Diabetes and Endocrine Therapeutics
Diabetes and endocrine prescribing in UK practice, for final-year medical students preparing for finals and the Prescribing Safety Assessment, final-year pharmacy students and foundation doctors. It covers choosing and intensifying type 2 diabetes therapy, insulin regimens and sick-day rules, hypoglycaemia, the variable rate insulin infusion, DKA and HHS, thyroid disease, corticosteroids and adrenal crisis, and calcium and sodium disorders. Dosing follows the British National Formulary.
About this course
This course covers the drug therapy of diabetes and the endocrine emergencies that students and new doctors meet on the wards. It is written for UK practice: doses follow the British National Formulary, and treatment choices are framed around NICE-style guidance. Where practice varies by region or formulary, the course says so, because local trust protocols often decide the answer.
Type 2 diabetes drug therapy
The first module works through the main drug classes and the reasoning behind choosing between them.
- Metformin: gastrointestinal intolerance, vitamin B12 monitoring, and review in chronic kidney disease.
- SGLT2 inhibitors and DPP-4 inhibitors: mechanism, place in therapy, adverse effects and cautions.
- GLP-1 receptor agonists: injectable and oral options, titration, tolerability, and use where weight loss is a treatment goal.
- Sulfonylureas and pioglitazone: hypoglycaemia risk, weight gain and fluid retention.
- Choosing and intensifying therapy by comorbidity, including established cardiovascular disease, heart failure, chronic kidney disease and obesity.
- Dose adjustment in chronic kidney disease, using estimated glomerular filtration rate to decide what to continue, reduce or stop.
- Foot protection: glycaemic control, smoking, footwear, routine foot checks and when to refer urgently.
Insulin and diabetic emergencies
The second module moves from routine insulin prescribing to acute illness. It covers insulin preparations and common regimens, including basal bolus and premixed, and the practical points of device choice, injection technique and hypoglycaemia awareness. Sick-day rules are taught as a prescribing task: which drugs to continue, which to hold, when to seek help, and how to counsel a patient before they need the advice. Hypoglycaemia recognition and treatment are covered at the bedside level, including the roles of oral glucose, intramuscular glucagon and intravenous glucose.
Perioperative care is handled through the variable rate intravenous insulin infusion: indications, the surrounding substrate infusion, monitoring, and the transition back to the patient's usual regimen. Diabetic ketoacidosis and hyperosmolar hyperglycaemic state are compared directly, with attention to fluid, insulin, potassium and the common errors that make either worse.
Thyroid disease
Levothyroxine replacement is taught with its cautions, particularly in ischaemic heart disease and in pregnancy. Antithyroid drugs, their monitoring and their adverse effects are covered, together with the management of thyroid storm at a level suitable for finals and foundation practice.
Corticosteroids and adrenal crisis
This section covers systemic corticosteroid therapy, tapering, adverse effects and the prevention of adrenal insufficiency, then the recognition and emergency treatment of adrenal crisis, including steroid replacement and the sick-day rules that patients need to know.
Calcium and sodium disorders
The final teaching section deals with hypercalcaemia and hypocalcaemia, and with hyponatraemia and hypernatraemia: how to assess them, what causes them, and how the underlying problem shapes treatment rather than the number alone.
How the course is taught, and who it suits
Every module pairs teaching with hands-on practice and ends with a quiz. Across the course that practice takes in branching clinical cases, prescribing scenarios checked against safety rules, and timed OSCE stations. A final exam must be passed before the certificate is issued.
The course is aimed at final-year medical and pharmacy students preparing for finals and the Prescribing Safety Assessment, and at foundation doctors who want their prescribing reviewed against a clear standard. Nursing students and others who prescribe or administer these drugs may also find it useful.
Content provided through Oskela is intended for education and training. It is not a substitute for professional clinical judgment, institutional protocols, current formularies, prescribing information, or specialist consultation. Doses discussed in teaching examples are not prescribing advice.
Curriculum
4 modules · 34 lessons
Covers the main drug classes used in type 2 diabetes, how to select and intensify therapy according to cardiovascular, renal and weight considerations, and how to adjust treatment in chronic kidney disease. Includes sick-day rules and foot risk assessment, preparing learners for prescribing and counselling activities.
- 10 min
This lesson covers the six main drug classes used in type 2 diabetes: metformin, SGLT2 inhibitors, DPP-4 inhibitors, GLP-1 receptor agonists, sulfonylureas and pioglitazone. For each class we examine the mechanism of action, expected effects on HbA1c and body weight, risk of hypoglycaemia, key cardiovascular and renal outcome data, and the contraindications and cautions that govern safe prescribing. Teaching doses are given as examples with reference to current BNF guidance. The lesson is written for final-year medical and pharmacy students and foundation doctors preparing for finals and the Prescribing Safety Assessment.
