22. Pharmacology of Diabetes Mellitus

Question 1

What are the options for insulin replacement in type 1?

Answer 1

Subcutaneous insulin

Islet replacement therapy

Question 2

What are the methods of delivering insulin in type 1?

Answer 2

Basal and bolus
Insulin pumps
Artificial pancreas (sensor and pump)

Question 3

How is the amount of insulin required calculated?

Answer 3

0.5 x kg/per day

Question 4

What is the difference between basal and bolus insulin?

Answer 4

Basal is long acting: between meals and overnight

Bolus is rapid acting before a meal

Question 5

What are the complications of an insulin pump?

Answer 5

Infection and ketoacidosis

Question 6

What are the side effects of insulin?

Answer 6

Hypoglycaemia
Weight gain
Oedema
Allergy

Question 7

What is the Hb1AC target in diabetes?

Answer 7

7%

Question 8

What is the first choice treatment for type 2 diabetes?

Why?

Answer 8

Metformin

Doesn’t cause weight gain or hypoglycaemia

Question 9

How does Metformin work?

Answer 9

Reduces hepatic glucose production

Increases sensitivity by increasing glucose uptake

Question 10

What are the side effects of Metformin?

Answer 10

GI
Lactic acidosis in renal impairment (eGFR <30)
B12 deficiency

Question 11

How do sulfonylureas work?

Answer 11

Stimulate insulin release by B-cells

Question 12

What are the side effects of sulphonylureas?

Answer 12

Hypoglycaemia
Weight gain
Stop responding over time

Question 13

Can sulphonylureas be used in renal failure?

Answer 13

Yes but at lower doses

Question 14

Name a sulphonylurea

Answer 14

Gliclazide

Question 15

Name 2 thiazolidinediones

Answer 15

Pioglitazone

Rosiglitazone

Question 16

How do thiazolidinediones work?

Answer 16

Bind to PPAR on muscle and regulate gene expression to increase insulin sensitivity

Question 17

What are the side effects of thizolidinediones?

Answer 17

Weight gain
Oedema
Increased risk of fractures

Question 18

Why is rosiglitazone no longer used?

Answer 18

Increased risk of CV events

Question 19

How does acarbose work?

Answer 19

Disaccharidase inhibitor: delays absorption of glucose from the GIT
Ineffective

Question 20

Why is more insulin released in response to oral glucose compared to IV?

Answer 20

Incretins GIP and GLP are released in response to oral stimulus

Question 21

What response do incretins cause?

Answer 21

Increase insulin release
Lower glucagon
Reduce appetite

Question 22

What enzyme breaks down incretins?

Answer 22

DPP4

Question 23

What are the side effects of GLP-1 analogues?

Answer 23

Nausea

Increased risk of gallstones

Question 24

Why are GLP-1 analogues useful in obesity?

Answer 24

Cause weight loss and reduce CV events

Question 25

When should GLP-1 analogues be avoided?

Answer 25

history of pancreatitis, pancreatic malignancy and medullary thyroid cancer

Question 26

Name a DPP4 inhibitor

Answer 26

Sitagliptin

Question 27

Name an SGLT-2 inhibitor

Answer 27

Dapagliflozin

Question 28

How do SGLT-2 inhibitors work?

Answer 28

Inhibit SGLT-2 in the kidney which blocks resorption Increased glucose excretion Weight loss and reduced BP as Na+ absorption also blocks

Question 29

What side effects are associated with SGLT-2 inhibitors?

Answer 29

UTIs

Question 30

What are the indications for insulin in type 2?

Answer 30

Not meeting glycaemic targets on oral drugs Illness, perioperative Pregnancy Hepatic or renal disease (if oral agents contraindicated) Allergy to oral agents Glucose toxicity

Question 31

What drugs are used to control blood pressure in diabetes?

Answer 31

ACE inhibitors or ARB Diuretic or calcium channel blocker B-blocker a-blocker

Question 32

What order should the diabetic drugs be given in?

Answer 32

Metformin SGLT-2 inhibitor and GLP1 injection Sulphonylureas Insulin