3.1 and 3.2 Diabetes Drugs

Question 1

What are the general names of drugs given to type 2 diabetics?

Answer 1

Metformin
Sulphonylurea
Glitazone
Acarbose
Incretin Based Drugs
SGLT2 Inhibitors

Question 2

What is the first line treatment of T2D?

Answer 2

Diet and Lifestyle Changes

Exercise and Weight Loss

Question 3

What is the first Pharmacological treatment of T2D?

How does it work?

Answer 3

Metformin (biguonide)
It increases insulin sensitivity (skeletal and adipose)
It decreases gluconeogenesis
Can also reduce V/LDLs

Question 4

What are the advantages of Metformin?

Answer 4

Can cause weight loss
It is cheap
It is effective
It is oral and can be taken long term, take 2-3 times a day before meals

Question 5

What side effects are common with Metformin

Answer 5

Hypoglycaemia
GI Effects
B12 Deficiency

Question 6

When should you NOT use Metformin?

Answer 6

CKD

<30ml/min

Question 7

What is the next drug you add to metformin in poor control?

Answer 7

Sulphonylurea

Question 8

How do Sulphonylureas work?

Answer 8

They stimulate insulin secretion from Beta Islet Cells
They are antagonists of the K+ATPase channel which leads to K+ increasing in the cell which increases Ca2+ entry.
Stimulates vesicle release of insulin

Question 9

What are the general mechanisms drugs take to treat diabetes?
Which drugs act in which way?

Answer 9

Insulin Sensitisers (Metformin and Glitazones)
Insulin Release Stimulators (sulphonylureas, glipizides)
Inhibit uptake of carbohydrate (acarbose)
Inhibit reabsorption in kidneys (SGLT2 inhibitors)
Increase action of GLP1 (incretin based therapy)

Question 10

What are some side effects of Sulphonylureas?

Answer 10

Weight Gain (insulin anabolic)
Risk of Hypo (due to increased half life/potency of some agents)
GI disturbance

Question 11

How does Acarbose work?

Answer 11

It inhibits alpha-glucosidase which normally breaks down complex carbohydrates

Question 12

What are the side effects of acarbose?

Answer 12

Flatulence
Diarrhoea
Loose Stools
Abdo Pain

Question 13

What are the risks of glitazones?

Answer 13

Bladder cancer
GI symptoms
Fluid retention
Weight Gain

Question 14

What are the types of incretin based therapy?

Answer 14

DPP4 Inhibitors
GLP1 receptor agonists
GLP1 agonists

Question 15

Why do incretin based therapies work?

Answer 15

They act on either the breakdown or action of GLP
GLP is a peptide which is released from intestinal L cells after a meal. It suppresses appetite, slows gastric emptying and gluconeogenesis and increases uptake into muscles and insulin secretion

Question 16

How do SGLT2 Inhibitors work?

Answer 16

They block SGLT2 in the PCT of the kidney

Prevent reabsorption in the kidney

Question 17

What are the side effects of SGLT2 Inhibitors?

Answer 17

UTIs (thrush due to glucose in urine)

Polyuria

Question 18

What are some advantages of SGLT Inhibitors?

Answer 18

Low risk of hypoglycaemia

Promote weight loss

Question 19

What are some pros and cons of GLP agonists?

Answer 19

Weight Loss

GI symptoms (reflux, loose stools, nausea, diarrhoea)
Expensive
Have to inject- pain

Question 20

What part of insulin is changed to affect the pharmacokinetics?

Answer 20

The B chain
Between regions 26-30
Helps change its absorption

Question 21

What are the types of insulin?

Answer 21

Rapid Acting
Short acting
Intermediate acting
Intermediate/Long Acting
very Long acting

Question 22

Why do you take long acting insulin?

Answer 22

To keep basal levels of insulin to prevent hyperglycaemia

Question 23

What are the risks of long acting insulin?

Answer 23

Hypoglycaemia at night

Question 24

How long do rapid acting insulin and short acting last?

How long to take effect?

Answer 24

30 mins, 10 Hours with peak at 2-3 Hours

15 mins, 4-6 Hours

Take just before eating

Question 25

How is insulin created?

Answer 25

Recombinant DNA technology

Question 26

What are some adverse effects of insulin therapy?

Answer 26

Painful to Inject
Hypo/Hypers
Lipodystrophy/Lipohypertrophy
Allergies (normally to the prep, switch brands)