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Pre-reg > Revise Pharma Diabetes > Flashcards

Revise Pharma Diabetes Flashcards

1
Q

what are the different causes of all types diabetes?

A
  • deficient insulin secretion (T1)
  • resistance of the action of inuslin (T2)
  • medication (steroids)
  • gestational
  • pancreatic impairment
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2
Q

do all diabetic patients need to alert the DVLA?

A

only those on insulin

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3
Q

what are drivers assessed on in terms of driving?

A

the awareness of hypoglycaemia
so the capability of the bringing their vehicle to a safe controlled stop

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4
Q

how many groups of drivers are there?
give examples

A

2
group 1 = normal car drivers
group 2 = lorrys etc

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5
Q

what are the group 1 driver requirements? (what do they need to be able to do and how many hypo episodes)

A
  • adeqaute awareness of hypoglycaemia
  • no more than 1 episode of severe hypoglycaemia whilse awakw in the preceeding 12 months
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6
Q

what are the group 2 driver requirements? (what do they need to be able to do and how many hypo episodes. glucose monitoring? visual compliactions?)

A
  • full awareness of hypoglycaemia
  • no episodes of hypoglycaemia
  • must report all episodes of hypoglycaemia including those in sleep
  • must use blood glucose monitor with suffiecient memory to store 3 months of readings
  • any visual complications must notify DVLA and don’t drive
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7
Q

what is the advice from the DVLA to diabetics? (5 things)

A
  1. drivers treated with insulin should always carry a glucose meter and blood glucose strips
  2. check blood glucose conc no more than 2 hours before driving and every 2 hours while driving
  3. blood glucose should always be above 5mmol/l while driving
  4. if falls below 5 take a snack
  5. ensure supply of fast acting carbohydrate in vehicle
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8
Q

what level should glucose be whilst driving?

A

5mmol/l

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9
Q

what blood glucose level is considered hypo whilst driving?

A

<4mmol/l

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10
Q

what should drivers do if they have hypo?

A
  1. safety stop
  2. switch off engine, remove keys from ignition, move from drivers seat
  3. eat/drink sugar source
  4. wait 45mins after blood glucose has returned to normal
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11
Q

what should driver do if hypoglycaemia awareness has been lost?

A

inform DVLA and do not drive

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12
Q

what is T1DM characterised by?

A

insulin deficiency - destroyed beta cells in islets of langerhan - most common before adulthood

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13
Q

what are the typical features of T1DM?

A
  • rapid weight loss
  • fam hx of autoimmune disease
  • hyperglycaemai >11mmol
  • ketosis
  • BMI <25kg/m2
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14
Q

how many times a day do t1DM need to monitor?

A

QDS - before each meal and before bed

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15
Q

whats the glucose target on waking?

A

5 - 7mmol/l

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16
Q

what is the glucose target level before eating?

A

4 - 7 mmol/l

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17
Q

whats the glucose target after eating?

A

5 - 9mmol/l

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18
Q

whats the 1st line insulin regimen for T1DM?

A

basal bolus = long/intermediate OD/BD
then short/rapid before meals

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19
Q

whats the first and second line choices of insulin in basal bolus?

A

1st line = detimer
2nd = glargine

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20
Q

in what 3 situations do insulin requirements increase?

A

infection
stress
trauma

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21
Q

when do you need to reduce insulin requirements?

A

physical activity
intercurrent illness
reduced food intake
impaired renal function
endocrine disorders

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22
Q

why does insulin need to be given SC?

A

would be inactivated by GI enzymes as is a protein

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23
Q

what areas of the body are best to inject insulin?

A

areas with plenty of SC fat

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24
Q

what areas of the body has the fastest insulin absorption? where is slower?

A

fastest = abdomen
slower = outer thigh, buttocks

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25
Q

why do you need to rotate injection site?
what are the risks of this?

A

risk of lipohypertrophy due to injecting in same area = leads to erratic absorpion of insulin

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26
Q

what are the 2 subtypes of short acting insulins?

A

soluble and rapid acting

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27
Q

what is soluble insulin?

