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SA Clinical Pharmacology & Therapeutics > S5) Diabetes > Flashcards

S5) Diabetes Flashcards

1
Q

Describe four different functions of insulin in the body

A
  • Stimulates uptake of glucose into liver, muscle and adipose tissue
  • Inhibits gluconeogenesis
  • Inhibits glycogenolysis
  • Promotes fat uptake
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2
Q

What are the six main insulin categories?

A
  • Ultrafast acting
  • Rapid acting (bolus → before meals)
  • Short acting
  • Intermediate acting
  • Long acting (basal - bolus → keeps steady levels)
  • Very long acting
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3
Q

How is insulin absorbed and administered?

A

Absorption into blood stream via subcutaneous injection

→ upper arms, thighs, buttocks, abdomen

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4
Q

Provide an example of an ultra fast acting insulin

A

Aspart (FiAsp)

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5
Q

Provide two examples of rapid acting insulins

A
  • Humalog
  • Novorapid
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6
Q

Describe the following for rapid acting insulins:

  • Onset
  • Administer
  • Peak
  • Duration
A
  • Onset: rapid (5-15 minutes)
  • Administer: inject just before eating
  • Peak: ~60 minutes
  • Duration: 4-6 hours
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7
Q

Provide two examples of short acting insulins

A
  • Actrapid
  • Humulin S
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8
Q

Describe the following for short acting insulins:

  • Onset
  • Administer
  • Peak
  • Duration
A
  • Onset: 30-60 minutes
  • Administer: inject at least 15-30 minutes before eating several times daily to cover meals
  • Peak: 2-3 hours
  • Duration: 8-10 hours
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9
Q

Provide an example of intermediate acting insulins

A

Humulin I

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10
Q

Describe the following for intermediate acting insulins:

  • Onset
  • Peak
  • Duration
A
  • Onset: 2-4 hours (slower)
  • Peak: 4-8 hours
  • Duration: 12-20 hours
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11
Q

Provide three examples of long and very long acting insulins

A
  • Glargine
  • Detemir
  • Degludec
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12
Q

Describe the following for long and very long acting insulins:

  • Onset
  • Duration
A
  • Onset: 2-66 hours (slow)
  • Duration: up to 24 hours (very long up to 50+ hours)
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13
Q

Identify five adverse effects of insulin

A
  • Hypoglycaemia
  • Hyperglycaemia
  • Lipodystrophy (lipohypertrophy / lipoatrophy) → lipid build up at sight of injection
  • Painful injections
  • Insulin allergies
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14
Q

How does one treat Type II diabetes?

A
  • Lifestyle +
  • Non-insulin therapies e.g. α- Glucosidase inhibitors, SGLT2s :1st step: metafotmin
  • 2; SGLT2 inhibitors (stop glucose reabsorption in kidneys)*
  • Non pharmacologic methods (bariatric surgery and very low calorie diets)
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15
Q

What are the key challenges for patients with Type 2 diabetes in terms of patient adherence and quality of life?

A
  • Weight gain (or fear of weight gain)
  • Risk of hypoglycaemia (or perceived risk)
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16
Q

What is the NICE target for Hbac1 for treating patients with Type II Diabetes?

A

In general target for all is HbA1c 6.5 to 7.5%

  • HbA1c 6.5%: Diet and first 2 treatment steps
  • HbA1c 7.5%: Beyond this or if at risk of severe hypoglycaemia
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17
Q

Describe the four effects of metformin (biguanides) on the body

A
  • ↓ insulin resistance leading to increased glucose by tissues
  • ↓ hepatic gluconeogenesis
  • Limits weight gain by surpassing appetite
  • ↓ CVS events
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18
Q

What are the side effects of metformin?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Vitamin B12 deficiency (uncommon)
  • Lactic acidosis (rare)
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19
Q

Describe the two effects of sulphonylureas on the body

A
  • Stimulate beta cell to release insulin
  • blocks ATP dependent K channels
  • ↓ Microvascular risk
20
Q

What are the side effects of sulphonylureas?

A
  • Weight gain → more insulin means more glucose being turned into fat
  • Hypoglycaemia (don’t give to people with hepatic or renal failure)
  • gi upset
21
Q

Describe the effects of acarbose, an α glucosidase inhibitor, on the body

A

Acarbose Inhibits the breakdown of carbohydrates to glucose by blocking action of the enzyme α glucosidase

22
Q

What are the side effects of acarbose?

