Insulin Degludec (Tresiba®) or Insulin glargine (300units/ml) (Toujeo®)

  • Once daily administration with flattest insulin profile
  • Duration of action of up to 42 hours
  • May be of benefit in patients with troublesome nocturnal hypoglycaemia or non adherent patients who forget to take insulin
31
Q

What is Non-human insulin?

A

RARELY USED

Options for all durations

Used for patients:
Taking historically
Unable to tolerate human insulin

32
Q

What is Biphasic insulin?

A

Contain a short or rapid acting insulin in a protamine suspension
Onset 1/2 hr, peak 1-2 hours, duration up to 12 hours
- Humulin M3
- Insuman Comb 15, 25, 50
- Humalog mix 25, 50
- Novomix 30

2 INJECTIONS A DAY

Good for patients who struggle with multiple injections and who are not able to carb count.
Not the best choice for good control (not used a lot in type 1 - more type 2)

33
Q

Describe continuous SC insulin infusion

A

Known to patients as a ‘pump’
Specialists to consider if
- attempts to achieve target HbA1c with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia
- HbA1c levels have remained high ( > 69 mmol/mol) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care
- Patient (or care giver) MUST also have commitment and competence to use

For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life
Patient has commitment and competence to use

34
Q

What courses are available for patient education?

A
  • DAFNE
  • X-PERT
  • DESMOND

Y3 Patient sem 1 (22 decks)

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