Flashcards in Diabetes Deck (130)
Benefits of metformin?
reduces macrovascular complications and death, fewer hypoglycaemic attacks then sulphonylureas, does not cause weight gain, can be used in combination
Risk of metformin?
can cause lactic acidosis, has GI side effects at higher doses (nausea, vomiting, anorexia), an insulin secretagogues and has drug interactions with ACE-I, alcohol, NSAIDs, steroids and contrast agents
Who is most at risk of lactic acidosis in metformin use?
renal insufficiency, CV disease, PVD, liver disease, pulmonary disease, >65
What is the second line medication that can be used for type 2 diabetes treatment and how do they work?
Sulphonylureas e.g. glipizideare - block potassium channels on cell membrane, increasing pancreatic islet cell function
opens calcium channels, increasing fusion of insulin granulae with the cell membrane to increase insulin release
stimulates glycolytic pathway in the liver and inhibits glucose production
Benefits of sulphonylureas?
last 12-24hrs, good if metformin is CI, reduced glycosylated Hb (HbA1c) over a ten year period
Risks of sulphonylureas?
hypoglycaemia, weight gain, liver dysfunction, GI disturbance, CI in renal failure, hepatic failure, porphyria, pregnancy, breast feeding, drug interactions with ACE-I, alcohol, NSAIDs and steroids
In who is hypoglycaemia from sulphonylureas most common?
older age, mild-moderate hepatic impairment, renal impairment
How can hypoglycaemia be reduced in sulphonylurea use?
use a short acting drug like tolbutamide
How do rapid acting insulin secretagogues treat type 2 DM?
they are post prandial glucose regulators e.g. repaglinide and nateglinide - block potassium channels on pancreatic beta cells, stimulating insulin release, short acting
Benefits of rapid acting insulin secretagogues?
short duration and rapid onset
repaglinide is better for irregular meal times and for poor glycaemic control and target post prandial hyperglycaemia
nateglinide is used with metformin and is a sulfonylurea receptor binder given before meals
Risks of rapid acting insulin secretagogues?
hypoglycaemia, weight gain, CI in hepatic failure, pregnancy and weight gain, drug interactions with ciclosporin, trimethoprim and clarithromycin
What is the third medication given in type 2 DM treatment and how does it work?
Thiazolidinediones (TDZs)/glitazones e.g. pioglitazone - activates nuclear peroxisome proliferation activated receptor (PPAR) which regulates genes that influence insulin sensitive genes to enhance production of mRNAs of insulin dependent enzymes and increasing hepatic sensitivity to insulin, enhancing glucose clearance
Benefits of TDZs?
used in combination with S or M, TDZ with M is good for obese patients but can cause deterioration of blood glucose control
pioglitazone can be used with insulin therapy if this happens
Risks of TDZs?
weight gain, hypoglycaemia, hepatoxicity, fracture risk, CI in heart failure due to fluid retention and cardiac failure risk, hepatic disease and type 1 DM, drug interactions with rifampicin and paclitaxel
How does Acarbose treat type 2 DM?
inhibits intestinal alpha glucosidases to delay absorptions and digestion or sucrose and starch and slows glucose absorption, reduces post prandial peaks
Benefits of acarbose?
use if all other CI, improves glycaemic control, can be used in combination
Risks of acarbose?
Gi disturbance, flatulance, bloating, CI in thyroid cancer, MEN2, drug interactions with orlistat and pancreatin
What is orlistat and how does it work?
an intestinal lipase inhibitor which reduces fat absorption for weight loss
What are incretins?
they increase insulin release from beta cells post eating before glucose levels become elevated
2 types: glucagon like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)
What inactivates incretins?
dipeptydyl peptidase 4 (DPP4)
Why is GLP1 not as useful in diabetic treatment and what could be used instead?
has a very short half life and must be given as a continuous SC injection
treatment to inhibit DPP4 which inactivates GLP1 would be more successful e.g. sitagliptin and vildagliptin
Benefits of DDP4-I?
can be used in combination if good glycaemic control, and good for those at risk of hypoglycaemia
Risks of DDP4-I?
hypersensitivity reactions so only continue if beneficial metabolic response, GI disturbance, CI in serious hypersensitivity reaction, Drug interactions with TDZs
How do GLP-1 mimetics treat DM?
analogue of GLP1 and is an insulin mimetic, given 2x SC/day up to 1h before meal, an alternative to insulin therapy in obese patients
Benefits of GLP1 mimetics?
good for those with LGV or PCV driving licences, has a good fixed dose regimen and can cause weight loss due to prolonged gastric emptying
Risks of GLP1 mimetics?
hypoglycaemia, GI disturbance, acute pancreatitis, weight loss, CI in thyroid cance, mEN2, drug interactions with warfarin and bexarotene
What are the different types of insulin therapy?
rapid acting (insulin lispro) - fast onset but short duration, so no overall control, but good for evening meal if have nocturnal hypoglycaemia
short acting (soluble) - work in 30mins for 4-6h, given 15mins before meal (4x/day) or continuously if labor, emergency, surgery
intermediate acting (isophane insulin) - 12-24h
long acting (insulin glargine) - premixed with with retarding agents to precipitate crystals which is slowly released and last >24hr,
biphasic (biphasic isophane insulin) - protamine insulins 2x/day
What insulin therapy is best in the young?
start on immediate acting
What insulin therapy is used in type 2 DM?
2x daily premixed soluble and isophane insulin