metabolic mc3

Question 1

initial drug for DM2

Answer 1

metformin

Question 2

when not to give metformin

Answer 2

avoid if eGFR below 30

Question 3

common metformin side effects

Answer 3

Abdominal pain; anorexia; diarrhoea (usually transient); nausea; taste disturbance; vomiting

Question 4

rare side effects of metformin

Answer 4

Decreased vitamin-B12 absorption; erythema; lactic acidosis (withdraw treatment); pruritus; urticaria

Question 5

how to imporve metformin tollerance

Answer 5

slow increase of dose

Question 6

what to do if metformins not working

Answer 6

metformin and a DPP‑4 inhibitor or
metformin and pioglitazone[4]or
metformin and a sulfonylurea.

Question 7

downside of sulfonyurea

Answer 7

weight gain and hypoglycemia.

Question 8

main risk with gliclazide

Answer 8

hypoglycaemia

Question 9

how to treat sulfonyurea hypogly

Answer 9

in hospital

Question 10

type two triple therapies

Answer 10

metformin, a DPP‑4 inhibitor and a sulfonylurea or
metformin, pioglitazone and a sulfonylurea or
starting insulin-based treatment

Question 11

DKA triad

Answer 11

DKA consists of the biochemical triad of ketonaemia (ketosis), hyperglycaemia, and acidaemia.

Question 12

how much ketone in DKA

Answer 12

above 3mmol

Question 13

how much bicarb in DKA

Answer 13

less than 15

Question 14

DKA therapy

Answer 14

Commence IV 0.9% sodium chloride solution
Commence a Fixed Rate Intravenous Insulin Infusion
Establish monitoring regime appropriate to patient

Question 15

when to start the FRIII

Answer 15

only after fluid therapy has been commenced

Question 16

how often to monitor BG in DKA

Answer 16

hourly

Question 17

how often to monitor k in DKA

Answer 17

2 hourly

Question 18

how often to monitor bicarb in DKA

Answer 18

2 hour;y

Question 19

how often to monitor ketone in DKA

Answer 19

hourly

Question 20

how does IV insulin work

Answer 20

Reduction in blood glucose and even more importantly suppression of lipolysis and resolution of ketonaemia

Question 21

how is insulin produced

Answer 21

genetic engineering through implanting of an insulin gene in bacteria grown in vats from which insulin is removed

Question 22

short acting human insulins

Answer 22

Humulin S and Actrapid

Question 23

short acting analogue insulins

Answer 23

Humalog and Novorapid

Question 24

how is absorption of humolog and novorapid increased

Answer 24

improving separation into insulin dimers

Question 25

what to combine with short acting insulin

Answer 25

An intermediate or long acting insulin

Question 26

analogue long acting insulin

Answer 26

lantus or levemir

Question 27

lantus genetic alterations

Answer 27

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

Question 28

how is levemir a long acting

Answer 28

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

Question 29

what are biphasic insulins

Answer 29

mixture of an analogue ultra quick acting insulin with an NPH (isophane)

Question 30

who is biphasic insulins used in

Answer 30

T2DM

T1DM learning difficulties

Question 31

what does U100 mean

Answer 31

There are 100 units of insulin per mL.