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CPT > L8 - Diabetes > Flashcards

L8 - Diabetes Flashcards

1
Q

What stimulates glucose release?

A

Increased blood glucose
Incretins (GLP-1, GIP)
Glucagon
Parasympathetic activity (M3)

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2
Q

What inhibits insulin release?

A

Low blood glucose
Cortisol
Sympathetic activity (alpha 2)

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3
Q

Role of insulin

A

Decreased hepatic glucose output by inhibiting gluconeogenesis and glycogenolysis

Promotes the uptake of fat

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4
Q

Symptoms of diabetes

A 
Polyuria 
Polydipsia 
Weight loss 
Lethargy 
Fatigue
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5
Q

Random plasma glucose hyperglycaemia

A

Above 11mmol/L

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6
Q

Risk factors for type 2 diabetes

A 
Obesity 
Family history 
Ethnicity 
Diet - high carbohydrate and sugar 
Drugs - thiazides/ thiazide like diuretics/ glucocorticoids/ Beta blockers 
Low birth weight
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7
Q

HbA1c

A

Percentage of glycated haemoglobin over 3 months

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8
Q

How is insulin given?

A

Subcutaneous injection in:

  • upper arms
  • thighs
  • buttocks
  • abdomen

Can be given via syringe, pen, pump or inhaler

IV insulin - emergency treatment

Insulin is a protein therefore if given as a pill orally, will be digested

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9
Q

Types of insulin

A

Bovine (cow) - 3 amino acid difference
Porcine (pig) - 1 amino acid difference
Human insulin - recombinant DNA or enzymatic modification of porcine insulin

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10
Q

Normal formula of insulin

A

100 U/ml

If obese or insulin resistant, higher doses of 300 - 500 U/ml are given

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11
Q

Half life on insulin

A

5 mins in plasma

- renal and hepatic metabolism and elimination

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12
Q

When should insulin be given?

A

15-30 mins prior to meals as has the greatest effect 2-3hr after dose

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13
Q

Protamine

A

Change hexomer formation

Fast acting insulin

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14
Q

Zinc

A

Delays absorption

Slow acting insulin

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15
Q

Why is the site of insulin administration rotated

A

Prevent lipodystrophy:

- atrophy or hypertrophy of lipids around the injection site

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16
Q

Insulin aspart

A

Onset of action - 10- 20 min
Peak - 40-50 min
Duration - 3- 5 hours

  • rapid action
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17
Q

Soluble insulin - humulin S, actrapid

A

Onset of action: 30 -60 mins
Peak - 2-5 hours
Duration - 5-8 hours

  • short acting
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18
Q

Isophane insulin

A

Onset of action: 1-2 hours
Peak - 4-12 hours
Duration - 18-24hours

  • Intermediate acting
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19
Q

Insulin glargine

A

Onset of action: 60-90 mins
Peak: plateau between 2 - 20 hours
Duration: 20-24 hours

Long acting

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20
Q

Contraindications and interactions of insulin

A

Contraindications:

  • hypoglycaemia
  • lipohypertrophy
  • lipoatrophy
  • renal impairment (hypoglycaemia if not cleared)

Interactions:

  • increased dose with steroids
  • other hypoglycaemic agents
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21
Q

Basal bolus dosing

A

Bolus dose

  • insulin aspart
  • mimic spike in insulin after eating food

Basal dose

  • insulin glargine
  • mimics baseline insulin
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22
Q

Diabetic ketoacidosis

A

Causes:
Hyperglycaemia
Metabolic acidosis
Ketoneamia

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23
Q

What can cause diabetic ketoacidosis?

A

Blood glucose 11 + mmol/L and:

  • infection
  • trauma
  • poor insulin adherence
  • ADR
  • ketosis
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24
Q

