Poster 2- treatment of diabetes Flashcards Preview

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Flashcards in Poster 2- treatment of diabetes Deck (32)
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1
Q

Generalised treatment of type 1 diabetes

A

Insulin therapy to get glycemic control. Done using a basal bolus regimen

2
Q

Generalised treatment of type 2 diabetes

A

First start with healthy diet and exercise to lose weight.
Then add oral therapy
Then injection therapy.
Exogenous insulin is the last line of treatment and occurs when all the beta cells have been destroyed.

3
Q

Treatment ladder for type 2 diabetes

A

Metformin
Metformin + sulphonylurea (consider swapping for a DPP4 inhibitor or TZD if contraindicated)
Add TZD or insulin
Metformin + sulphonylurea + insulin
Increase insulin dose and intensify regime.

4
Q

Metformin is a….. drug

A

Biguanide

5
Q

Metformin does…. to the body

A

Reduces hepatic gluconeogenesis (therefore the liver isn’t contributing to raising the blood glucose)
Increases glucose uptake in skeletal muscles
Reduces carbohydrate absorption
Increases oxidation of fatty acids

6
Q

Dosage of metformin

A

Max- 3g daily

Usually start on 500g OD or BD

7
Q

Positive outcomes for patients on metformin

A

Reduction in HbA1c of 15-20mmol by lowering insulin resistance
Weight loss
Reduction in bp
No hypos
Prevents microvascular and microvascular complications
Safe in pregnancy

8
Q

Which drugs can metformin be used alongside

A

Sulphonylureas, glitazones and insulin

9
Q

Examples of sulfonylureas and their doses

A

Glicazide (40mg OD to 160mg BD)
Glipizide (2.5mg to 15mg)
Glibenclamide

10
Q

How do sulfonylureas work?

A

They work by binding to the ATP dependent potassium channel closing it. This causes depolarisation of the cell that then leads to calcium channels opening. Calcium influx then stimulates insulin release.

11
Q

Describe the Katp channel

A

Made up of 4 Kir6 subunits and 4 SUR1 subunits.
Usually the ATP binds to the 4 Kir6 subunits closing the channel.
ADP-Mg binds to the SUR1 channels thus opening the channels.
Sulfonylureas displace the ADP-Mg keeping the channel patent.

12
Q

Positive effects of sulfonylureas

A

Drop HbA1c by 15-20mmol.
Prevent microvascular complications (however not macrovascular)
More rapid effects than metformin

13
Q

Adverse effects of sulfonylureas

A
Weight gain
Hypoglycaemia risk (especially in elderly)
14
Q

Why might sulfonylureas fail to work in late stages of disease?

A

Sulfonylureas need functioning beta cells to work and in late stages of disease they may all be destroyed.

15
Q

Examples of TZD’s

A

Pioglitazone

16
Q

How do TZD’s work?

A

They work on nuclear receptors causing transcription of insulin sensitive genes.

17
Q

Positive effects of TZD’s

A

Increase fatty acid and triglyceride uptake (less likely to get DKA because less free fatty acids)
Increased sensitivity to insulin
Reduce hepatic glucose output
Prevent macrovascular complications (not microvascular)

18
Q

Adverse effects of TZD’s

A

Hypoglycaemia
Weight gain
Heart failure (due to them causing fluid retention because they promote Na+ reabsorption)

19
Q

When are TZD’s contraindicated?

A

In patients with osteoporosis or bone fractures

In patients with increased cardiovascular risk

20
Q

What are incretins?

A

GLP-1 or GIP drugs.

They stimulate hormones that increase the secretion of insulin from beta cells after meals.

21
Q

Positive effects of incretins

A
They reduce HbA1c
Weight loss
Increased insulin secretion
Decreased glucagon secretion
Slow gastric emptying
22
Q

Incretin analogues

A

Mimic the effects of incretins but are longer lasting.

They bind to GPCR GLP1 receptors that increase intracellular cAMP.

23
Q

Negative effects of GLP-1 drugs

A

Cause nausea

Have to be injected

24
Q

Example of a GLP1 drug?

A

Exenatide

25
Q

How do SGLT2 inhibitors work?

A

They inhibit the reabsorption of glucose in the proximal tubule of the kidney to deliberately cause glucosuria. They block S1 channels which is where 90% of the glucose is reabsorbed.

26
Q

Positive effects of SGLT2 inhibitors

A

Cause weight loss

Reduce CV risk

27
Q

Adverse effects of SGLT2 inhibitors

A

More likely to develop thrush and urine infections.

28
Q

Name some SGLT2 inhibitors

A

Dapagliflozin
Canagliflozin
Empagliflozin

29
Q

How do alpha glucosidase inhibitors work?

A

For dietary carbohydrate to be absorbed it needs to be in its monomer form. A brush border enzyme called alpha glucosidase does this. The drug works by delaying this enzyme therefore you don’t have the spike in blood glucose post prandially.

30
Q

Positive effects of alpha glucosidase inhibitors

A

No risk of hypoglycaemia.

31
Q

Adverse effects of alpha glucosidase inhibitors

A

GI upset- flatulence, abdominal pain, loose stools ect.

32
Q

Why would you maybe consider not using insulin therapy on obese patients?

A

For insulin therapy to work- you can’t have complete insulin resistance which tends to occur in people with obesity.