22. Pharmacology of Diabetes Mellitus Flashcards
What are the options for insulin replacement in type 1?
Subcutaneous insulin
Islet replacement therapy
What are the methods of delivering insulin in type 1?
Basal and bolus
Insulin pumps
Artificial pancreas (sensor and pump)
How is the amount of insulin required calculated?
0.5 x kg/per day
What is the difference between basal and bolus insulin?
Basal is long acting: between meals and overnight
Bolus is rapid acting before a meal
What are the complications of an insulin pump?
Infection and ketoacidosis
What are the side effects of insulin?
Hypoglycaemia
Weight gain
Oedema
Allergy
What is the Hb1AC target in diabetes?
7%
What is the first choice treatment for type 2 diabetes?
Why?
Metformin
Doesn’t cause weight gain or hypoglycaemia
How does Metformin work?
Reduces hepatic glucose production
Increases sensitivity by increasing glucose uptake
What are the side effects of Metformin?
GI
Lactic acidosis in renal impairment (eGFR <30)
B12 deficiency
How do sulfonylureas work?
Stimulate insulin release by B-cells
What are the side effects of sulphonylureas?
Hypoglycaemia
Weight gain
Stop responding over time
Can sulphonylureas be used in renal failure?
Yes but at lower doses
Name a sulphonylurea
Gliclazide
Name 2 thiazolidinediones
Pioglitazone
Rosiglitazone