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Clinical Pharmacy > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is the definition of diabetes?

A
  • a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both
  • may result in long term microvascular, microvascular and neuropathic complications
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2
Q

What is the main neuropathic complication of that arises in diabetes?

A
  • loss of feeling in their feet
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3
Q

What is the definition of type 1 diabetes?

A
  • primarily result of pancreatic beta cell destruction and prone to ketoacidosis
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4
Q

What is the definition of type 2 diabetes?

A
  • may range from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance
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5
Q

What is the definition of gestational diabetes?

A
  • glucose intolerance with onset or first recognition during pregnancy
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6
Q

Why goes blood glucose exponentially increase in diabetes?

A
  • cells start to lose their energy source and start to starve (but there is glucose in the blood still - the body starts to produce more glucose when there is not enough insulin. One of the diagnostic components of diabetes is high blood pressure
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7
Q

What is the definition of the fasting plasma glucose?

A
  • may also be known as fasting glucose test
  • blood tests are performed when the patient has not eaten or had anything to drink for several hours (generally 8-10 hours)
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8
Q

What is the definition of the glycosylated hemoglobin (A1C) test?

A
  • may be referred to as hemoglobin A1C
  • measures the percentage of hemoglobin that is coated with sugar (ie. glycated)
  • reflects the average blood glucose control for the preceding 2-3 months (120 days)
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9
Q

What is the definition of the oral glucose tolerance test (OGTT)?

A
  • a dose of glucose is given to the patient to drink and then blood glucose levels are measured. Usually, patient is fasting prior to test and blood glucose is taken before and then 2 hours after the test
  • used to determine the body’s ability to break down and use carbs
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10
Q

What are the test results that constitute pre diabetes?

A
  • impaired fasting glucose (6.1 - 6.9)
  • impaired oral glucose tolerance test (7.8-11.1) and A1C of 6 - 6.4%
  • at a high risk of developing diabetes and its complications
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11
Q

A1C helps to predict microvascular disease and is an average over _____ months

A

2-3

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12
Q

What is the symptom progression of type 1 diabetes vs type 2 diabetes

A

type 1 diabetes will show diabetes symptoms very rapidly – this is why we do NOT use the A1C test in them. There can be a lot of progression over the course of the 2 months

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13
Q

What constitutes metabolic syndrome?

A 
Multifaceted condition
- abdominal obesity 
- hypertension 
- dyslipidemia 
- insulin resistance 
- dysglycemia 
Increased risk of diabetes and CVD
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14
Q

What test results can constitute a diagnosis of diabetes?

A
  • fasting plasma glucose: > 7 mm/L
  • A1C > 6.5% (in adults)
  • 2 hour plasma glucose value in an oral glucose tolerance test of 75 g > 11.1 mmol/L
  • random plasma glucose test of 11.1 mmol/L
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15
Q

What is the definition of polycystic ovarian syndrome?

A
  • inappropriate gonadotropin secretion and hyperinsulinemia results in excess androgen production and potential an anovulation
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16
Q

What are the long term effects of polycystic ovarian syndrome?

A
  • glucose intolerance, dyslipidemia, increased blood pressure
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17
Q

Who should be screened for type 2 diabetes?

A
  • anyone over 40 years old should be screened every 3 years

- individuals at high risk should begin screening earlier and more often

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18
Q

What are some of the prevention parameters that should be done with patients with an IGT, IFG or an A1C of 5.7 - 6.4%?

A

-should be referred to an effective ongoing support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 minutes a week of moderate activity such as walking

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19
Q

When can metformin therapy be started for prevention of type 2 diabetes?

A
  • must be considered in those with IGT, IFG or an A1C of 5.7 - 6.4%, especially in those with a BMI >35 kg/m2, <60 years and women with prior GDM
    (typically it is started whenever the A1C is above 8.4)
20
Q

What are the goals of therapy of diabetes treatment?

A
  • to decrease/prevent symptoms
  • improve quality of life
  • reduce risk of microvascular and macrovascular complications
  • reduce mortality
21
Q

What is the action of metformin?

A

(a biguanide)

  • acts as an insulin sensitizer
  • reduces A1C by 1.5% to 2%
  • modest effect on decrease in weight and cholesterol
  • renal elimination
22
Q

Should metformin be taken with food?

A
  • yes, it helps to reduce the GI effects
23
Q

What are some of the most common side effects associated with taking metformin?

