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Diabetes > Management > Flashcards

Management Flashcards

1
Q

How to manage diabetes

A

Pharmacologic
-insulin
-oral noninsulin treatment for T2DM
-injectable noninsulin therapies for T2DM
Non pharmacologic
-diet modification
-weight loss and exercise
-smoking cessation

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2
Q

Types of insulin

A

-rapid acting insulin
-short acting insulin
-intermediate acting insulin
-long acting insulin

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3
Q

Why is the action of soluble insulin delayed?

A

It forms stable hexamers which need to dissociate to monomers or dimers before it can enter the circulation

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4
Q

Insulin regimens

A

Basal-bolus regimen
Twice-daily mixed insulin regimen
Basal-only and basal-plus insulin regimens

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5
Q

Basal-bolus regimen

A

Both short and long acting insulin are administered. Long-acting insulin is injected 1-2 times per day to provide the background (basal) insulin to keep the glucose concentration consistent during periods of fasting. Short-acting insulin is given shortly before eating as a bolus to control glucose concentration following meals

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6
Q

Twice-daily mixed insulin regimen

A

A mixture of short- and long-acting insulin is injected before breakfast and the evening meal

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7
Q

Basal-only and basal-plus insulin regimens

A

A less intensive insulin regimen. Basal long-acting insulin at night, together with other non-insulin treatments during the day. Addition of mealtime insulin may become necessary.

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8
Q

Complications of insulin administration

A

-Lipohypertrophy and lipoatrophy
-Generalized allergic responses
-Injection site abscess

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9
Q

Symptoms of hypoglycemia

A

Autonomic symptoms
-sweating
-paresthesia
-feeling hot
-shakiness
-anxiety
-palpitations
-palor
Neuroglycopenia
-slurring of speech
-altered behavior
-loss of concentration
-drowsiness
-low mood
-dizziness
-hemiplegia
-fits
-coma
-death

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10
Q

Management of hypoglycemia

A

Immediate treatment with 15-20g of oral glucose, repeat after 15 minutes of glucose concentrations does not rise above 4.0mmol/l
For unconscious patients give intramuscular glucagon or intravenous glucose.

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11
Q

Oral non-insulin treatment for T2DM

A

Biguanides
Sulphonylureas
Meglitinides or post-prandial insulin releasers
Dipeptidyl peptidase-4 inhibitors
Sodium-glucose transporter 2 inhibitors
Alpha-glucosidase inhibitors
Quick release bromocriptine
Colesevalam

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12
Q

Examples of biguanides

A

Metformin

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13
Q

Mode of action of biguanides

A

Activate the enzyme adenosine monophosphate (AMP) kinase, which regulates cellular metabolism. Reduces the rate of gluconeogenesis and increases insulin sensitivity. May also suppress appetite and stabilize weight.

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14
Q

First line drug in the treatment of T2DM?

A

Metformin

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15
Q

Clinical use of biguanides?

A

Lowers plasma fasting glucose by 2-4mmol/l, corresponding to a fall in HbA1c of 11-22mmol/mol(1-2%)

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16
Q

Adverse effects of biguanides

A

Gastrointestinal side effects (10-20%), such as anorexia, nausea, abdominal discomfort and diarrhea.
Reduces vitamin B12 absorption
Lactic acidosis

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17
Q

Contraindications of biguanides

A

-renal impairment
-cardiac failure
-hepatic failure
Due to risk of lactic acidosis

18
Q

Sulphonylureas examples

A

Gliclazide
Glimepiride
Glibenclamide
Glipizide
Tolbutamide

19
Q

Examples of meglitinides

A

Repaglinide
Nateglinide

20
Q

Examples of thiazolidinediones

A

Pioglitazone

21
Q

DPP-4 inhibitors

A

Sitagliptin
Linagliptin
Vlidagliptin
Alogliptin
Saxagliptin

22
Q

Examples of SGLT2 inhibitors

A

Dapagliflozin
Empagliflozin
Canagliflozin

23
Q

Examples of alpha-glucosidase inhibitors

A

Acarbose
Miglitol
Voglibose

24
Q

Examples of GLP-1 receptor agonists

A

Exenatide
Liraglutide
Lixisenatide
Dulaglutide
Semaglutide
Albiglutide

25
Q

Mechanism of action of sulphonylureas

A

Binds to the sulphonylureas receptor on the beta cell membrane, which closes ATP-sensitive potassium channels and blocks potassium efflux. The resulting depolarization promotes calcium influx and stimulates insulin release.

26
Q

Adverse effects of sulfonylureas

A

-weight gain
-hypoglycemia

27
Q

Mechanism of action of meglitinides

A

Closes the K+ ATP channel in the beta cells. Are rapidly metabolized (work for less than 3 hrs)

28
Q

Adverse effects of meglitinides

A

-hypoglycemia
-weight gain

29
Q

Mechanism of action of thiazolidinediones

A

Reduce insulin resistance by interaction with peroxiding proliferator-activated receptor-gamma, a nuclear receptor that regulates large numbers of genes, including those involved in lipid metabolism and insulin action. They reduce hepatic glucose production and also enhance peripheral glucose uptake.

30
Q

Adverse effects of thiazolidinediones

A

-Weight gain
-fluid retention precipitating heart failure
-mild anemia
-osteoporosis

31
Q

Mechanism of action of DPP4 inhibitors

A

Increases the incretin effect by inhibiting the DPP4 enzyme

32
Q

DPP4 inhibitors adverse effects

A

-nausea
-acute pancreatitis (rare)

33
Q

Mode of action of SGLT2 inhibitors

A

Lowers the renal threshold for glucose, subsequently increasing urinary glucose excretion. Reduces the risk of MI, stroke, cardiovascular death and HF

34
Q

Adverse effects of SGLT2 inhibitors

A

-genital candidiasis
-dehydration
-rare: diabetic ketoacidosis, fournier’s gangrene, lower limb amputation

35
Q

Mode of action of alpha-glucosidase inhibitors

A

Prevents alpha-glucosidase, the lasts enzyme involved in carbohydrate digestion, from breaking down disaccharides to monosaccharides. This slows the absorption of glucose after a meal and lowers post-prandial glucose.

36
Q

Adverse effects of alpha-glucosidase inhibitors

A

-flatulence
-abdominal distension
-diarrhea

37
Q

MOA of quick release bromocriptine

A

Resets hypothalamic dopamine circadian rhythms. Abnormal circadian rhythm is associated with the development of insulin resistance, obesity and diabetes.

38
Q

MOA of colesevelam

A

Is a bile acid-binding resin that lowers cholesterol.

39
Q

Examples of amylin analogues

A

Pramlintide

40
Q

Non-insulin injectable therapies for T2DM

A

GLP-1 agonists
Amylin analogues

41
Q

Side effects of GLP-1 agonists

A

-nausea, vomiting, bloating, diarrhea
-acute pancreatitis

42
Q

Amylin analogues

A

Amylin is co-secreted with insulin and delays gastric emptying, suppresses post-prandial glucagon secretion and increases satiety.

Diabetes (3 decks)

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