Diabetes Flashcards
Diabetic values
> 11.1 random
7 fasting
11.1 OGTT
48 HbA1c
Diagnostic criteria DM
Symptoms + Random / Fasting / OGTT
No symptoms + 2 of Random / Fasting / OGTT
Impaired glucose tolerance values
6-7mmol/L fasting
7.9-11mmol/L OGTT
Inhibits alpha glucosidase in brush border of small bowel, leaving undigested sugar in the bowel
Side effect = wind
Acarbose
Inhibits DPP-IV enzyme
DPP-IV degrades GLP-1 (GLP-1 stimulates insulin release)
Gliptin
How does glucose stimulate insulin release?
Glucose is absorbed into B-cells and used to generate ATP
ATP closes ATP-sensitive K+ channel so K+ can’t leave cell
Cell depolarises and releases insulin
Closes K+ channels on B-cells independent of ATP
Can cause hypoglycaemia
Sulphonylureas (e.g. gliclazide, glibenclamide)
Block SGLT2 in kidney to stop glucose absorption
SGLT2 inhibitors (gliflozins)
Regarding ACEi in diabetics
- Diabetic nephropathy is a problem in diabetics
- ACEi prevent progression to end stage renal failure - given to diabetics UNLESS CI like bilateral renal artery stenosis
- BUT ACEi initially cause a worsening renal function + rise in creatinine
- Normally JGA detects reduced GFR + secretes renin to increase angiotensin II production + constrict the efferent arteriole, raising glomerular pressure + increasing GFR
- ACEi inhibits this from happening so there is a slight decrease in GFR (but this will recover over time)
- The real reason we give ACEi in diabetes though is to reduce microalbuminuria + the benefit over this outweighs the initial reduction in GFR
- SO the overall message is to continue giving ACEi despite initial decrease in GFR
What are the main diabetic drugs?
Acarbose - inhibits alpha-glucosidase in brush border
Gliptin - inhibits DPP-IV to stop degradation of GLP-1
Sulphonylureas (gliclazide, glibenclamide) - close K+ channels independent of ATP to depolarise and release insulin
SGLT-2 inhibitors - inhibit SGLT glucose uptake channels in kidney