A
  • human + bovine/ porcine
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28
Q

how long before meals do you need to inject souble insulin?
whats the onset?
how long does soluble insulin work for?

A

15 - 30mins
onset = 30 - 60 mins
works for up to 9 hours

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29
Q

name 3 rapid acting insulins?
NO LAGing

A

lispro, aspart, glulisine

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30
Q

when do you inject rapid acting?
whats the onset?
whats the duration?

A

immediately before meal
onset - 15 mins
duration 2 - 5 hrs

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31
Q

what HbA1c is considered prediabetic?

A

42 - 47 mmol/l

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32
Q

what HbA1c is considered diabetic?

A

> 48mmol/l

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33
Q

what targets are T2DM now given?

A

an indivudually agreed threshold agreed by Dr

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34
Q

whats section 1 to the pathway for T2DM (low CVD risk)?

A
  1. assess HbA1c, kidney function and CV risk
    treat with metformin
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35
Q

whats section 2 to the pathway for T2DM (low CVD risk)?

A
  1. if HbA1c still not controlled then add in DDP4i, sulfonylurea, SGLT2i or pioglitazone
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36
Q

whats section 3 to the pathway for T2DM (low CVD risk)?

A
  1. triple therapy if HbA1c still uncontrolled by adding/swaping class of antidiabetic
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37
Q

what factors mean someone with T2DM is high risk?

A

established atherosclerotic disease, heart failre, QRISK >10%

38
Q

whats the treatment pathway for someone with T2DM and CV risk?

A
  1. treat with metformin
  2. once metformon tolerated add SGLT2i
39
Q

what drug do you treat T2DM with if a patient with high CV risk doesn’t tolerate metformin/mr metformin?

A

SGLT2i alone

40
Q

whats the 1st thing to do if a pt cant tolerate merformin SE?

A

switch to mr

41
Q

what do you do if a pt os resisitant to all metformin preperations?

A

DDP4i, sulphonyurea, pioglitazome
SGLT2i if high CV risk

42
Q

what are the 3 main SE with metformin?

A

lactic acidosis
GI effects
B12 deficiency

43
Q

what eGFR should you avoid metformin in and why?

A

30ml/min due to lactic acidosis risk

44
Q

when do you need to hold metformin?

A

when acutely unwell due to AKI risk

45
Q

name the 2 short acting sulphonylureas

A

gliclazide
tolbutamide

46
Q

name 2 long acting sulphonylureas

A

glibeclamide
glimpride

47
Q

why should you avoid long acting sulphonylureas in the elderly?

A

associated with prolonged and sometimes fatal hypoglycaemia

48
Q

what are 3 side effects of sulphonylureas?

A
  1. high risk of hypoglycaemia
  2. need to avoid prescribing in acute porphyria
  3. avoid in hepatic and renal impairment
49
Q

in patients with heart failure, what antidiabetic should you avoid?

A

piogliazone

50
Q

what antidiabetic should you avoid in patients with bladder cancer/hx of bladder cancer?

A

pioglitazone

51
Q

what antidiabetic should you avoid in pts with high risk of bone fractures?

A

pioglitazone - increases risk of bone fractures

52
Q

as piogliazone increases risk of bladder cancer, what monitoirng should be in place?

A
  • review safety and efficacy after 3 - 6 months
  • stop treatment if pt doesn’t have much benefit
  • report signs of haematuria, urinary urgency
53
Q

does pioglitazone cause renal or liver toxicity?

A

liver toxicity

54
Q

what do DDP4i end in? name some

A

gliptin
alogoliptin
linagliptin
saxagliptin
sitagliptin
vildagliptin

55
Q

what is the main risk with DDP4i?
what are the symptoms?
what should you do to the medicine?

A

pancreatitis
signs - persistnet abdo pain
discontinue

56
Q

what DDP4i can cause heptaotoxicity?

A

new one - vildagliptin

57
Q

what are the 4 MHRA warnings with SGLT2i?

A
  1. severe DKA risk
  2. need to monitor ketones if treatment interrupted for surgical prodcedure or illness
  3. fourniers gangrene
  4. risk of lower limb amputation (canglifozin only)
58
Q

what 3 SGLT2i require renal funciton monitoirng?

