diabetes

Question 1

What is the definition of diabetes mellitus

Answer 1

it is a group of metabolic disorders in which persistent hyperglycaemia is caused due to deficient insulin secretion or by resistance to the action of insulin

Question 2

what are the three types of diabetes mellitus

Answer 2

type 1
type 2
secondary diabetes

Question 3

what may cause secondary diabetes

Answer 3

gestational diabetes

OR

pancreatic damage

Question 4

What are the symptoms of diabetes

Answer 4

Polyphagia
Polydipsia
Polyurea
Weight loss
Fatigue
Blurred Vision

Question 5

What does a patient need to present with to be diagnosed with diabetes

Answer 5

A patient must present with 2 or more of the symptoms

A random venous plasma glucose of 11.1mmol / l or more

A fasting plasma glucose of 7 mmol / l or more

An oral glucose tolerance test result of 11mmol / or more

Question 6

What would a patients random venous plasma glucose result be if they had diabetes

Answer 6

11.1mmol or more

Question 7

what would a patients fasting plasma glucose result be if they had diabetes

Answer 7

7mmol or more

Question 8

what would a patients ogtt result be if they had diabetes vs if they had impaired oral glucose tolerance

Answer 8

11.1 mmol or more for diabetes

7-11 mmol for impaired oral glucose tolerance.

Question 9

how would we monitor a patient with diabetes

Answer 9

we would take the hba1c as it is a good indicator of the three “opathy” complications

Question 10

how often should we take a hba1c for a type 1 patient

Answer 10

every three to six months

Question 11

how often should we take a hba1c for a type 2 patient

Answer 11

every 3 months till stabilized then every 6

Question 12

What is the process by which glucose is converted to acetylcoa which is later used for atp synthesis

Answer 12

glycolysis

Question 13

What is the process by which glucose is converted into glycogen

Answer 13

glyycogenesis

Question 14

what is the process by which acetylcoa are broken down into glucose

Answer 14

glyconeogenesis

Question 15

what is the process by which glycogen is converted to glucose

Answer 15

glycogenolysis

Question 16

what is the aim of treatment for type 1 iabetes

Answer 16

use insulin regiments to achieve optimal control of blood pressure

Question 17

what is the target hba1c for a type 1 diabetec

Answer 17

less than 48 mmol / l

Question 18

what is the target hba1c for a type 1 diabetic in %

Answer 18

less than 6.5%

Question 19

how many times a day should a type 1 diabetic measure their blood glucose

Answer 19

4 times

one before each meal and one before bed

Question 20

what are the rules around a type 1 diabetic driving

Answer 20

must inform dvla

must also take their blood glucose 2 hours before driving and 2 hours every 2 hours after

Question 21

what is the fasting glucose goal for a type 1 diabetic

Answer 21

5-7 mmol/l

Question 22

what is the aim for glucose before meals for type 1 diabetics

Answer 22

4-7 mmol / l

Question 23

what is the aim for glucose after meals for type 1 diabetics

Answer 23

5-9 mmol / l

Question 24

what is the minimum blood glucose a type 1 diabetic should have before driving

Answer 24

5mmol/l

Question 25

what is the gold star insulin regimen

Answer 25

basal - a baseline with intermediate or long acting insulin bolus - a rapid acting insulin before meals this mimics the bodys natural insulin production system

Question 26

what is a insulin regimen that is gaining popularity

Answer 26

continuous subcutaneous insulin infusion

Question 27

how does continuous subcutaneous insulin infusion work

Answer 27

it pumps a rapid acting insulin every hour as a baseline it then provides a bolus dose based off the meal and the number of calories it has

