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Pharmacology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How many types of diabetes mellitus exist?

A

Type 1 (insulin dependent)
Type 2
Gestational - during pregnancy

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2
Q

Describe type 1 diabetes

A

Peak age for diagnosis 9-14
Autoimmune condition - not caused by lifestyle
Pancreas stops producing insulin
Need to take insulin for life

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3
Q

How common is type 1 diabetes?

A

Roughly 345,000 people live with type 1 in the UK

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4
Q

Describe type 2 diabetes

A

Occurs in people >40
Increasingly more frequent in children due to obesity
Insulin resistance and decreased production
Genetic and lifestyle factors

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5
Q

What is gestational diabetes?

A

Occurs between 24-28 weeks of pregnancy
Caused by hormones produced during pregnancy causing insulin resistance

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6
Q

What are the risk factors associated with gestational diabetes?

A

Obesity
Previous gestation diabetes
Previously had a large baby
Family history of diabetes
Asian/ African/ middle eastern background

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7
Q

Where are the micro vascular complications of diabetes seen?

A

Eye
Kidney
Nerves - Neuropathy

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8
Q

Where are the marcovasculature complications of diabetes seen?

A

Brain
Heart
Extremities

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9
Q

How is the eye damaged due to diabetes?

A

High blood glucose levels
High blood pressure
Damage eye blood vessels and cause retinopathy, cataracts and glaucoma

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10
Q

Explain how the kidney is damaged due to diabetes

A

High blood pressure - Damages small blood vessels
Excess blood glucose - overworks the kidneys resulting in neuropathy

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11
Q

Explain how nerves are damaged in diabetes

A

Hyperglycaemia - damages nerve in PNS
Results in pain and numbness
Feet wounds likely go undetected and get infected potentially leading to gangrene

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12
Q

How is the brain affected by diabetes?

A

Increased risk of stroke and cerebrovascular disease
Transient ischaemic attack
Cognitive impairment

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13
Q

How is the heart affected by diabetes?

A

High blood pressure
Insulin resistance
Increase risk of coronary heart disease

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14
Q

Describe the effect diabetes has on the extremities

A

Peripheral vascular disease from narrowing blood vessels
Increased of insufficient blood flow to legs
Feet wound go undetected and heal slowly which can contribute to gangrene

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15
Q

Why is insulin important?

A

Regulates
Carbohydrate ]
Fat ] Metabolism
Protein ]

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16
Q

What types of insulin exist?

A

Animal (pork and beef)
Human
Human analogues

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17
Q

How can insulin be classified?

A

Short duration, rapid onset
Intermediate action
Slow onset, long periods of time

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18
Q

What are the genetic factors in developing type 2?

A

Ethnicity
Higher rates in African, African-Caribbean and south Asian peoples

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19
Q

What are the environmental factors associated with type 2?

A

Obesity
Physical activity
Dyslipidaemia
Existing CVD
Medications (corticosteroids)

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20
Q

What dietary changes should be made to alleviate type 2?

A

Increase vegetables, whole grains and fibre
Reduce processed fats/ meats, sugar, salt
Eat more fish, beans, pulses, lentils

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21
Q

What other changes should be made by those with type 2?

A

Weight loss
Exercise
Smoking cessation

22
Q

What are the two ways of diagnosing type2?

A

HbA1c
Fasting venous plasma glucose

23
Q

Why is HbA1c ideal testing?

A

Represents average plasma glucose over the previous months without fasting

24
Q

What is the cut off for HbA1c?

A

Above 48 mmol/mol
Should repeat the test

25
Q

When is fasting venous levels used?

A

During pregnancy, anaemia, end stage CKD

26
Q

What are the aims of managing type 2?

A

Lower blood glucose levels
Provide relief of symptoms
Prevent micro / macro complications

27
Q

What symptoms are seen with type 2?

A

Thirst
Polyuria
Nocturia
Blurred vision
Infections

28
Q

What things are monitored in type 2 patients?

A

Blood glucose
Weight, height, BP, lipids
Renal function
Retinopathy
Podiatry
Distal pulse checks

29
Q

What is the difference in HbA1c targets for newly diagnosed and older patients?

A

New - tight glycaemic targets to improve short term micro and long term macro and mortality
Old - relaxed glycaemic targets, tight targets won’t help micro/macro but may cause harms

30
Q

What is the optimum BP for type 2?

A

<130/80 mmHg
<140/80 mmHg

31
Q

Where should you go to get information on best medications, efficacy, safety and cost?

A

NI formulary website

32
Q

What are the two dipeptidyl-4 inhibitors (DPP-4)?

A

1st choice - sitagliptin tablets
2nd choice - linagliptin tablets

33
Q

What hypoglycaemic agents and anti diabetic treatments exist?

A

Biguanides
Sulfonylureas
DPP-4 inhibitors
Thiazolidinedione
Sodium glucose Co transporter 2 inhibitors (SGLT2)
Glucagon like peptide 1 agonists (GLP-1)

34
Q

When should SGLT2 inhibitors be used instead of metformin?

A

Patient has heart failure
Established atherosclerotic CV disease
High risk of CV disease

35
Q

Why are biguanides (metformin) first line treatments?

A

Reduced mortality
Decreases hepatic glucose production
Increases insulin sensitivity
No weight gain or hypoglycaemia

36
Q

What is the side effect of metformin?

A

Nausea
Can be avoided when starting low and incrementally increasing the dose

37
Q

Where is SGLT2 found?

A

The proximal convulted tubule of the kidneys

38
Q

What do SGLT2 inhibitors do?

A

Reduce absorption of filtered glucose in the kidney
Increases the excretion of glucose into the urine

39
Q

What are the side effects seen with SGLT2 inhibitors?

A

Genitourinary infections
Excess diuresis
Weight loss
Small reduction in BP
Increased risk of diabetic ketoacidosis

40
Q

What do DPP-4 inhibitors do?

A

Increase secretion of insulin and lowers glucagon release

41
Q

What effects are seen with DPP-4 inhibitors?

A

No effect on weight gain
Modest effects on HbA1c
Low risk of hypoglycaemia
Small increased risk of acute pancreatitis

42
Q

What do thiazolidinediones do?

A

Reduce insulin resistance

43
Q

What adverse effects are seen when using thiazolidinediones?

A

Increased risk of heart failure, bladder cancer and fractures
Significant weight gain and fluid retention
Low risk of hypoglycaemia
Can use in renal impairment

44
Q

What do sulfonylureas do?

A

Stimulate release of insulin from the pancreas

45
Q

What effects are seen when using sulfonylureas?

A

Hypoglycaemia
Weight gain
Avoid in renal impairment

46
Q

How are GLP-1 agonists delivered?

A

Subcutaneous injection

47
Q

What do GLP-1 agonists do?

A

Stimulate insulin secretion
Reduces glucagon secretion
Reduces gastric emptying

48
Q

What side effects are associated with GLP-1 agonists?

A

Nausea reduced appetite
Weight loss
Low risk of hypoglycaemia
Can be used in moderate renal impairment
Rare reports of acute pancreatitis

49
Q

What are the three examples of GLP-1 agonists?

A

Liraglutide
Dulaglutide
Semaglutide

50
Q

What would the features of an ideal diabetic drug include?

A

Effect on blood glucose
Effect on mortality & CV outcomes
Test ability and quality of life
Reduced adverse effects
Reasonable cost
Ease of administration

Pharmacology (18 decks)

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