Type I Diabetes Mellitus Flashcards
What does diabetes cause?
Diabetes is a major cause of blindness,
kidney failure, heart attacks, stroke and
lower limb amputation
Diabetes types?
Type 1 (β-cell destruction, usually leading to
absolute insulin deficiency), 5-10%
Type 2 (Insulin resistance with relative insulin
deficiency), 90-95%
Insulin function?
-Regulates glucose metabolism
-Inhibits the release of glucagon
-↑ lipogenesis
- ↓ Lipolysis
- ↑ amino acid transport into
cells
-↓ blood levels of glucose,
free fatty acids and ketones
Types of insulin?
- Ultra fast-acting
- Fast-acting
- Intermediate to long acting
- Biphasic
- Ultra long-acting
Ultra fast-acting :
- Drugs
- Type of solution
- Hexamers
- OOA
- DOA
- Peak action
- Drugs:
Lispro, Aspart, Glulisine - Type of solution;
Clear solution - Hexamers:
Weak hexamers - OOA: 10-15mins
- DOA: 3-5hrs
- Peak action: 45-90mins
Short-acting insulin
- Complex
- Type of insulin
- Admin in emergency
- OOA
- DOA
- Complex:
Soluble Zn-insulin complex - Type of insulin:
Regular / soluble / human insulin - Admin in emergency: IV in emergency
- OOA: 30mins
- DOA: 6-8hrs
Intermediate-acting insulin:
- Type of solution
- Formulation
- OOA
- DOA
- Type of solution:
-Cloudy solution – crystal formation
-Protamine in phosphate buffer – isophane
(NPH) – 6 insulin : 1 protamine
- Formulation:
-Formuled with Zn or protamine - OOA: 1-3HRS
- DOA: 18-20hrs
Premixed insulin:
- Combination
- OOA
- DOA
- Combination:
Combination of short and intermediate-acting insulin - OOA: 30mins
- DOA: 24hrs
Long-acting insulin drugs?
DDG
- Glargine
- Detemir
- Degludec
Glargine OOA and DOA?
OOA: 1hr
DOA: 24hr
Detemir OOA & DOA?
OOA: 1-2hrs
DOA: 20hrs
Degludec OOA & DOA?
OOA: 30-90mins
DOA: >24HRS
DI for hypoglycaemic and hyperglycaemic effects?
Hyperglycaemic effects: GED
- Glucocorticoster-oids
2.Glucagon - Estrogens
- Diuretics
Hypoglycaemic effects: SABA
- Alcohol
- Salicylates (aspirin)
- βeta blockers
- ACE inhibitors (eg captopril)
Drugs that mask hypoglycaemia?
Beta-blockers
eg: Propanolo, carvedilol
Therapeutic treatment regimes?
- Basal Bolus injection
- Daily regime
- Once daily regime
Basal bolus regimen
-30-45 min preprandial – short-acting 60% total daily dose in 3 divided doses
-Bedtime – intermediate acting
40% total daily dose
-Alternative: ultra-long acting at bedtime
Twice daily regimen?
-Mixed short and intermediate-acting
-Breakfast – 67%; Supper – 33%
-If hyperinsulinemia occurs late evening\
hypoglycemia
→ hyperglycaemia
Somogyi phenomenon
Once daily regimen?
Elderly, Type 2 diabetics – before bedtime, use
intermediate acting with oral hypoglycaemic
agent
Pharmacology of Insulin S/E?
.1 Lipohypertrophy/Lipodystrophy
- Hypoglycaemia (tachycardia, tremors, polyphagia,
confusion, vertigo) - Allergic skin reactions
Insulin treatment:
- Pregnancy
- Lactation
- Illness
- Pregnancy –
- Agent of choice for treatment of diabetes (Both DB I &
DB II)
- Doses may require adjustment - Lactation –
- Not excreted in breast milk - Illness – insulin requirements increase
Insulin CI?
Hypoglycaemia
Insulin of injection?
Sites of injection must be rotated regularly
Insulin & massaging site of injection?
Massaging site of injection ↑ absorption by 10-20%
Insulin and meals?
Time of injection prior to meal is NB
Insulin and changing regime?
Changing patient’s insulin type & regimen should be
avoided
Insulin pump QOL?
insulin pump (ultra fast acting insulin) ↑ QOL
