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2014-04-26 15:45:56

exam revision
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  1. Diabetes Medications including action of drug and side effects
    • 1. Metformin
    • Action: Decreases hepatic glucose production
    • Increases muscle insulin sensitivity
    • effective as monotherapy or in combination with sulphonylureas or as adjunct to insulin therapy
    • Main side effects: Nausea and diarrhoea,lactic acidosis (rare but potentially fatal), decreased vitamin B12 absorption).

    • 2. Sulfonylureas
    • Stimulates secretion of insulin from functioning pancreativ B cells.
    • Used in non-obese patients where the main defect is impaired insulin secretion
    • May cause weight gain
    • Main adverse event is hypoglycaemia
    • May have GI effects and cause skin rashes

    • Repaglinide: (prandial glucose reg)
    • Stimulates release of insulin from b-cells at meal times (prandial glucose regulator) Rapid onset of action and short duration of activity, administered shortly before each main meal.
    • Side effects: weight gain, hypoglycaemia risk
    • less risk of hypo's than longer acting insulin secretagogues. 

    Nateglinide (prandial glucose regulator)

    • Only licensed for use with metformin
    • Stimulates insulin release
    • Rapid onset and short duration
    • take befor each main meal

    • a-Glucosidase inhibitor - Acarbose
    • Delays digestion of carbs and slows glucose entry into the systemic circulation
    • Does not cause weight gain
    • Side effects: GI side effects in 30% of people diminish with continued use, bloating abdominal discomfort, flatulence
    • Reduces post prandial glucose, need glucose o threat hypos (if on agent which causes hypos)
    • Glitazone

    • Reduces insulin resistance and improves insulin sensitivity
    • Side effects: oedema, weight gain, poss hypo

    • Incretin mimetics
    • Bind and activate GLP-1 receptors increasing insulin secretion, suppressing glucagon secretion and slow gastric emptying
    • May prevent weight gain and help aid weight loss
    • DPP4 Inhibitors or (gliptins)
    • block the action of the enzyme DDP4 which destroys the horme incretin. more insulin when needed and less hepatic glucose production when not needed
    • HbA1c must be reduceds by at least 0.5% within 6 months for continued use

    • Dapagliflozin
    • Sodium-glucose co-transporter2 inhibitor
    • reduces glucose reabsorption in the proximal convoluted tubule increasing urinary glucose excretion
    • Side effects: hypo (in combination with insulin or sulphonlurea), constipation, dyslipidaemia, gential infection, UTI, POLYURIA, THIRST, HYPOTENSION
  2. What does the treatment of diabetes include?
    •Lifestyle changes at least 3 months

    • Medication plus diet

    • Type of medication will depend on weight, renal function, individual targets

    • • NICE guidance to guide medication
    • use.
  3. What are the different types of Insulin?
    •Short acting and analogues

    •Intermediate acting


    •Long acting and analogues
  4. What are the aims for control in T1 for:
    Self-monitored BG
    • Self monitoring BG
    • –Fasting/pre-prandial: 3.5-5.5mmol/l before meals
    • –Postprandial: less than 8mmol/l, two hours after meals.

    • Children
    • –Before meals: 4-8mmol/l
    • –Two hours after meals: less than 10mmol/l

    • Adults –Before
    • meals: 4-7mmol/l–Two hours
    • after meals: less than 9mmol/l
  5. What are the aims for control in T2

    –Before meals: 4-7mmol/l

    –Two hours after meals: less than 8.5mmol/l
  6. When is Serum Fructosamine used what does it tell you and what are the non-diabetic ranges
    • –Glycated serum proteins mostly
    • albumin

    • –Indication of control over last 2-3
    • weeks

    –Non diabetic is 205-285umol/l

    • –May be used in pregnancy or in Hb
    • variants
  7. What are the signs and symptoms for both T1 and T2
    •Type 1

