HD46-7 Diabetes

Question 1

Why is blood glucose raised in type 1 diabetes?

Answer 1

• Due to autoimmune destruction of beta cells= insulin

Question 2

Why is blood glucose raised in type 2 diabetes?

Answer 2

• Due to combination of insulin resistance and relative insulin lack

Question 3

what are the types of diabetes?

Answer 3

1, 2 , gestational, or secondary to other condition

Question 4

Uses of measurements of glycated Haemoglobin:

Answer 4

Diagnosis can also be made by HbA1c level of over 48mmol/mol

This test is also used over a few weeks to measure success of tx.

Question 5

Does this raise or lower blood glucose?

food

Answer 5

raise

Question 6

Does this raise or lower blood glucose?

starvation

Answer 6

lower

Question 7

Does this raise or lower blood glucose?

glucagon

Answer 7

raise

Question 8

Does this raise or lower blood glucose?

adrenaline

Answer 8

raise

Question 9

Does this raise or lower blood glucose?

cortisol

Answer 9

raise

Question 10

Does this raise or lower blood glucose?

growth hormone

Answer 10

raise

Question 11

Does this raise or lower blood glucose?

Insulin

Answer 11

lowers

Question 12

Does this raise or lower blood glucose?

anti-diabetic drugs

Answer 12

lowers

Question 13

Does this raise or lower blood glucose?

illness

Answer 13

raises

Question 14

Does this raise or lower blood glucose?

stress

Answer 14

raises

Question 15

Does this raise or lower blood glucose?

excersize

Answer 15

lowers

Question 16

Which 4 hormones increase glucose levels?

Answer 16

1. Glucagon – made by a alpha cell of islets of Langerhann in pancreas = make
2. Adrenaline
3. GH
4. Cortisol – hydrocortisone steroid hormone

Question 17

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sulphoylureas

Answer 17

secretagogue

can cause hypoglycaemia and weight gain

Question 18

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
gliclazide

Answer 18

secretagogue
(a type of sulphonyureas )
(can cause hypoglycaemia and weight gain)

Question 19

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
DPP4 inhibitors

Answer 19

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

Question 20

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sitagliptin

Answer 20

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

Question 21

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
vildagliptin

Answer 21

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

Question 22

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
GLP-1 binder

Answer 22

tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

Question 23

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
exanetide

Answer 23

-tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

Question 24

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
liraglutide

Answer 24

tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

Question 25

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion: biguanides

Answer 25

biguanides (metformin) | sensitiser

Question 26

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion: metformin

Answer 26

biguanides (metformin) | sensitiser

Question 27

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion: thiazolidines

Answer 27

thiozolidinediones ("glitazones"e.g. pioglitazone | sensitiser

Question 28

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion: pioglitazone

Answer 28

thiozolidinediones ("glitazones"e.g. pioglitazone | sensitiser

Question 29

it a secretagogue or sensitzer, or does it delay carbohydrate absortion: acarbose

Answer 29

3. Delayed carbohydrate absorption: | Acarbose: alpha-glucosidase inhibitor (rarely used= wind)

Question 30

it a secretagogue or sensitzer, or does it delay carbohydrate absortion: guar gum

Answer 30

delayed carb absorption

Question 31

it a secretagogue or sensitzer, or does it delay carbohydrate absortion: alpha glucosidase inhibitors

Answer 31

3. Delayed carbohydrate absorption: | Acarbose: alpha-glucosidase inhibitor (rarely used= wind)

Question 32

Short acting types of insulin:

Answer 32

soluble e.g. actrapid, humulin S, 2) insulin aspart e.g. novorapid 3) insulin lispro e.g. humalog

Question 33

intermediate / long acting types of insulin

Answer 33

1) isophane insulin e.f. humulin I, insulatard 2) insulin glargine e.g. lantus 3) insulin detemir e.g. levemir

Question 34

Biphasic types :

Answer 34

1) biphasic isophane insulin 2) biphasic insulin aspart 3) biphasic lispro

Question 35

concs of soluble in insulin to isophane in biphasic isophane insulin:

Answer 35

30% soluble, 70% isophane | mixtard 30 or Humulin M3

Question 36

concs of insulin aspart to isophane in biphasic aspart insulin:

