Diabetes

?
Which treatment is essential in the management of type 1 diabetes?
Insulin
1 of 65
Type 1 diabetes is an autoimmune condition.
T/F?
True
2 of 65
Which cells do the body attack that results in insulin not being released?
Pancreatic beta cells
3 of 65
What does insulin do?
Allows glucose into cells to be used for energy
4 of 65
What is insulin storage conditions?
Fridge - 2-6 degrees
5 of 65
What layer of skin should this be injected into?
Subcutaneous fat
6 of 65
Where in the body and at what angle should insulin be injected?
Thighs, buttocks, arms, stomach
90 degree angle
7 of 65
There is residual function of pancreatic beta cells in people with type 2 diabetes.
T/F?
True
8 of 65
What are the 5 different types of insulin?
Rapid acting
Short acting
Mixed insulin
Intermediate acting
Long acting
9 of 65
Name some generic and brands of rapid acting insulin.
Insulin aspart - Novorapid, Fiasp
Insulin Lispro - Humalog
10 of 65
Name the only generic and its brands of short acting insulin.
Soluble insulin - Actrapid, Humulin S, Insuman Rapid
11 of 65
Name the only generic and its brands of intermediate acting insulin.
Isophane insulin - Insulatard, Humulin I, Insuman basal
12 of 65
Name some generic and brands of long acting insulin.
Insulin glargine - Absagalar, Lantus
Insulin detemir - Levemir
Insulin degludec - Tresiba
13 of 65
Name some mixed insulin brands
Humalog mix
Humulin M3
Novomix
Insuman Comb
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When should rapid acting insulin be taken?
Just before, with or just after a meal
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When should short acting insulin be taken?
15-30 mins before food
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What is the HbA1c target for diabetic patients?
48 mmol/L
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What are microvascular complications of diabetes?
Diabetic neuropathy, nephropathy and retinopathy
18 of 65
Diabetes in more common in caucasians.
T/F?
False - more common with afro-carribean or south asian family origin
19 of 65
What treatment should be offered to patients with type 2 diabetes who have symptomatic hyperglycaemia?
Either sulfonylurea or insulin and then review when BG is controlled
20 of 65
What is 1st line treatment in type 2 diabetes?
Metformin
21 of 65
What would you give if GI side effects occurred with metformin?
Switch to metformin M/R tablets
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Which 2nd line drug should you give when a patient has chronic heart failure or established atherosclerotic CVD?
SGLT2 inhibitor as it has proven cardiovascular benefits
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This drug should also be considered in which patients?
Patients at high risk of CVD (QRISK3 score >10%)
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What is 2nd line treatment for patients not at high risk of CVD?
DPP-4 inhibitor
or
Pioglitazone
or
Sulfonylurea
25 of 65
These drug treatments can be switched/added up to triple therapy.
T/F?
True
26 of 65
Which 2 diabetic drugs should not be used together due to their similar mechanism of action?
DPP-4 inhibitors
GLP-1 receptor agonists
27 of 65
When is metformin contraindicated?
eGFR <30ml/min
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History of heart failure, previous or active bladder cancer and hepatic impairment are contraindications for use of which drug?
Pioglitazone
29 of 65
Pioglitazone can promote weight loss.
T/F?
False - weight gain
30 of 65
What effect does sulfonylureas have on weight?
Weight gain
31 of 65
Which oral diabetic drug has high risk of hypoglycaemia?
Sulfonylureas
32 of 65
Which drug has increased risk of fractures?
Pioglitazone
33 of 65
Which class has an increased risk of genital infections?
SGLT2 inhibitors
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Which class of drugs can may contribute to the worsening of dementia?
Sulfonylureas
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Which drug has probable CV benefits but may cause fluid retention when combined with insulin?
Pioglitazone
36 of 65
Therefore which contraindication is related to this risk?
Heart failure
37 of 65