- 10 minChoosing and intensifying therapy in type 2 diabetes: matching the drug to the patient
This lesson covers how to choose and intensify glucose-lowering therapy in type 2 diabetes by matching the drug to the individual. It begins with individualised HbA1c targets and the NICE-style sequence from metformin monotherapy through dual and triple therapy to insulin. It then shows how comorbidities steer the choice of second and third agents: established cardiovascular disease, heart failure, chronic kidney disease and obesity, together with the need to avoid hypoglycaemia. It covers when to refer, and how to hold a shared decision-making conversation with a patient who is reluctant to intensify treatment. Doses quoted are teaching examples only; safety decisions rest with the platform's deterministic rules, local formularies and current prescribing information.
- 10 minPrescribing safely in chronic kidney disease: eGFR banding, sick-day rules and annual foot risk assessment
This final lesson in the module applies drug-class knowledge to prescribing for people with type 2 diabetes and chronic kidney disease. It covers eGFR-based dose adjustment and stopping rules for metformin, SGLT2 inhibitors, sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists and pioglitazone; the rationale for sick-day rules; monitoring in renal impairment; and the annual diabetic foot examination, risk stratification and referral to a foot protection service. Teaching examples illustrate principles, but current BNF dosing, local formularies and specialist advice govern individual decisions. The lesson is for education and training and does not replace clinical judgment or institutional protocols.
- 15 min
- 15 min
- 15 min
- 11 min
- 11 min
- 11 min
- 8 minQuiz: Type 2 Diabetes Drug Therapy: Choosing, Intensifying and Prescribing Safely
This module covers insulin as a hospital and community medicine: the preparations and regimens in common UK use, sick-day rules for intercurrent illness, and the recognition and treatment of hypoglycaemia. It then moves to the two hyperglycaemic emergencies, diabetic ketoacidosis and hyperosmolar hyperglycaemic state, and to the perioperative variable rate intravenous insulin infusion. Teaching uses generic drug names and British National Formulary style dosing as illustrative examples; local protocols and formularies vary and must be checked.
- 10 minInsulin Preparations, Regimens and Sick-Day Rules in Type 1 and Type 2 Diabetes
Insulin therapy is a core prescribing skill, and errors in preparation choice, timing or sick-day management cause harm. This lesson classifies the insulins in UK use by time-action profile: rapid-acting and short-acting analogues, isophane, long-acting analogues and premixed biphasic insulins. It then shows how these are combined into basal-bolus and twice-daily regimens, how doses are titrated against glucose readings and meals, and how injection technique and site rotation affect absorption. The final section sets out sick-day rules for people already on insulin: never omit basal insulin, monitor glucose more often, test for ketones when unwell, expect higher insulin requirements during infection, keep metformin and fluid advice in mind, and know when to seek same-day or emergency help. Doses quoted are teaching examples only; safety decisions rest with local protocols, the current BNF and the platform's deterministic rules.
- 10 minHypoglycaemia and the Perioperative Variable Rate Intravenous Insulin Infusion
This lesson covers two linked topics: recognising and treating hypoglycaemia, and managing the nil-by-mouth perioperative patient with a variable rate intravenous insulin infusion (VRIII). It defines hypoglycaemia biochemically and clinically, contrasts autonomic warning symptoms with neuroglycopenic features, and notes presentations that are easily missed, such as impaired awareness and confusion in older adults. Risk factors that make low glucose more likely or more dangerous are then listed: renal impairment, older age, sulfonylureas, missed meals, alcohol and exercise. Treatment is taught stepwise, from oral fast-acting carbohydrate, through intramuscular glucagon, to intravenous glucose, with the follow-on starch each step needs. The second half covers the surgical patient who is nil by mouth: why VRIII is used, how insulin and substrate infusions are prescribed together, how the rate is titrated to capillary glucose, and how to stop safely with overlap of subcutaneous insulin.
- 10 minDiabetic Ketoacidosis and Hyperosmolar Hyperglycaemic State: Recognition and Emergency Management
This lesson distinguishes diabetic ketoacidosis (DKA) from hyperosmolar hyperglycaemic state (HHS) by presentation, biochemistry and typical patient, and includes euglycaemic ketoacidosis. It works through emergency management: resuscitation, diagnostic criteria, fixed-rate intravenous insulin, fluid and potassium replacement, monitoring, and the switch to subcutaneous insulin. It notes the slower correction needed in HHS. Doses are teaching examples only; the platform's deterministic rules decide prescribing safety. Practice varies by region and formulary.
- 20 min
- 20 min
- 15 min
- 15 min
- 11 min
- 9 minQuiz: Insulin Therapy and Diabetic Emergencies: Regimens, Sick-Day Rules, Hypoglycaemia, VRIII, DKA and HHS
This module covers the drug therapy of thyroid disease: levothyroxine replacement and its cautions in ischaemic heart disease, antithyroid drugs and their serious adverse effects, and the recognition and emergency treatment of thyroid storm. It follows the diabetes modules and prepares learners for prescribing and examination questions in UK practice.
- 10 minLevothyroxine Replacement: Starting, Titrating and Monitoring, Including Cautions in Ischaemic Heart Disease
This lesson covers levothyroxine replacement from first principles to practical prescribing. It begins with thyroid hormone physiology and the thyrotropin feedback loop, then sets out when treatment is justified in overt and subclinical hypothyroidism. The main body works through formulation choice, starting doses, and the lower starting dose with slower titration needed in ischaemic heart disease and in older adults. It covers dose timing and factors affecting absorption, monitoring intervals and targets for TSH and free T4, and clinically important interactions with iron, calcium, proton pump inhibitors and warfarin. Doses given are teaching examples only: always check current prescribing information, the formulary and local guidance before prescribing.
- 10 minAntithyroid Drugs: Carbimazole, Propylthiouracil and Their Serious Adverse Effects
This lesson covers the thionamide antithyroid drugs used in hyperthyroidism, focusing on carbimazole and propylthiouracil. It explains their mechanism of action, compares titration and block-and-replace regimens, and sets out baseline and on-treatment monitoring. It then examines the serious adverse effects learners must counsel on and act on, including agranulocytosis, hepatotoxicity and ANCA-associated vasculitis. It also considers when surgery or radioiodine is preferred and notes regional differences in drug availability. The lesson is written for UK practice and supports safe prescribing for finals and the Prescribing Safety Assessment.
- 10 minRecognising and Managing Thyroid Storm: Precipitants, Clinical Features, Scoring Tools and the Immediate Management Sequence
Thyroid storm is a life-threatening exacerbation of thyrotoxicosis that is diagnosed clinically and treated before laboratory results return. This final lesson in the module covers the precipitants that tip compensated thyrotoxicosis into decompensation, the clinical features that distinguish storm from uncomplicated thyrotoxicosis, the scoring tools used to support recognition and their limitations, and the order in which drugs must be given. The sequence matters: a thionamide is given first, iodine only after the thionamide has had time to act, with beta-blockade, glucocorticoid, supportive care and treatment of the precipitating illness alongside. The lesson closes with the thresholds for escalating to endocrine or critical care and the prescribing errors that finals and the Prescribing Safety Assessment commonly test.
- 20 min
- 15 min
- 13 min
- 9 minQuiz: Thyroid Disease: Levothyroxine Replacement, Antithyroid Drugs and Thyroid Storm
This module covers corticosteroid prescribing and the electrolyte disorders that follow it: steroid adverse effects, bone protection and safe withdrawal, high-dose treatment of giant cell arteritis, glucocorticoid replacement and adrenal crisis, hypercalcaemia of malignancy, and hyponatraemia from SIADH. Written for final-year medical and pharmacy students and foundation doctors preparing for finals and the Prescribing Safety Assessment, with British National Formulary doses and NICE-style guidance. Local protocols vary.
- 10 minCorticosteroid Therapy: Adverse Effects, Bone Protection, Safe Withdrawal and High-Dose Use in Giant Cell Arteritis
This lesson covers the safe and effective use of systemic glucocorticoids in adult practice. It reviews adverse effects by body system and explains how risk depends on dose, duration and route. It describes glucocorticoid-induced osteoporosis, who should be assessed, and bone protection with calcium, vitamin D and antiresorptive drugs. It sets out the principles of tapering after a prolonged course, including suppression of the hypothalamic-pituitary-adrenal axis, and the features of steroid withdrawal. The final section covers emergency high-dose glucocorticoid when giant cell arteritis with visual symptoms is suspected, and the monitoring that follows. Doses quoted are teaching examples; always check the current British National Formulary and local guidance.
- 10 minAdrenal Insufficiency and Adrenal Crisis: Glucocorticoid Replacement, Sick-Day Rules and Emergency Treatment
This lesson covers the causes and recognition of primary and secondary adrenal insufficiency, then focuses on maintenance glucocorticoid replacement with hydrocortisone and fludrocortisone in UK practice. It explains patient education, including steroid emergency cards and sick-day rules for intercurrent illness. The emergency management of adrenal crisis is described: fluid resuscitation, parenteral hydrocortisone, and subsequent adjustment of replacement. Teaching examples use British National Formulary dosing principles; local protocols and formularies vary. Content is for education and training, not a substitute for clinical judgment.
- 10 minHypercalcaemia of Malignancy and SIADH Hyponatraemia: Recognition, Investigation and Drug Treatment
This lesson covers two electrolyte emergencies seen in cancer and other settings: hypercalcaemia of malignancy and hyponatraemia caused by SIADH. It explains how to grade hypercalcaemia by corrected calcium and symptoms, when to use intravenous 0.9% sodium chloride, and how antiresorptive drugs such as zoledronic acid, pamidronate and denosumab fit into treatment, with monitoring of calcium and renal function. For hyponatraemia, it reviews causes, volume status assessment, and the diagnostic features of SIADH. Management options include fluid restriction, oral urea and hypertonic saline, with careful limits on sodium correction to avoid osmotic demyelination. Doses are teaching examples only and regional protocols vary.
- 20 min
- 20 min
- 20 min
- 15 min
- 9 minQuiz: Adrenal, Calcium and Sodium Disorders: Corticosteroid Therapy, Adrenal Crisis, Hypercalcaemia and Hyponatraemia
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