10 Diabetes- Insulins and Oral Hypoglycaemic agent Flashcards
What is insulin secreted in response to? What is insulin inhibited by? What is the role of insulin?
Why does insulin need to be given parenterally? What are the injection sites used for it (need to be rotated)?
Insulin= a protein
–> to avoid digestion in the gut
Injection sites:
- Upper arms
- Thighs
- Buttocks
- Abdomen
How is human insulin produced? In what unit is it formulated
Recombinant DNA (bacteria/yeast) or Enzymatic modicfication of porcine
What is the half life of insulin like in plasma?
What is the concentration of insulin in plasma greatest?
What can be added to insulin to modify its absorption?
- t1/2 - ~ 5 minutes in plasma – renal and hepatic metabolism and elimination
- [plasma] greatets after 2-3 hr – dose 15-30 min prior to meals
- Protamine and zinc used to modify absorption
Identify 4 different types of insulin. (insulin analogues)
What are the warnings/contraindications for insulin and what are the important interactions to consider?
Warnings/contraindications:
- Hypglycaemia
- Lipohypertrophy/lipoatrophy
- Renal impairment- hypeglycaemia risk
Important interactions:
- Steroids?
- Other hypoglycaemic agents
Sometimes a long acting insulin is given to a patient with short acting insulins given in between. What is this called and why is it done?
To mimic normal release of insulin- have baseline insulin
What factors should lead you to suspect diabetic ketoacidosis?
- blood glucose > 11mmol/L
- infection
- stress/trauma
- poor insulin adherence
- ADRs
- ketosis
How should diabetic ketoacidosis be treated?
FIRST- fluids
NEXT- insulin (stat dose), glucose, K+ (as insulin may cause hypokalaemia)
Biguanides are typically the first drug offered in the treatment of type 2 diabetes. How do biguanides work? (3)
- Decrease hepatic glucose output (gluconeogenesis, glycogenolysis)
- Increase glucose utilisation in skeletal muscle
- Supress appetite- limit weight gain
What are the main side effects of biguanides and what important drug interactions should we be aware of?
Side effects:
- GI upset- nausea, vomiting, diarrhoea
- (Stop if eGFR <30mL/min- excreted unchanged by kidneys)
Interactions:
- Anything impairing renal function- can increase glucose so reduce action of metformin
- ACEi
- Diuretics
- NSAIDs
Name a Biguanide.
metformin
How do sulfonylureas work to treat type 2 diabetes? What does it require in order to work? (1)
Typically used in combination or first line if metformin contraindicated
- Block ATP-dependant K+ channels–> stimulate β̞-cell pancreatic insulin secretion
Need residual pancreatic function
What are the side effects, important interactions and contraindications to be aware of with sulfonylureas?
Side effects:
- Mild GI upset
- Weight gain
- Hypoglycaemia
- Hypersensiitivity reactions
Interactions:
- Other hypoglycaemic agents
- Thiazide like diuretics (increase glucose so impair function)
Contraindications:
- Hepatic impairment
- Renal impairment
Name an examples of a sulfonylureas.
Gliclazide