Metformin decreases _______ glucose production, decreases __________ absorption of glucose and increases insulin __________ by increasing peripheral glucose uptake and utilisation.
Hepatic
Intestinal
Sensitivity
38 of 65
Metformin dose does not need to be reduced when GFR is 30-45ml/min.
T/F?
False - Needs to be reduced
39 of 65
Why should metformin be stopped when a patient is acutely unwell?
Reduce risk of lactic acidosis
40 of 65
Which other antidiabetic drug needs to be withheld in line with the sick day rules?
SGLT2 inhibitors
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What is MOA of SGLT2 inhibitors?
Inhibits re-uptake of glucose in kidneys
42 of 65
Why do SGLT2 inhibitors increase risk of genital infections?
Increased amount of glucose being excreted in the urine - glucose provides a good environment for bacteria to thrive
43 of 65
Name the generic SGLT2 inhibitors and their brands
Empagliflozin - Jardiance
Dapagliflozin - Forxiga
Canagliflozin - Invokana
44 of 65
Which drug increases the risk of lower limb amputation?
A. Gliclazide
B. Canagliflozin
C. Alogliptin
D. Dulaglutide
Canagliflozin
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What is the MOA of gliclazide?
Stimulates insulin secretion from pancreatic beta cells
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What is the equivalent dose of gliclazide immediate release to gliclazide modified release?
80mg gliclazide immediate release
=
30mg gliclazide modified release
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Which patient group do sulfonylureas need to be used with caution in?
Elderly/frail
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Why is this?
SUs increase the risk of hypoglycaemia which can result in falls
49 of 65
Pioglitazone reduces peripheral insulin resistance by increasing sensitivity of which cells to insulin?
Fat, muscle and liver cells
50 of 65
Which GLP-1 agonist has CV benefits?
Liraglutide
51 of 65
GLP-1 agonists can be considered in patients with BMI >__kg/m2
30
52 of 65
Name 3 GLP-1 agonists and their brands
Dulaglutide - Trulicity
Semaglutide - Ozempic
Liraglutide - Victoza, Saxenda
53 of 65
What does GLP-1 do in the body?
Enhances insulin release and inhibits glucagon release from pancreatic beta cells
54 of 65
Which enzyme in the body breaks down GLP-1?
DPP-4 enzyme
55 of 65
Therefore why are DPP-4 inhibitors used in diabetes treatment?
They inhibit the DPP-4 enzyme from breaking down GLP-1 so allows more time for it to work on their receptors to increase insulin release.
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What is the mechanism of action of GLP-1 agonists?
They mimic the actions of GLP to promote insulin release from pancreatic beta cells and also are able to protect itself from being broken down by DPP-4 enzyme.
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What is the brand name for semaglutide tablets?
Rybelsus
58 of 65
Name some of the DPP-4 inhibitors
Alogliptin
Sitagliptin
Saxagliptin
Linagliptin
59 of 65
DPP-4 inhibitors promote weight loss and have CV benefits.
T/F?
False - Neutral weight loss and no CV benefit
60 of 65
Which oral diabetic drug would require BG monitoring?
Sulfonylureas
61 of 65
Bus and lorry drivers who are being treated with a sulfonylurea must notify the DVLA that they are on this medication as it can cause hyperglycaemia.
T/F?
False - Hypoglycaemia
62 of 65
What are common side effects of GLP-1 agonists?
GI disturbance
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When reviewing GLP-1 agonists, what target must have been met for continuation of the drug in terms of weight and HbA1c?
Weight must reduce by 3%
and
HbA1c must reduce by approx 11mmol/mol
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What is a red flag symptoms of GLP-1 agonists?
Acute pancreatitis
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Other cards in this set

Card 2

Front

Type 1 diabetes is an autoimmune condition.
T/F?

Back

True

Card 3

Front

Which cells do the body attack that results in insulin not being released?

Back

Preview of the front of card 3

Card 4

Front

What does insulin do?

Back

Preview of the front of card 4

Card 5

Front

What is insulin storage conditions?

Back

Preview of the front of card 5
View more cards

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