A

canaglifozin, dapaglifozin, empaglifozin

59
Q

what should you do if a patient is volume depleted and needs to start SGLT2i?

A

correct hypovolaemia before starting
NB makes pt wee a lot

60
Q

whats the MHRA warning with GLP-1 agonists?

A

DKA risk - especially when sed with insulin and insulin dose reduced rapidly

61
Q

along with DDP4i, what other class of antidiabetic drug can cause acute pancreatitis?

A

GLP1 agonists

62
Q

why is there a risk of dehydration with GLP1 agonists?

A

due to GI side effects - need to avoid fluid depletion

63
Q

if someone if being treated with meglitides (nateglinide, repaglinide) what should you do in stress expousre?

A

treat interruption and replacement with insulin to maintain glycaemic control

64
Q

what antibiabetics cause weight gain?

A

pioglitazone, sulphonylureas

65
Q

what antidiabetics are weight neutural?

A

DDP4i

66
Q

what antidiabetics cause weight loss?

A

metformin, glp 1 agonists, sglt2i

67
Q

what patients need a low dose statin?

A

all type 1
offerred to age 40+, diabetic for 10+ years, nephropathy or other CVD risk factors

68
Q

what antihypertensive is given to diabetics?

A

ACEi

69
Q

when do you add an ACEi/ARB for nephropathy?
what are the risks associated with it?

A

when its causing proteinuria
can potentiate the signs of hypoglycaemia

70
Q

what cuases diabetic foot?

A

diabetic neuropathy

71
Q

what are the 5 parts to diabetic neuropathy?

A
  1. painfu peripheral neuropathy
  2. autonomic neuropathy (diarohea)
  3. neuropathy postural hypotension
  4. gustatory sweating
  5. erectile dysfunction
72
Q

how often to diabetics need eye checks ?

A

annually

73
Q

what is DKA characetrised by?

A

severe hypoerglycaemia

74
Q

what are the symptoms of DKA?

A

pear drop breath
polyuria
thirsty
confusion
lethargy
deep/fast breathing
confusion

75
Q

what ketone level means pt at increased risk of DKA? what should you do?

A

1.6 - 2.0
refer to gp

76
Q

what ketone level means medical emergency?

A

3.0

77
Q

what drugs are used to treat DKA?

A

NaCl
insulin
glucose

78
Q

at what time point do you stop DKA treatment?

A

1 hour after food

79
Q

how long do you continue insulin to treat DKA? (what does the ketone level and pH need to be?)

A

<0.3
pH 7.3

80
Q

what do you need to do to insulin for elective surgery, minor procedure and good glycaemic control?

A

day before: reduce OD long acting by 20%
rest as usual

81
Q

what do you do to insulin for major surgery or poor glycaemic control?

A

day before = reduce OD long acting by 20%, rest as normal
on day: reduce OD long acting by 20%, stop other insulin until pt eating
- IV infusion of glucose
- variabe rat einsulin
- hourly blood glucose for 12 hrs

82
Q

what should you do in major surgery in glucose dips under 6mmol/l?

A

give IV glucose 20%

83
Q

what are the SICK day rules?

A

sugar levels - blood glucose should be checked regularly
Insulin - carry on taking it
Carbohydrates - keep eating and hydrated
Ketones - measre regularly

84
Q

what HbA1c level should pateints with diabetes who want to get pregnant aim for?

A

<48mmol/l

85
Q

what dose folic acid is given to pregnant diabetics?

A

5mg

86
Q

whats the insulin of choice in pregnancy?

A

isophane

87
Q

can antidiabetic drugs be continued during pregnancy?

A

only metformin
pts should be switched to insulin unless taking metformin

88
Q

do you continue antidiabetic treatment after birth in gestational diabetes?

A

no

89
Q

how do you manage gestational diabetes when fasting BG <7mmol/l?

A

diet ans exercise for 2/52, if requirements not met then start metformin

90
Q

how should you manage gestatinal diabetes in fasting BG >7mmol/l ?

A

diet and exercise + insulin and/or metformin

Pre-reg (47 decks)

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