10) Diabetes Flashcards
Where is Insulin produced in the body
A naturally occurring hormone secreted by beta cells in the islets of langerhans
What effect does insulin have ?
> Glucose uptake by liver, muscle cells and adipose cells
Glycogen Synthesis
Inhibits break down of Fatty Acids
What is Type 1 Diabetes caused by ?
Autoimmune disease where beta cells of islets of langerhans is destroyed
What are the symptoms of Type 1 Diabetes ?
> Polydipsia
Polyuria
Weight Loss
Fatigue / Lethargy
What complications can arise with Type 1 Diabetes ?
> Hyperglycaemia - Causes Swelling in the brain
Ketoacidosis
Dehydration
Macrovascular - Increased risk of stroke and MI
Microvascular - Diabetic eye disease, Retinopathy, Nephropathy, Neuropathy
What treatments are used for Type I Diabetes ?
> Give examples
Rapid Acting - Insulin Aspart (Novorapid)
Short Acting - Soluble Insulin (Actrapid), Humulin
Intermediate Acting - Isophane Insulin
Long Acting - Insulin Degludec, Insulin Glargine
What regimes are provided when taking insulin for Type 1 Diabetes
Basal -> Long acting so that you have the same basal level of insulin all the time
Basal Bolus -> Long Acting but before eating inject / short acting so that insulin levels increase when eatingn
Intermediate -> 2 Injections a day of combined of combined and short acting insulins
Where is Insulin injected ? and why is it important to rotate site of administration
> Buttocks
Abdomen
Thighs
Upper Arms
Prevent Lipodystrophy
What are some Warnings / Contraindications to using Insulin ?
> Hypoglycaemia
Lipohypertrophy / Atrophy
Renal Impairments
What are some important interactions / considerations when using Insulin ?
> Must increase dose when used with steroids
> Use with caution alongside other hypoglycaemic agents
How is DKA treated ?
Fluids => Insulin => Glucose + K+
What is Type 2 Diabetes caused by ?
Decrease in the sensitivity of the insulin receptors
> Initially overcame by increase insulin productions
-> Decreased insulin receptors
> Glucotoxicity from fatty acids and ROS lead to beta cell dysfunction
What is a difference between Type 1 and 2 DM
Type 2 cannot present with DKA
How is Type 2 DM initially treated ?
Non pharmacological Interventions
> Diet
> Exercise
> Education
How do Biguanides work to treat Type 2 DM
> Give an example of Drug
> When is it used
Metformin
> Decreases Hepatic Glucose output
> Increase Glucose Utilisation in Skeletal Muscle
> Suppresses appetite to minimise weight gain
First line of treatment
What are the contraindications / warning when using Biguanides
GI upset
- N+V
Stop if eGFR <30ml/min
What are some important interactions / considerations when using Biguanides
Don’t use with drugs that can affect kidneys function
- ACEi
- Diuretics
- NSAIDS
How do Sulfonylureas work to treat Type 2 DM
> Give examples of drugs
> When is it used
Glicazide
> Blocks ATP dependent K+ channels
> This prevents hyperpolarisation and thus membrane is depolarised leading to influx of Ca2+
> Vesicles containing insulin is released
- However this requires at least some residual pancreatic function
- Used in combination of other agents or first line when Metformin Contraindicated
How does DKA present ?
Clinical triad
1) Hyperglycaemia
2) Acidosis
3) Ketonaemia
Low blood ketones
Hyperglycaemia might not always be present
What should be considered when using Sulfonylureas ?
> Warnings / Contraindications
> Important Interactions / Considerations
Warnings: > Mild GI Upset > Hypoglycaemia > Some hypersensitivity reactions > Weight gain due to Anabolic Actions of Insulin
Import Interactions: > Other hypoglycaemic Agents > Hepatic Impairment > Renal Impairment > Thiazide like diuretics can increase glucose so can reduce action
How does Thiazolidenediones (Glitazones) work to treat Type 2 DM ?
> Give examples of drug
> When is it used
PioGLITAZONE
RosiGLITAZONE
> Insulin Sensitisation in Muscle and Adipose
Decreased Hepatic Glucose Output
Activates PPar-y -> Gene transcription
- Used less frequently and other agents
What should be considered when using Thiazolidenediones ?
>Warnings / Contraindications
> Important Interactions / Considerations
Warnings: > GI Upset > Fluid Retention > Fracture Risk > CVD concerns > Bladder Cancer > Weight Gain
Important Interactions:
> Other hypoglycaemic agents
How does SGLT-2 (Gliflozin) work to treat Type 2 DM
> Give examples
> When is it used ?
DapaGLIFLOZIN
CanaGLIFLOZIN
> Prevents Glucose absorption from Tubular Filtrate so increases urinary glucose excretion
Competitive reversible inhibition in PCT
-Used in both Type 1 and 2 DM as add on therapy
What should be considered when using SGLT-2 Inhibitors
> Warnings / Contraindications
> Important Interactions / Considerations
Warnings:
> UTI and Genital Infection
> Thirst
> Polyuria
Important Interactions
> Antihypertensives
> Other hypoglycaemic agents
