Diabetes

Question 1

What is the treatment for type 1 diabetes?

Answer 1

• Insulin therapy

Question 2

What does insulin therapy consist of?

Answer 2

• SC injection but and IV in emergency

- Insulin dose that is given to try lower the glucose levels in the bloodstream

Question 3

Why is insulin not given orally?

Answer 3

• Insulin is a protein and would get broken down before absorption can even occur.

Question 4

Describe basal-bolus loading

Answer 4

• Rapid dose that increases insulin just before meal times = bolus. Rapid acting insulin, e.g. aspart
• Basal dose is given to maintain a certain level of insulin at all times in the body. This is usually long acting insulin.

Question 5

Avoid insulin therapy in patients who are:

Answer 5

• Hypoglycaemic

- Have renal impairment

Question 6

Contraindications with insulin therapy

Answer 6

• Increase dose of insulin with steroids because they cause hyperglycaemia.

Question 7

What is the benefit of manufacturing the insulin therapy as a soluble preparation?

Answer 7

• Delays absorption and overcomes short plasma half-life. Soluble insulins form hexamers at site of injection, contributing to delay in absorption.

Question 8

Name a biguanide and what it is used to treat?

Answer 8

• Metformin

- Treats type 2 diabetes

Question 9

Mechanism of action of metformin

Answer 9

• Suppresses appetite so limits weight gain by decreasing hepatic glucose output (decrease gluconeogenesis and glycogenolysis)

Question 10

Side effects of metformin

Answer 10

• GI upset

Question 11

Avoid the use of metformin in

Answer 11

• GFR < 30ml/min as metformin is nephrotoxic

Question 12

Contraindications of metformin

Answer 12

• ACEi
• NSAIDs
• Diuretics: thiazides cause hyperglycaemia

All of these drugs are nephrotoxic.

Question 13

What is the first line pharmacological treatment for type 2 diabetes?

Answer 13

• Metformin (biguanides)

Question 14

Name a sulfonylurea and describe it’s mechanism of action

Answer 14

• Glicazide
• Blocks K+ATP channels so depolarisation occurs and calcium enters the cell causing insulin to be released.
• Insulin has anabolic effects = weight gain

Question 15

Side effects of sulfonylureas

Answer 15

• GI upset

Question 16

Avoid sulfanylureas in

Answer 16

• Hepatic and renal impairment

Question 17

Contraindications of sulfonylureas

Answer 17

• Thiazides

- other hypoglycaemic agents

Question 18

How are sulfonylureas metabolised

Answer 18

• Hepatically

Question 19

Name some thiazolidinediones

Answer 19

• Pioglitazone
• Rosiglitazone

Glitazones

Question 20

Mechanism of action of thiazolidinediones

Answer 20

• Increases insulin sensitivity

- Activates PPAR-gamma to increase adipogenesis = weight gain.

Question 21

Side effects of thiazolidinediones

Answer 21

• GI upset
• Oedema
• CVD risk increases (HF)
• Fracture risk

Question 22

Contraindications of thiazolidinediones

Answer 22

• Hypoglycaemic agents

Question 23

Name SGLT-2 inhibitors

Answer 23

• Dapagliflozin
• Canagliflozin

Gliflozins

Question 24

Mechanism of action of SGLT-2 inhibitor

Answer 24

• In PCT

- Decreases glucose in plasma so weight loss due to beta oxidation of fat.

Question 25

Side effects of SGLT-2 inhibitors

Answer 25

- UTI - genital infections - Thirst - Polyuria

Question 26

Contraindications of SGLT-2 inhibitors

Answer 26

- Anti-hypersensitives as they cause hypoglycaemia

Question 27

Name some dipeptidyl peptidase 4 inhibitors

Answer 27

- Sitagliptin - Saxagliptin Gliptins

Question 28

Mechanism of action of DP4 inhibitor

Answer 28

- Prevents incretin degradation so increased insulin release and suppressed appetite.

Question 29

Side effects of DP4 inhibitors

Answer 29

- GI upset | - Pancreatitis

Question 30

Avoid the use of DP4 inhibitors

Answer 30

- Pregnancy

Question 31

Contraindications of DP4 inhibitor

Answer 31

- Hypoglycaemic agents | - Diuretics causing hyperglycaemia

Question 32

When are DP4 inhibitors used?

Answer 32

- First line treatment when metformin is contraindicated.

Question 33

Name some glucagon-like-peptide 1 (incretin) receptor agonists. SC injection.

Answer 33

- Exenatide | - Liraglutide

Question 34

Mechanism of action of glucagon-like-peptide 1 receptor agonist

Answer 34

- Increased insulin release - Decreased glucagon release - Promotes satiety

Question 35

Side effects of GLP-1 receptor agonists

Answer 35

- GI upset | - GORD from delayed gastric emptying caused by GLP-1

Question 36

Avoid GLP-1 receptor agonists in patients with:

Answer 36

- eGFR < 30ml/min

Question 37

Contraindications of GLP-1 receptor agonist

Answer 37

- Hypoglycaemic agents