Question 28

For basal bolus insulin regimen what are the choices for the basal insulin

Answer 28

insulin detemir bd insulin glargine bd insulin determir od

Question 29

What type of insulin is insulin lispro

Answer 29

rapid

Question 30

what type of insulin is humalog

Answer 30

rapid - lispro

Question 31

what type of insulin is aspart

Answer 31

rapid

Question 32

what type of insulin is novorapid

Answer 32

rapid - aspart

Question 33

what type of insulin is glulisine

Answer 33

rapid

Question 34

what type of insulin is apidra

Answer 34

rapid - glulisine

Question 35

what type of insulin is fiasp

Answer 35

rapid - aspart

Question 36

what is the onset of action of rapid acting insulin

Answer 36

within 15 mins

Question 37

when is the peak of rapid acting insulin

Answer 37

1 - 2 hours

Question 38

what is the duration of action of rapid acting insulin

Answer 38

2 - 5 hours

Question 39

What additional ingredient does fiasp have that speeds up the onset of action

Answer 39

vitamin b3

Question 40

What type of insulin is actrapid

Answer 40

short acting

Question 41

what type of insulin is insuman rapid

Answer 41

short acting

Question 42

what type of insulin is humulin s

Answer 42

short acting

Question 43

what is short acting insulin also known as

Answer 43

soluble insulin

Question 44

When should we inject short acting insulin before food

Answer 44

15-30 mins before

Question 45

what is the onset of action of short acting insulin

Answer 45

30-60 mins

Question 46

what is the peak of short acting insulin

Answer 46

1-4 hours

Question 47

what is the duration of action of a short acting insulin

Answer 47

5-8 hours

Question 48

What is the benefit of being able to give short acting insulin intramuscularly / intravenously

Answer 48

Can give it to a patient who is not conscious i.e. if a patient has diabetic ketoacidosis

Question 49

What type of insulin is NPH

Answer 49

intermediate acting

Question 50

what type of insulin is isophane

Answer 50

intermediate acting

Question 51

what is the onset of action of intermediate acting insulin

Answer 51

1-2 hours

Question 52

what is the peak of intermediate insulin

Answer 52

3-12 hours

Question 53

what is the duration of action of intermediate insulin

Answer 53

11-24 hours

Question 54

what is intermediate insulin used in

Answer 54

biphasal insulin meaning two insulins together

Question 55

what are two examples of biphasal insulins

Answer 55

novodisk novonordisk humalog mix 25

Question 56

what type of insulin is insulin glargine

Answer 56

long acting

Question 57

what type of insulin is insulin detemir

Answer 57

long acting

Question 58

what type of insulin is inssulin degludec

Answer 58

long acting

Question 59

what type of insulin is lantus

Answer 59

glargine

Question 60

what type of insulin is levemir

Answer 60

detemirw

Question 61

what type of insulin is tresiba

Answer 61

degludec

Question 62

What is the duration of action of a long acting insulin

Answer 62

varies but can last up to 42 hours

Question 63

how long does it take to achieve a steady state level

Answer 63

2 - 4 days

Question 64

how often is insulin glargine given

Answer 64

bd

Question 65

how often is insulin degludec given

Answer 65

od

Question 66

how often is detemir given

Answer 66

od or bd

Question 67

name 3 dpp4 inhibitors

Answer 67

sitagliptin linagliptin saxagliptin

Question 68

what is the moa of a dpp4 inhibitor

Answer 68

prevents the breakdown of incretins increases insulin secretion reduces glucagon release

Question 69

when on a dpp4 inhibitor what medication doses may need to be reduced

Answer 69

insulin sulfonylurea

Question 70

when should we discontinue a dpp4 inhibitor

Answer 70

acute pancreatitis e.g. persistent and severe abdominal pain

Question 71

name an alpha glucosidase inhibitor

Answer 71

acarbose

Question 72

what is the moa of alpha glucosidase inhibitor

Answer 72

delays the digestion and absorption of starch and surcrose reducing blood glucose

Question 73

what are the main side effects of acarbose

Answer 73

diarrhoea gi discomort

Question 74

antacids with mg and aluminium are not suitable when treating a diabetic patient with what

Answer 74

acarbose

Question 75

can a pregnant or breastfeeding patient take acarbose

Answer 75

avoid

Question 76

what advice can we give around taking acarbose

Answer 76

tablets should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.

