Intro to diabetes Flashcards
What are the 4 T’s in identifying type 1 diabetes in children?
Toilet
Thirsty
Tired
Thinner
What is Diabetic Ketoacidosis (DKA)?
The body completely switches to lipid metabolism - the body cannot process glucose so excretes in urine.
Glycogen is stored as fat - body starts burning fat - produces ketones and fatty acids
How does type 2 diabetes present?
- Often not symptomatic
- Like type 1 but slower onset and less extreme
- Increased episode of genital thrush
- Slow wound healing
- Tends to be in older patients with larger BMI
What are the characteristics of type 1 diabetes?
- No insulin produced
- quickly life threatening
- no diet restrictions (just careful monitoring)
- no risk factors (slight genetic link)
What are the characteristics of type 2 diabetes?
- Insulin is usually produced at the beginning
- body doesn’t respond to insulin properly (controlled with diet and exercise)
- rarely life threatening
- insulin used as last option
What are the risk factors of type 2 diabetes?
- ethnicity
- age
- obesity
- genetics
- smoking/alcohol
- raised BP
- PCOS - polycystic ovary
- poor sleep
What drugs reduce hepatic glucose out put?
- metformin
- pioglitazone
- DPP-4 inhibitors
- GLP-1 agonists
What drugs reduce glucose re-uptake from glomerular filtrate?
- SGLT-1 inhibitors
What drugs reduce peripheral insulin resistance ?
- Pioglitazone
- Metformin
- improve effect of insulin at end point
What drugs enhance insulin secretions by affecting the pancreas?
- Sulphonylureas
- Meglitanides
What drugs enhance the action of incretin?
- GLP-1 agonists
- DPP-4 inhibitors (ends in gliptin)
- Increases insulin
What drugs delay carbohydrate absorption?
- Acarbose
- GLP-1 agonist
- Carbs pass through untouched so glucose stays low, bad GI side effects, not usually used
What are the advantages and disadvantages of Metformin?
Advantages; - cheap - weight neutral - low risk of hypo Disadvantages: - commonly causes GI side-effects - rare but serious side effect of lactic acidosis - short half life so TDS frequency - caution in egfr < 45 - contraindicated in egfr < 30 - takes 3 weeks to titrate up dose
What is the 1st line drug choice for all type 2 patients?
Metformin
used to be Sulfonylureas
What is the mode of action of metformin?
- Makes muscles more sensitive to insulin, doesn’t produce MOEW.
- Less likely to have a hypo*
What are the advantages and disadvantages of Sulfonylureas?
Advantages: - Can be OD or BD - works quickly to lowers blood glucose levels so improves symptoms - fewer GI side effects than metformin Disadvantages: - can cause hypos - can cause weight gain - need functional pancreas to work - can be un-predictable in renal impairment and in the elderly
What are the advantages and disadvantages of pioglitazone?
Advantages: - OD dosing - low risk of hypo - suitable in renal impairment Disadvantages: - associated with heart failure - increased risk of bladder cancer and fractures - causes weight gain - rarely causes liver toxicity - can take 3-6 months to show benefit (not quick acting)
What are the advantages and disadvantages of DPP-4 inhibitors?
Advantages: - once a day - no weight gain - low risk of hypo - some can be used in renal impairment Disadvantages: - commonly causes GI side-effects, rash ancf UTI - rarely causes inflammation - doesn't work as well, although well tolerated
What are the advantages and disadvantages of SGLT-2 Inhibitors?
Advantages:
- Can cause weight loss
- can reduce BP
- Low risk of hypo
Disadvantages:
- Can cause thrush and UTIs especially on starting treatment (excess glucose urinated out instead of being reabsorbed - bacteria like sugar)
- Only effective if reasonable renal function
- Lower BP can increase fall risk
- risk of DKA
- risk of kidney injury and and foot ulcers?
What are the advantages and disadvantages of GLP-1 agonists?
Advantages:
- weight loss
- once a day (or weekly with some preparations)
- rarely cause hypos
Disadvantages:
- injections
- severe GI side-effects are very common
- suitable in moderate renal impairment
- rarely causes pancreatitis
- expensive
- have to have BMI greater than 30 with complications (e.g. knee problems)
What are the insulin treatments for type 1 diabetes?
- Basal bolus: one (or two) long acting in evening (and morning). 3 doses of short/rapid acting during day before meals
- Biphasic (insulin and a salt - free insulin works straight away on muscles) Two biphasic insulin doses, one in the morning and one at teatime. Dose split (breakfast/teatime) dependent on when biggest meals is eaten
What are the 5 types of insulin?
- rapid acting (Novorapid, Humalong, Apidra)
- short acting (Actrapid, Humulin S, Insuman rapid)
- intermediate acting (Insulatard, Humulin I, Insuman basal)
- long acting (Lantus, Abaseglar)
- super long acting (Toujeo, Tresiba)
What is the first line therapy for type 1 diabetes in adults and children?
Basal bolus regime
Describe the basal bolus regime?
- Long-acting insulin analogue ONCE daily (night time)
OR - Long-acting insulin analogue TWICE daily (breakfast and night time)
AND - Rapid acting insulin analogue THREE times daily with meals: dose based on carb intake
*bolus preferred in people that like to snack throughout the day