    •Sudden onset

    •Severe symptoms

    •recent weight loss

    •usually lean

    •spontaneous ketosis

    •Absent C peptide

    •Markers of autoimmunity present

    Type 2

    •Gradual onset

    •May be asymptomatic

    •Often no weight loss

    •usually obese

    •Not ketotic

    •C peptide detectable

    •no markers of autoimmunity
  8. Diagnostic criteria for T1
    –Random venous glucose of ≥ 11.1mMol/l

    • –Fasting plasma glucose ≥ 
    • 7.0mMol/l

    –2 hours plasma glucose ≥ 11.1mMol/l after 75g glucose OGTT

    • –An HbA1c of 6.5%  (48mmol/mol) is
    • recommended as the cut point for diagnosing diabetes. (Adopted by Diabetes UK  in July 2011)
  9. Name the symptoms of undiagnosed diabetes



    •Extreme tiredness

    •Weight loss

    • •Genital itching or regular episodes
    • of thrush

    •Blurred vision.
  10. What are the short term complications of diabetes?

  11. What are the long term complications of diabetes

    –  Heart disease

    –Cerebral vascular disease

    - PVD 


    –Eye disease


    Other is Neuropathy
  12. What disease accounts for most of the excess mortality in patients with diabetes
  13. What is the target for hypertension for non diabetics and diabetics

    –Systolic >160 mm Hg

    –Diastolic >90 mm Hg

    •Target for hypertension in diabetes

    –Systolic >140 mm Hg

    –Diastolic >90 mm Hg
  14. What is Autonomic neuropathy and what are the complications?
    • •Disturbance of the sympathetic and
    • parasympathetic nervous system

    •Results in


    –Gastric paresis (stasis)



  15. Give some factors which affect diabetic control






  16. Give the different methods of insulin delivery



    •CSII pump

    •Insulin jet system

  17. Give the symptoms for hypoglycaemia

    –Increased heart rate


    –Increased systolic blood pressure




    –Impaired intellectual activity

    –Impaired cognitive function

    –Diminished psychomotor  skills

    –Loss of coordination

    –Sensation of drowsiness

    • –Coma/seizure (severe and
    • potentially fatal)
  18. What are the four most common presenting complications in the diagnosis of type 2 diabetes?
    • Hypertension 35%
    • Retinopathy 21%
    • Erectile dysfunction 20%
    • Abnormal ECG 18%
  19. The tight control of 2 which things are important in diabetes?
  20. What should people be offered on diagnosis of Diabetes (t1 or t2)
    • All people with diabetes and/or
    • their carer should be offered structured education at the time of diagnosis
    • with an annual follow-up.
  21. What are the 5 recommendation for glycaemic control and type 2 diabetes
    • –Weight
    • management should be the primary nutritional strategy in managing glucose
    • control in Type 2 diabetes for people who are overweight or obese. (A)

    • –Regular,
    • moderate physical activity can reduce HbA1c by 0.45 – 0.65 per cent independent
    • of weight loss. (A)

    • –Focus
    • should be on total energy intake rather than the source of energy in the diet
    • (macronutrient composition) for optimal glycaemic control. (A)
    • •The total amount of carbohydrate consumed is a strong predictor of
    • glycaemic response and monitoring total carbohydrate intake whether by use of
    • exchanges, portions or experience-based estimation, remains a key strategy in
    • achieving glycaemic control. (A)

    •Low GI diets may redcue HbA1c up to 0.5 per cent . (A)
  22. What are the aims of dietary management in diabetes
    • –↓ of risk for microvascular disease by achieving near normal glycaemia
    • without undue risk of hypoglycaemia

    • –↓ of macrovascular disease, including management of body weight,
    • dyslipidaemia and hypertension

    • –To optimise outcomes in diabetic nephropathy and in concomitant
    • disorder such as coeliac disease or cystic fibrosis
  23. What factors are considered when a patient is on fixed or variable insulin regimes?
    • •type of treatment, motivation of
    • patient, willingness to check blood glucose
  24. What are the target for control in gestational diabetes
    •Pre-prandail 4.0-5.9mmol/l (NICE 3.5-5.9mml/l)

    •1 hour post prandail <7.8mmol/l (Capillary blood)