Question 77

what is the gold standard of diabetic type 2 treatment

Answer 77

use of a biguanide

Question 78

what is the most common biguanide

Answer 78

metformin

Question 79

what are the main side effects of biguanides

Answer 79

gi side effects that do pass after a couple of weeks

Question 80

how can we avoid the gi associated side effects of biguanides

Answer 80

start on a lower dose and build them up over weeks e.g. OD for a week before or after meals then bd etc

Question 81

what is the mechanism of action of biguanides

Answer 81

increased utilisation of glucose and decreases gluconeogenesis

Question 82

what is one of the major risks associated with the use of biguanides

Answer 82

lactic acidosis

Question 83

what is lactic acidosis

Answer 83

build up of lactic acid in blood

Question 84

name three sulponyl urea's

Answer 84

gliclazide glliplazide glibenclamide

Question 85

moa of sulphonylureas

Answer 85

act by stimulating the insulin release

Question 86

what are the main side effects of sulphonyl ureas

Answer 86

weight gain hypoglycaemia

Question 87

what are the cautions for sulphonyl ureas

Answer 87

elderly weight gain g6pd deficiency pregnant breastfeeding

Question 88

name two thiozolidinediones

Answer 88

pioglitazone rosiglitazone

Question 89

moa of thiozolidinediones

Answer 89

reduce insulin resistance reduce blood glucose concentration as the insulin is having better effect

Question 90

when pioglitazone is used alongside insulin what sort of disease has increased chance

Answer 90

cardiovasscular bladder cancer

Question 91

what are some rare but IMPORtant side effects of thiozolidinediones

Answer 91

liver dysfunction -> jaundice if this presents discontinue use

Question 92

can pioglitazone be used in pregnancy or breastfeeding

Answer 92

no

Question 93

what does sglt2 inhibitor stand for

Answer 93

sodium - glucose co transporter 2 inhibitors

Question 94

name 3 sglt2 inhibitors

Answer 94

canagliflozin dapagliflozin empagliflozin

Question 95

what is the moa of sglt2 inhibitors

Answer 95

inhibits the transporter located in the proximal convuluted tubule which reduces glucose reabsorption increase urinary excreation

Question 96

what are the ways in which sglt2 inhibs can be used

Answer 96

with metformin or as monotherapy

Question 97

Note what is there a risk of while using sglt2 inhibs

Answer 97

ketoacidosis fourniers gangrene

Question 98

what does the mhra reccomend aroudn the monitoring of the sglt2 inhibs

Answer 98

monitor ketones during surgical procedures and if they suffer from an acute medical illness

Question 99

what are the side effects of sglt2 inhibs

Answer 99

back pain balanoposthitis DKA

Question 100

can pregnant and breastfeeding women use sglt2 inhibs

Answer 100

no

Question 101

When a patient becomes unwell with diabetes what rules come into play

Answer 101

the sick day rules

Question 102

what do the sick day rules state in regards to lifestyle advice

Answer 102

Ensure to STAY HYDRATED DONT FAST IF CANNOT EAT take sugary drinks and or icecream to replace the blood sugar IF CAN BLOOD SUGAR MONITOR do every 2 - 4 hours IF NOT look out for signs of hyperglycaemia

Question 103

what are some signs of hyperglycaemia

Answer 103

Thirst Polyurea Weight loss Fatigue

Question 104

What medications need to be stopped when sick day rules come into place

Answer 104

Metformin Sulfonylurea GLP-1 Analogues SGLT2 Inhibitors

Question 105

Why does metformin need to be stopped during sick days

Answer 105

increased chance of lactic acidosis due to the increased thirst when we are sick

Question 106

Why do Sulphonylureas need to be stopped during sick days if cannot eat or drink

Answer 106

If unable to eat or drink then makes more prone to hypoglycaemia

Question 107

Why do GLP-1 Analogues need to be stopped during sick days

Answer 107

dehydration leads to higher chance of serious side effects

Question 108

Why do SGLT2 Inhibitors need to be stopped during sick days

Answer 108

higher chance of keto acidosis

Question 108

what adjustment to the insulin should be made when we are taking a sick day and we have a blood glucose of less than 4 mmol/ l

Answer 108

firstly treat the hypo by having a sugar snack e.g. jelly babies or ice cream then reduce the regular insulin dose by 20%

Question 109

what adjustment to the insulin should be made when we are taking a sick day and we have a blood glucose of more than 13mmol/l

Answer 109

Take carbs as a meal replacement Sip sugar free fluids 100ml per hour to stay hydrated Increase insulin dose by either 2, 4 or 6 units to increase depending on how high it is over 13 if < 17 then 2 if < 22 then 4 if > 22 then 6

Question 110

What non diabetic medications may need to be stopped on a sick day for a diabetic patient

Answer 110

ace inhibitor angiotensin receptor blocker diuretics nsaids