Answer 36

30% insulin aspart 70% aspart protamine (novomix)

Question 37

concs of insulin lispro to isophane in biphasic lispro insulin:

Answer 37

25% lispro | 75% lispro protamine

Question 38

2 ways of taking insulin injections other than the insulin pump:

Answer 38

1) basal-bolus (Can check insulin level before they eat and adjust the amount of insulin they need to inject in accordance with the amount of carbohydrate they are going to eat, take a intermediate action one in morning or night) 2) Twice daily (take soluble and isophane insulin twice so don't have to inject at lunch)

Question 39

group the following newer modified insulin into very long acting and very quick acting: glulisine glargine,lispro, aspart, detimir

Answer 39

Newer modified insulins • Very long acting – glargine, detimir • Very quick acting – lispro, aspart, glulisine

Question 40

what are the 3 acute complications of diabetes:

Answer 40

ketoacidosis (type 1) • Hyperosmolar hyperglycaemic state (type 2) • Hypoglycaemia – complication of treatment

Question 41

what are the chronic complication of diabetes:

Answer 41

``` • Microvascular o Retinopathy o Neuropathy o Nephropathy • Macrovascular o Peripheral o Coronary o Cerebral • Neuropathy • Foot problems ```

Question 42

true or false | Microvascular problems and foot problems are unique to diabetes

Answer 42

true

Question 43

What is Diabetic cheiroarthropathy

Answer 43

limited joint mobility can't flatten hands, occurs in those with diabetic neuropathy

Question 44

Prevention of long-term complications

Answer 44

``` • Meticulous glucose control - difficult • Control of blood pressure • Avoidance/treatment of other risk factors o Smoking o Hyperlipidaemia o Obesity o Inactivity • Early detection and management - SCREENING ```

Question 45

How is the following complication of diabetes treated:• Retinopathy

Answer 45

laser photocoagulation (burns out bits of ischemic retina)

Question 46

How is the following complication of diabetes treated: Nephropathy

Answer 46

ACE inhibition, dialysis & transplantation

Question 47

How is the following complication of diabetes treated: Neuropathy

Answer 47

advice about foot care = amputation if necessary

Question 48

How is the following complication of diabetes treated: PVD

Answer 48

peripheral vascular disease (ache in leg)– bypass surgery, angioplasty with stents or amputation

Question 49

How is the following complication of diabetes : | foot ulcers

Answer 49

chiropody, protection from pressure, good footwear & surgery

Question 50

What hospital procedures require diabetics to fast?

Answer 50

.e. endoscopy | • For short procedures ‘fast and check’

Question 51

for short procedures in hospital operations for diabetics, how are they carried out different to normal?

Answer 51

* Omit morning insulin/tablets and breakfast * Do procedure first on list * Give treatment and breakfast immediately afterwards

Question 52

for major/longer procedures in hospital operations for diabetics, how are they carried out different to normal?

Answer 52

• Intravenous treatment with drip and insulin • GKI – glucose, potassium, insulin infusion o Monitor glucose hourly – adjust insulin content of bag to keep between 6 and 12

Question 53

GKI is given IV during major operations, All recipes contain: 2) glucose is monitored hourly, what is the range of gluc conc that is considered fine?

Answer 53

glucose , insulin and potassium | 2) 4-10

Question 54

``` what is the folloowing a recipe for: • 10% dextrose 500ml • 10mmol KCl • 16u soluble (short-acting) insulin • Rate 100ml/hour ```

Answer 54

GKI

Question 55

in a major hospital op a pt is recieving GKI via IV, there blood glucose falls to bellow 6 and is falling after 2 hours into the operation. What is the response? 2) what is the infusion rate at the start of the operation and after replacing the GKI

Answer 55

replace GKI with one containing 4 less units of insulin. , diet diabetic may not need insulin but stress and illness may alter glucose levels so monitor glucose 2)2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour

Question 56

in a major hospital op a pt is recieving GKI via IV, there blood glucose is above to and rising after 2 hours into the operation. What is the response? 2) what is the infusion rate at the start of the operation and after replacing the GKI?

Answer 56

replace bag with one containing 4 more units of insulin | 2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour