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Pharmacology > 10) Diabetes > Flashcards

10) Diabetes Flashcards

1
Q

Where is Insulin produced in the body

A

A naturally occurring hormone secreted by beta cells in the islets of langerhans

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2
Q

What effect does insulin have ?

A

> Glucose uptake by liver, muscle cells and adipose cells
Glycogen Synthesis
Inhibits break down of Fatty Acids

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3
Q

What is Type 1 Diabetes caused by ?

A

Autoimmune disease where beta cells of islets of langerhans is destroyed

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4
Q

What are the symptoms of Type 1 Diabetes ?

A

> Polydipsia
Polyuria
Weight Loss
Fatigue / Lethargy

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5
Q

What complications can arise with Type 1 Diabetes ?

A

> Hyperglycaemia - Causes Swelling in the brain
Ketoacidosis
Dehydration
Macrovascular - Increased risk of stroke and MI
Microvascular - Diabetic eye disease, Retinopathy, Nephropathy, Neuropathy

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6
Q

What treatments are used for Type I Diabetes ?

> Give examples

A

Rapid Acting - Insulin Aspart (Novorapid)

Short Acting - Soluble Insulin (Actrapid), Humulin

Intermediate Acting - Isophane Insulin

Long Acting - Insulin Degludec, Insulin Glargine

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7
Q

What regimes are provided when taking insulin for Type 1 Diabetes

A

Basal -> Long acting so that you have the same basal level of insulin all the time

Basal Bolus -> Long Acting but before eating inject / short acting so that insulin levels increase when eatingn

Intermediate -> 2 Injections a day of combined of combined and short acting insulins

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8
Q

Where is Insulin injected ? and why is it important to rotate site of administration

A

> Buttocks
Abdomen
Thighs
Upper Arms

Prevent Lipodystrophy

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9
Q

What are some Warnings / Contraindications to using Insulin ?

A

> Hypoglycaemia
Lipohypertrophy / Atrophy
Renal Impairments

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10
Q

What are some important interactions / considerations when using Insulin ?

A

> Must increase dose when used with steroids

> Use with caution alongside other hypoglycaemic agents

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11
Q

How is DKA treated ?

A

Fluids => Insulin => Glucose + K+

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12
Q

What is Type 2 Diabetes caused by ?

A

Decrease in the sensitivity of the insulin receptors
> Initially overcame by increase insulin productions
-> Decreased insulin receptors
> Glucotoxicity from fatty acids and ROS lead to beta cell dysfunction

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13
Q

What is a difference between Type 1 and 2 DM

A

Type 2 cannot present with DKA

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14
Q

How is Type 2 DM initially treated ?

A

Non pharmacological Interventions
> Diet
> Exercise
> Education

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15
Q

How do Biguanides work to treat Type 2 DM
> Give an example of Drug
> When is it used

A

Metformin
> Decreases Hepatic Glucose output
> Increase Glucose Utilisation in Skeletal Muscle
> Suppresses appetite to minimise weight gain

First line of treatment

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16
Q

What are the contraindications / warning when using Biguanides

A

GI upset
- N+V
Stop if eGFR <30ml/min

17
Q

What are some important interactions / considerations when using Biguanides

A

Don’t use with drugs that can affect kidneys function

  • ACEi
  • Diuretics
  • NSAIDS
18
Q

How do Sulfonylureas work to treat Type 2 DM
> Give examples of drugs
> When is it used

A

Glicazide
> Blocks ATP dependent K+ channels
> This prevents hyperpolarisation and thus membrane is depolarised leading to influx of Ca2+
> Vesicles containing insulin is released

  • However this requires at least some residual pancreatic function
  • Used in combination of other agents or first line when Metformin Contraindicated
19
Q

How does DKA present ?

A

Clinical triad

1) Hyperglycaemia
2) Acidosis
3) Ketonaemia

Low blood ketones
Hyperglycaemia might not always be present

20
Q

What should be considered when using Sulfonylureas ?
> Warnings / Contraindications
> Important Interactions / Considerations

A 
Warnings:
> Mild GI Upset 
> Hypoglycaemia 
> Some hypersensitivity reactions 
> Weight gain due to Anabolic Actions of Insulin 
Import Interactions:
> Other hypoglycaemic Agents 
> Hepatic Impairment 
> Renal Impairment 
> Thiazide like diuretics can increase glucose so can reduce action
21
Q

How does Thiazolidenediones (Glitazones) work to treat Type 2 DM ?
> Give examples of drug
> When is it used

A

PioGLITAZONE
RosiGLITAZONE

> Insulin Sensitisation in Muscle and Adipose
Decreased Hepatic Glucose Output
Activates PPar-y -> Gene transcription

  • Used less frequently and other agents
22
Q

What should be considered when using Thiazolidenediones ?
>Warnings / Contraindications
> Important Interactions / Considerations

A 
Warnings:
> GI Upset 
> Fluid Retention 
> Fracture Risk 
> CVD concerns 
> Bladder Cancer 
> Weight Gain

Important Interactions:
> Other hypoglycaemic agents

23
Q

How does SGLT-2 (Gliflozin) work to treat Type 2 DM
> Give examples
> When is it used ?

A

DapaGLIFLOZIN
CanaGLIFLOZIN

> Prevents Glucose absorption from Tubular Filtrate so increases urinary glucose excretion
Competitive reversible inhibition in PCT

-Used in both Type 1 and 2 DM as add on therapy

24
Q

What should be considered when using SGLT-2 Inhibitors
> Warnings / Contraindications
> Important Interactions / Considerations

A

Warnings:
> UTI and Genital Infection
> Thirst
> Polyuria

Important Interactions
> Antihypertensives
> Other hypoglycaemic agents

25
Q

What physiological effects does GLP-1 (Incretin) have ?

  • Pancreas
  • Brain
  • Liver (Indirect)
  • Stomach
  • Muscle (indirectly)
A

Pancreas:

  • Increase insulin secretion
  • Decrease Glucagon secretion
  • Increase Insulin Biosynthesis

Brain:
- Decrease food intake through increased satiety

Liver:
- Decreased glucose production

Muscle:
- Increased Glucose Uptake

Stomach:
- Decreased Gastric Emptying

26
Q

How does Dipeptidyl Peptidase - 4 (DPP-4) Inhibitors (Gliptins) work to treat Type 2 DM ?
> Give Examples
> When is it used

A

SitaGLIPTIN
SaxaGLIPTIN

> Prevent Incretin Degradation
Incretin is glucose dependent so postprandial action does not stimulate insulin secretion at normal blood glucose - lower hypoglycaemic risk

  • First line if Metformin is contraindicated
  • Suppresses appetite
27
Q

What should be considered when using DPP-4 Inhibitors ? Dipeptidyl peptidase inhibitor
> Warnings / Contraindications
> Important interactions / Considerations

A

Warnings:
> GI upset
> Small Pancreatitis risk
> Avoid in Pregnancy

Important Interactions
> Other hypoglycaemic agents
> Drugs which can increase glucose
- Thiazide like diuretic

28
Q

How does GLP-1 Receptor Agonists (Incretin Mimetics) work to treat Type 2 DM ?
> Give examples
> When is it used

A

ExenaTIDE
LiragluTIDE

> Increase glucose dependent synthesis of insulin secretion by activating GLP-1 receptor

> Add on if triple therapy is ineffective given subcutaneous

29
Q

What should be considered be using GLP-1 Receptor Agonists ?
> Warning / Contraindications
> Important Interactions / Considerations

A

Warnings:
> GI upset
> GORD
> Stop if eGFR <30

Important interactions
> other hypoglycaemic agents

30
Q

What is the NICE Guideline for treating Type 2 DM

A

W/ Metformin
If HbA1c rises to 48 mmol/mol on lifestyle interventions
- standard release Metformin

1st intensification 58mmol
- Add DDP-4i or other dual therapy

2nd Intensification => aim for 53
- Triple Therapy add SU

W/o Metformin
- SU Or DDP-4i

1st
- Dual Therapy

2nd
- Consider Insulin Based treatment

Pharmacology (25 decks)

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