metabolic mc3 Flashcards
initial drug for DM2
metformin
when not to give metformin
avoid if eGFR below 30
common metformin side effects
Abdominal pain; anorexia; diarrhoea (usually transient); nausea; taste disturbance; vomiting
rare side effects of metformin
Decreased vitamin-B12 absorption; erythema; lactic acidosis (withdraw treatment); pruritus; urticaria
how to imporve metformin tollerance
slow increase of dose
what to do if metformins not working
metformin and a DPP‑4 inhibitor or
metformin and pioglitazone[4]or
metformin and a sulfonylurea.
downside of sulfonyurea
weight gain and hypoglycemia.
main risk with gliclazide
hypoglycaemia
how to treat sulfonyurea hypogly
in hospital
type two triple therapies
metformin, a DPP‑4 inhibitor and a sulfonylurea or
metformin, pioglitazone and a sulfonylurea or
starting insulin-based treatment
DKA triad
DKA consists of the biochemical triad of ketonaemia (ketosis), hyperglycaemia, and acidaemia.
how much ketone in DKA
above 3mmol
how much bicarb in DKA
less than 15
DKA therapy
Commence IV 0.9% sodium chloride solution
Commence a Fixed Rate Intravenous Insulin Infusion
Establish monitoring regime appropriate to patient
when to start the FRIII
only after fluid therapy has been commenced
how often to monitor BG in DKA
hourly
how often to monitor k in DKA
2 hourly
how often to monitor bicarb in DKA
2 hour;y
how often to monitor ketone in DKA
hourly
how does IV insulin work
Reduction in blood glucose and even more importantly suppression of lipolysis and resolution of ketonaemia
how is insulin produced
genetic engineering through implanting of an insulin gene in bacteria grown in vats from which insulin is removed
short acting human insulins
Humulin S and Actrapid
short acting analogue insulins
Humalog and Novorapid
how is absorption of humolog and novorapid increased
improving separation into insulin dimers
what to combine with short acting insulin
An intermediate or long acting insulin
analogue long acting insulin
lantus or levemir
lantus genetic alterations
soluble at a slightly acid pH (in the cartridge) but when at a physiological pH of close to 7.0 it crystalises out at the injection site thus retarding the absorption into the blood stream at the injection site and giving it close to a 24 hour duration of action
how is levemir a long acting
fatty acid moiety stuck to the end of the beta chain which binds to human albumin in the blood and in the interstitial fluid at the injection site and thus retarding the action by delaying absorption into the blood stream
what are biphasic insulins
mixture of an analogue ultra quick acting insulin with an NPH (isophane)
who is biphasic insulins used in
T2DM
T1DM learning difficulties
what does U100 mean
There are 100 units of insulin per mL.