A
  • GI side effects (abdominal discomfort, stomach upset, diarrhea)
  • metallic taste
  • interference with vitamin B12 absorption
  • hypoglycemia with intense exercise
  • lactic acidosis
24
Q

What are the contraindications and cautions of using metformin?

A
  • renal and hepatic dysfunctions - dose reduction in renal insufficiency
25
Q

If patient is undergoing a diagnostic rest using ________, need to withhold metfomin prior to or at any time of procedure and for at least 48 hours afterwards

A

iodinated contract media

26
Q

What are the diagnostic treatment goals in type 1 and type 2 diabetes?

A
  • A1C: < 7.0%
  • PreMeal or FPG (mmol/L): 4.0 to 7.0
  • 2 hours after meals (mmol/L): 5-10
27
Q

What can a person be at risk for if they have an A1C under 6.5%?

A

patients here can be at a high risk of kidney or cancer diseases

28
Q

What was found when there was tight glucose control using insulin in style 1 diabetics?

A
  • reduced progression and incidence of retinopathy
  • reduced microalbuminuria
  • reduced clinical neuropathy
29
Q

The frequency of self-monitoring depends on what:

A
  • type of diabetes
  • type of therapy
  • glycemic control
  • patient factors (literacy and numeracy)
  • hypoglycemia: risk and awareness
  • occupation
  • acute illness
30
Q

What are some of the healthy eating tips that should be followed in diabetes?

A
  • have 3 meals a day at regular times and no greater than 6 hours apart. Healthy snacks can be beneficial
  • eat more high fibre foods
  • encourage water drinking when thirsty
  • decrease sugars and sweet items
  • decrease high fat food
  • encourage physical activity
31
Q

What are the 3 examples of sulfonylureas?

A
  • gliclazide, glimepiride, glyburide
32
Q

What is the MOA of sulfonylureas?

A
  • enhance insulin secretion
  • decrease A1C by 1.5%
  • risk of hypoglycaemia
  • can cause weight gain
33
Q

What difference must be made in dosing with those that are on sulfonylureas and also have renal insufficiency?

A
  • the initial dosing, dose increments and maintenance dosage should be lower to avoid hypoglycaemia
34
Q

What are the two drugs that make up the drug class meglitinides?

A
  • nateglinide

- repaglinide

35
Q

What is the MOA of meglitinides?

A
  • stimulate insulin secretion
  • require presence of glucose to stimulate insulin secretion. When glucose levels return to normal, stimulated insulin secretion diminishes
36
Q

Do we want to use both a sulfonourea and a meglitinide?

A
  • NO. we do not, they have the same MOA
37
Q

What is the method of weight loss when using orlistat?

A
  • reduces up to 30% of dietary fat absorption

- absorption of fat soluble vitamins may be affected

38
Q

What are the SE of using orilistat?

A
  • fatty oily stools, fecal urgency, fecal incontinence, oily spotting, abdominal discomfort and flatulence
39
Q

What are the early symptoms of hypoglycaemia?

A
  • sweating
  • hunger
  • shakiness
  • palpitations
  • anxiety, irritability, mood or behavioural changes
  • numb lips or tongue
  • headache
40
Q

What may hypoglycaemia progress to?

A
  • blurred vision
  • confusion
  • slurred speech
  • convulsions
  • coma
  • death
41
Q

What is the recommended treatment for hypoglycemia?

A
  • oral ingestion of 15 g of carbohydrate preferably as glucose or sucrose tabs or solution of hydrolyzed polysaccharide
  • typically will produce and increase in blood glucose of 2.1 mol/L within 20 minutes
  • these are preferred over orange juice or glucose gels which are slower to work
42
Q

After ingesting of glucose tablets, wait 15 minutes and test the blood glucose- if it is still under _______, then take another 15 g of glucose

A

4.0 mmol/L

43
Q

What should be done as soon as possible after taking a glucose tablet to maintain blood sugar and prevent another episode?

A
  • the patient should eat a carbohydrate and protein as soon as they can (snack should be 15g of carb plus a protein)
44
Q

Diabetics are at a higher risk of experiencing a ________ and slower rate of ______

A

skin infection

- healing

45
Q

What gives diabetics an impaired defence against infections?

A
  • hyperglycemia
  • poor circulation (from vascular abnormalities)
  • peripheral neuropathy

Clinical Pharmacy (24 decks)

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