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4 Clinical Pharmacology and Intro to Prescribing > 10 Diabetes- Insulins and Oral Hypoglycaemic agent > Flashcards

10 Diabetes- Insulins and Oral Hypoglycaemic agent Flashcards

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1
Q

What is insulin secreted in response to? What is insulin inhibited by? What is the role of insulin?

A
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2
Q

Why does insulin need to be given parenterally? What are the injection sites used for it (need to be rotated)?

A

Insulin= a protein

–> to avoid digestion in the gut

Injection sites:

  1. Upper arms
  2. Thighs
  3. Buttocks
  4. Abdomen
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3
Q

How is human insulin produced? In what unit is it formulated

A

Recombinant DNA (bacteria/yeast) or Enzymatic modicfication of porcine

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4
Q

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?

A
  • 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
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5
Q

Identify 4 different types of insulin. (insulin analogues)

A
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6
Q

What are the warnings/contraindications for insulin and what are the important interactions to consider?

A

Warnings/contraindications:

  • Hypglycaemia
  • Lipohypertrophy/lipoatrophy
  • Renal impairment- hypeglycaemia risk

Important interactions:

  • Steroids?
  • Other hypoglycaemic agents
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7
Q

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?

A

To mimic normal release of insulin- have baseline insulin

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8
Q

What factors should lead you to suspect diabetic ketoacidosis?

A
  • blood glucose > 11mmol/L
  • infection
  • stress/trauma
  • poor insulin adherence
  • ADRs
  • ketosis
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9
Q

How should diabetic ketoacidosis be treated?

A

FIRST- fluids

NEXT- insulin (stat dose), glucose, K+ (as insulin may cause hypokalaemia)

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10
Q

Biguanides are typically the first drug offered in the treatment of type 2 diabetes. How do biguanides work? (3)

A
  1. Decrease hepatic glucose output (gluconeogenesis, glycogenolysis)
  2. Increase glucose utilisation in skeletal muscle
  3. Supress appetite- limit weight gain
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11
Q

What are the main side effects of biguanides and what important drug interactions should we be aware of?

A

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
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12
Q

Name a Biguanide.

A

metformin

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13
Q

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

A
  1. Block ATP-dependant K+ channels–> stimulate β̞-cell pancreatic insulin secretion

Need residual pancreatic function

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14
Q

What are the side effects, important interactions and contraindications to be aware of with sulfonylureas?

A

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
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15
Q

Name an examples of a sulfonylureas.

A

Gliclazide

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16
Q

How do thiazolidinediones (glitazones) work to treat types 2 diabetes? (2) What are their durations of action like?

A
  1. Insulin sensitisation in muscle and adipose
  2. Decrease hepatic glucose output

Activate PPAR-y gene transcription- duration of action= 6-8 weeks

17
Q

What are the major side effects and interactions for glitazones?

A

Side effects:

  • GI upset
  • Fluid retention (weight gain)
  • Fracture risk
  • CVD concerns
  • Bladder cancer

Important interactions:

  • Other hypoglycaemic agents
18
Q

Name 2 glitazones (Thiazolidinediones).

A

Pioglitazone

Rosiglitazone

19
Q

How do sodium glucose co-transporter inhibitors (SGLT-2 inhibitors or gliflozins) work to treat types 2 diabetes?

A
  1. Decrease glucose absorption from tubular filtrate –> increase urinary glucose excretion

(used in type 1 and type 2)

20
Q

What are the side effects and interactions to be aware of for SGLT-2 inhibitors (using them to treat diabetes)?

A

Side effects:

  1. UTIs
  2. Thirst
  3. Polyuria

Interactions:

  1. Other hypoglycaemic agents
  2. Other antihypertensives
21
Q

Give 2 examples of SGLT-2 inhibitors.

A

Dapagliflozin

Canagliflozin

22
Q

How do gliptins (dipeptidyl peptidase-4 inhibitors) (DPP-4 inhibitors) work to treat type 2 diabetes?

A
  • Dipeptidyl peptidase-4 destroys hormone incretin
  • Incretins: help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed
  • There with gliptins- more incretin in body
    • Also supress appetite

Low risk of hypoglycaemia when administered alone- incretins are glucose dependent

23
Q

What are the side effects and important interactions to remember when prescribing gliptins (DPP-4 inhibitors)?

A

Side effects:

  • GI upset
  • Pancreatitis risk

Interactions:

  • Other hypoglycaemic agents
  • Drugs increasing glucose eg certain diuretics

AVOID IN PREGNANCY

24
Q

Give 2 examples of Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins).

A

Sitagliptin

Saxagliptin

25
Q

How do Glucagon-like peptide-1 receptor agonists work to treat type 2 diabetes? How are they administered? When are they indicated?

A

Administered: Subcutaneous injection

Indicated: add-on if triple therapy ineffective

26
Q

What are the side effects and interactions to be aware of with GLP-1 receptor agonists?

A

Side effects:

  • GI upset
  • GORD

Interactions:

  • Other hypoglycaemic agents

STOP if eGFR <30mL/min

27
Q

What is diabulimia?

A

Condition- patient with type 1 diabetes deliberately stops taking their insulin for the purpose of weight loss

28
Q

Name two GLP-1 agonists to treat type 2 diabetes (Glucagon- like peptide-1).

A

Exenatide

Liraglutide

29
Q

Useful summary of drugs used to treat type 2 diabetes:

A

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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