How to treat diabetic ketoacidosis

A

FLUIDS - 1st
Insulin
K+
Glucose

25
K+ concentration in diabetic ketoacidosis
K+ in blood may be high due to acidosis But overall K+ in body is low due to diuresis and osmolality Therefore when giving fluids - K+ fluctuates
26
Type 2 diabetes mellitus
1. Cellular resistance to insulin due to obesity 2. Resistance overcome by increased insulin production by pancreas 3. Overtime: - insulin receptors decrease - GLP-1 decreases due to decrease in beta cells and oral glucose 4. Glucotoxicty from FA and ROS - beta cell dysfunction
27
Treatment of T2DM
Lifestyle modifications: - increased exercise - decreased carb diet - weight reduction Bariatric surgery Education
28
Treatment when HbA1c rises above 48mmol (6.5%)
Standard releases metformin | Aim for 48 mmol
29
HbA1c above 58mmol (7.5%)
Metformin + adjunct
30
Biguanides
Decreases hepatic glucose output Decreases gluconeogenesis and glycogenolysis Increases glucose utilisation in skeletal muscle Suppress appetite - limit weight gain
31
Example of biguanides
Metformin
32
Contraindications and interactions of metformin
Contraindications: - GI upset - nausea - vomiting - diarrhoea - lactic acidosis (rare) - eGFR below 39 ml/min Interactions: - ACEi (impair renal function) - NSAIDs (impair renal function) - thiazide like diuretics- increases glucose
33
Sulfonylureas mechanism of action
Stimulates beta cell pancreatic insulin secretion Decreases insulin resistance 1. Inhibits ATP - dependent K+ channels 2. Decreased efflux of K+ 3. Membrane depolarisation 4. Ca2+ influx 5. Insulin exocytosis - increasing insulin Needs residual pancreatic function
34
Contraindications and interactions of sulfonylureas
Contraindications - mild GI upset - nausea - vomiting - diarrhoea - hypoglycaemia - rare hypersensitivity reactions Interactions: - other hypoglycaemic agents - hepatic impairment - renal impairment - thiazide like diuretics
35
Name of a sulfonylurea
Gliclazide
36
When is gliclazide used?
Commonly used with metformin when metformin is not enough | Can be used alone if patient has a intolerance to metformin
37
Thiazolidinediones (glitazones)
Increases insulin sensitivity in muscle and adipose Decreased hepatic glucose output - activates PPAR - gamma - causes gene transcription - increased storage of FAs therefore less circulation - increased need for glucose uptake by cells
38
Gliclazide affect on weight
Increased weight gain as has anabolic effects of insulin
39
Glitazones affect on weight
Weight gain - fatty acid storage
40
Contraindications and interactions of glitazones
``` Contraindications: GI upset Fluid retention Fracture risk CVD concerns Bladder cancer ``` Interactions: Other hypoglycaemic agents
41
Name of glitazones
Pioglitazone | Rosiglitazone
42
Sodium glucose co-transporter inhibitors SGLT2 (gliflozins)
Inhibition of sodium- glucose cotransporter in PCT Therefore less glucose reabsorption - modest weight loss - hypoglycaemia risk is low
43
SGLT 2 inhibitor use
T1DM - dka risk | T2DM - adjunct
44
Contraindications and interactions of SGLT 2inhibitors
Contraindications: - UTI - Genital infection - thirst - polyuria Interactions: - antihypertensives - other hypoglycaemic agents
45
GLP-1 effects
Pancreas: - increased insulin secretion - decreased glucagon secretion - increased insulin biosynthesis Brain: - increased satiety therefore decreases food intake Liver: - indirect decreases in glucose production Muscle: - increased glucose uptake Stomach: - decreased gastric emptying
46
Where is GLP - 1 secreted from
Intestines
47
Name of SGLT2 inhibitors
Dapagliflozin | Canagliflozin
48
Dipeptidyl peptidase - 4 inhibitors (DPP-4) - gliptins
Prevent incretin degradation Increased plasma GLP-1 - glucose dependent on postprandial action - works after eating therefore decreased risk of hypoglycaemia - suppresses appetite - weight neutral
49
When is DPP-4 inhibitors used
If metformin is contraindicated (first line) | As adjunct
50
Contraindications and interactions of gliptins
Contraindications: - GI upset - small risk of pancreatitis - pregnancy Interactions: - other hypoglycaemic agents - thiazides and loop diuretics- increase glucose
51
Examples of DPP-4 inhibitors
Sitagliptin | Saxagliptin
52
GLP-1 receptor agonist - incretin mimetics
Increase glucose dependent synthesis of insulin from Beta cells Activate GLP-1 receptors Not degraded by DPP-4
53
How are incretin mimetics given
Subcutaneous injection
54
GLP-1 receptor agonist effect on weight
Increase satiety - weight loss
55
When is GLP -1 receptor agonist given
Add on if Triple therapy is not effective
56
Contraindications and interactions of GLP-1 receptor agonists
Contraindications: GI upset GORD Stop if eGFR below 30ml/min Interactions: - other hypoglycaemic agents
57
Combined hypoglycaemic pill
Increased adherence Less frequent dosing Taken whole as slowly absorbed and dissolved in stomach Harder to change individual drug doses
58
Diabulimia
Not taking insulin appropriately in order to lose weight

CPT (23 decks)

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