A

Predictable:

  • Flatulence
  • Loose stools
  • Diarrhoea
23
Q

Describe the 3 effects of glitazones on the body

A
  • ↑ insulin sensitivity in muscle and adipose tissue
  • ↓ hepatic glucose output
  • they interfere with gene transcription
  • Bind to and activate 1/more peroxisome proliferator-activated receptors (PPARs)
24
Q

Describe the side effects for the following glitazone drugs:

  • Rosiglitazone

- Pioglitazone

A
  • Rosiglitazone – heart failure due to fluid retention
  • Pioglitazone – weight gain, fluid retention, heart failure, effects on bone metabolism and bladder cancer
25
Q

Describe the mechanism and use of glucagon like peptide 1 therapies

A
  • Mechanism: alternative hormone system influencing glucose metabolism
  • Use: high glucose in Type II diabetes due to insufficient release of insulin and over production of glucagon

subcutaneous injection

26
Q

Identify three drugs used in GLP 1 therapy

A
  • Exenatide
  • Liraglutide
  • Lixisenatide
27
Q

Describe the physiological effects of GLP 1 therapies on the pancreas

A
  • Increase insulin secretion from the beta cells
  • Decreases production of glucagon from alpha cells
28
Q

What are the side effects of GLP 1 agonists?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Gastro oesophageal reflux
  • Hypoglycaemia (low risk)
  • Pancreatitis and pancreatic carcinoma (possible)
29
Q

Identify a contra-indication for GLP 1 agonists

A

Avoid if eGFR < 30ml/min

30
Q

Provide four examples of Gliptins (/ DPP-4 inhibitors)

A
  • Sitagliptin
  • Vildagliptin
  • Saxagliptin
  • Linagliptin
31
Q

Describe the effects of gliptins on the body

A

Inhibits DPP-4 activity by increasing postprandial active GLP-1 concentrations, prevents breakdowns of insulin so increased plasma insulin levels

→ glucose dependent

→ surpasses appetite

32
Q

What are the side effects of gliptins?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Pancreatitis
  • Hypoglycaemia (low risk)
  • HbA1c reduction (modest)
33
Q

When are glifozins used and how do they work?

A

Glifozins can be used for patients with Type I and Type II diabetes as add on therapy (started to give to people with CVD risk patients)

SGLT-2 inhibitors

→ reduce glucose reabsorption in proximal tubule so increase glucose urinary excretion

34
Q

Provide three examples of glifozins

A
  • Dapagliflozin
  • Canagliflozin
  • Empagliflozin
35
Q

What are the side effects of glifozins?

A
  • Lower urinary tract symptoms (increased risk)
  • Polyuria
  • Hypoglycaemia (low risk)
36
Q

difference between measuring glucose and HbA1c levels

A

→ glucose measures immediate glucose in the body

→ HbA1c shows percentages of red blood cells that are gylcated (sugar coated)

37
Q

diabetic ketoacidosis (bichemical triad)

A

→ low insulin so glucose isn’t being stored in cells and they can’t use it

-→ body breaks down ketones to use for energy

TRIAD:

  1. hyperglycemia
  2. ketonaemia
  3. acidosis
38
Q

if someone is suspected with diabetic ketoacidosis what tests will you do?

A

→ blood glucose > 11 mmol/L BAD

→ test for ketones in URINE

→ test blood for acidosis (HC03 levels)

39
Q

why can’t you give insulin as a tablet?

A

→ it is a protein so the body will break it down before it can act appropriately

→ we need slow absorption

40
Q

what can you use to slow down the absorption of insulin (not used as much now)

A

→ protamine and/or Zinc with natural (bovine/porcine) insulin

41
Q

what medication causes insulin dose to be increased

A

systemic steroids

steroids can cause insulin resistance

42
Q

what is diabulimia

A
  • person with type 1 diabetes stops taking insulin to control weight
  • eating disorder
43
Q

drug interactions of metformin

A
  • ACEi (can increase effect of metformin)
  • NSAIDS -. Lactic acidosis
  • loops and thiazide like diuretics (increases glucose so oppose metformin)
44
Q

overall what type of agents should you avoid giving hypoglycaemic agents with

A

→ other hypoglycaemic agents as you will result dropping glucose levels too low

→ some loop diuretics and thiazide like diuretics can increase glucose levels in the body

45
Q

Role of glp-1

A
46
Q

why would It be difficult to have a single pill that contains multiple drugs in it

A

→ if you wanted to slightly change dose it would be hard to manufacture and expensive

but it would be easy adherence for the patient

47
Q

how will the dose of insulin change with people who have renal impairment

A

their kidneys don’t work as well

reduced insulin clearance

more plasma insulin

so less dosage of insulin needed

SA Clinical Pharmacology & Therapeutics (36 decks)

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