T1&T2DM management

Question 1

Pancreatic beta cell deficiency causing hypoinsulinaemia and hyperglucagonaemia

Answer 1

T1DM

Question 2

Insulin resistance causing hypoinsulinaemia

Answer 2

T2DM

Question 3

Role of insulin and glucagon in response to homeostasis

Answer 3

Stimuli: Low BSL
Alpha cell in pancreas release glucagon into the bloodstream stimulating the breakdown and release of glycogen in the liver, therefore raises BSL to normal lvl.

Stimuli: High BSL
Beta cell in pancreas release insulin into the bloodstream attaching to insulin receptors of muscles and tissues stimulating the uptake of glucose from the blood therefore lowers BSL.

Question 4

form of diabetes diagnosed during pregnancy

Answer 4

gestational diabetes

Question 5

__________develops in baby and _____________ during post delivery. Gestational diabetes can develop ____________ later in life.

Answer 5

hyperinsulinaemia (high BSL of mother can bring extra glucose to baby causing extra weight)
hypoglycaemia
T2DM

Question 6

Main treatment for T1DM

Answer 6

Insulin only!

Question 7

Main treatment for T2DM

Answer 7

Lifestyle management
oral hypoglycaemics

Question 8

Lifestyle management for chronic conditions - DM

Answer 8

exercise
get enough sleep
reduce stress
healthy diet (limit sugar and starch)
have fun

Question 9

Oral hypoglycaemics

Answer 9

Metformin
SGLT-2 inhibitors
Sulphonylureas
Thiazolidinediones

Question 10

Metformin pharmacodynamics

Answer 10

GI: decrease glucose absorption and increases anaerobic glucose metabolism

Liver: decrease gluconeogenesis, glycogenolysis, fatty acid oxidation

Skeletal muscle: increase insulin-mediated glucose uptake, increase glycogenesis (storing of excess glucose)
upregulates GLUT4 transporter (act as insulin, up-taking excess glucose to muscle and fat tissues)

Question 11

Metformin benefits

Answer 11

NO weight gain
POSITIVE EFFECTS on cholesterol levels
DO NOT CAUSE hypoglycaemia

Question 12

Metformin adverse effects

Answer 12

GI discomfort (N&V)
increase risk of lactic acidosis
CAUTION with people with renal failure

Question 13

Metformin only works in the presence of ______________

Answer 13

insulin

Question 14

Metformin can be used for T1DM to

Answer 14

decrease risk of insulin resistance or T2DM (double diabetes)

Question 15

SGLT-2 inhibitors pharmacodynamics

Answer 15

inhibit SGLT-2 transporter which allows glucose reabsorption in the kidneys. As a result, increases urinary glucose excretion

Question 16

SGLT-2 inhibitor medication

Answer 16

dapagliflozin - only for T2DM

Question 17

SGLT-2 inhibitors benefits

Answer 17

lowers BSL and BP
weight loss
good for cholesterol levels
unlikely to cause hypoglycaemia

Question 18

SGLT-2 adverse effects

Answer 18

UTIs
candidiasis (fungal infection)
polyuria and polydipsia
hypotension
acute renal injury
risk of ketoacidosis

Question 19

Incretins: GLP1R agonist and DPP4 inhibitors pharmacodynamics

Answer 19

GLP1R agonises GLP1 (hormone released by GIT) which stimulates insulin to increase glucose uptake. Decrease stimulation of glucagon which decreases hepatic gluconeogenesis

DPP4 inhibits DPP4 enzyme which destroys GLP1

Question 20

Incretins benefits

Answer 20

decrease BSL
no hypoglycaemia
weight loss
reduced appetite
protect beta cells
positive effects on cholesterol levels

Question 21

incretins adverse effects

Answer 21

GI upset
NOT FOR PREGNANCY and LACTATION
Liver disfunction
slows gastric emptying
pancreatitis

Question 22

Sulphonylureas pharmacodynamics

Answer 22

closes potassium channels in the beta cells stimulating more insulin release

Question 23

sulfonylureas adverse effects

Answer 23

GI upset
HYPOGLYCAEMIA
weight gain
allergic reactions to sulfonamide
hepatitis
photosensitivity
blood dyscrasias

Question 24

sulfonylureas nursing considerations

Answer 24

TAKE WITH FOOD
ONE daily doses
DONT TAKE WITH NSAIDS (increase risk of HYPO)

Question 25

Thiazolidinediones pharmacodynamics

Answer 25

PPAR-Y agonists which creates extra adipose tissue > increasing glucose reauptake Pancreas: decrease insulin demand Liver: increase insulin sensitivity, decrease hepatic gluconeogenesis and decrease triglycerides

Question 26

Thiazolidinediones benefits

Answer 26

lowers BSL good for cholesterol levels no hypoglycaemia

Question 27

Thiazolidinediones adverse effects

Answer 27

weight gain GI upset oedema increase risk of HF, osteoporosis (older adults), bladder cancer and liver toxicity

Question 28

Exogenous and endogenous insulin difference

Answer 28

Exogenous - external substance injected in the body Endogenous - internal insulin made by pancreas

Question 29

exogenous insulin pharmacodynamics

Answer 29

increase glucose uptake in muscles and adipose tissues stimulate glycogen synthesis, glycolysis, protein synthesis inhibit lipolysis, ketogenesis and gluconeogenesis

Question 30

insulin is mainly administered where

Answer 30

Subcutaneous only - easiest access to fat layers and better absorption

Question 31

types of insulin

Answer 31

rapid acting short acting intermediate acting long acting

Question 32

insulin adverse effects

Answer 32

HYPOGLYCAEMIA weight gain lipohypertrophy - fat deposits from long-term use of impure insulin local allergic reactions systemic allergies

Question 33

nursing management for diabetes

Answer 33

encourage self-monitoring of BSLs healthy balanced diet, exercise, lifestyle adjustment and medication adherence awareness in long term management of consequences of HYPERGLYCAEMIA - CADs, retinopathy, nephropathy, dementia, PVD, neuropathy and cancer

Question 34

Hypoglycaemia occurs when

Answer 34

BSL is less than < 3.5 - 4.0 mmol/L - means your glycogen is depleted

Question 35

hypoglycaemia S&S

Answer 35

tremor, shaking, sweating, anxious, hunger, tachycardia, confusion, seizures and LOC

Question 36

causes of hypoglycaemia

Answer 36

fasting increased physical activity incorrect dose of insulin - usually high more alcohol no food

Question 37

happens when BSL is low but symptoms are absent (even low as < 2mmol/L

Answer 37

hypoglycaemia unawareness

Question 38

exogenous glucagon pharmacodynamics

Answer 38

causes breakdown of glycogen in the liver (glycogenolysis) to stimulate the release of glucose in the bloodstream increasing BSL REQUIRES stored glycogen - risk of depletion if the pt has exercised, fasted or drank alcohol without food