5. Diabetes Mellitus Flashcards
What is the biochemical triad in diabetic ketoacidosis?
Hyperglycaemia
Ketonaemia
Acidosis
What should be given in DKA?q
IV fluids with K+ and then IV soluble insulin
How are insulin preparations made to slow absorption?
Protamine and/or zinc complex with natural insulin’s
Soluble insulin forms hexameter
Insulin analogues
What are the adverse effects of insulin prescription?
Hypoglycaemia
Lipodystrophy
What are the contraindications of insulin prescriptions?
Renal impairment
What are the important drug reactions with insulin prescriptions?
Dose needs increasing with systemic steroids
Caution with other hypoglycaemic agents
What is the management of type 2 diabetes?
Lifestyle, education Weigh loss Initially non-insulin therapies Insulin in poorly managed or later stage disease Treat comorbidities
What is the action of biguanides?
Reduce hepatic glucose production by inhibiting gluconeogenesis
Suppress appetite so limit weight gain
Lower risk of hypoglycaemia
Name a biguanide drug
Metformin
What are some adverse effects of metformin?
GI upset - nausea, vomiting, diarrhoea
What are some contraindications of metformin?
Excreted unchanged by kidney - stop in eGFR <30ml/min, alcohol intoxication
What are the important drug interactions with metformin?
ACEi
Diuretics
NSAIDs
What is the action of sulfonylureas?
Stimulate beta cell pancreatic insulin secretion by blocking ATP-dependent K+ channels
Need residual pancreatic function to work
Weight gain through anabolic effects of insulin
Name a sulfonylurea drug
Gliclazide
What are the adverse effects of sulfonylureas?
Mild GI upset
Hypoglycaemia
What are the contraindications for sulfonylureas?
Hepatic and renal disease
What are the important drug interactions with sulfonylureas?
Other hypoglycaemic drugs
Loops and thiazide diuretics - oppose actions of SU
What are the actions of thiazolidinediones?
Insulin sensitisation in muscle and adipose, reduce hepatic glucose output by activation of PPAR-gamma, affects gene transcription
Causes weight gain because of fat cell differentiation
Name examples if thiazolidinediones
Pioglitazone
Rosiglitazone
What are the adverse effects of thiazolidinediones?
GI upset
Fluid retention
Fracture risk
Bladder cancer
What are the contraindications of thiazolidinediones?
Heart failure because of fluid retention
What are the important drug reactions with thiazolidinediones?
Other hypoglycaemic agents
What is the action of SGLT-2 inhibitors?
Decrease glucose absorption from tubular filtrate, increase urinary glucose excretion by competitive reversible inhibition of SGLT-2 in PCT
Moderate weight los, hypoglycaemic risk low
Name 2 SGLT-2 inhibitors
Dapagliflozin
Canagliflozin
What are the adverse effects of SGLT-2 inhibitors?
UTI
Genital infection
Thirst
Polyuria
What are the contraindications of SGLT-2 inhibitors?
Risk of DKA in type 1 diabetes, possible hypotension
What are the important drug interactions with SGLT-2 inhibitors?
Antihypertensive and other hypoglycaemic agents
What is the action of dipeptidyl peptidase-4 (DPP-4) inhibitors?
Prevent increasing degradation - increase [plasma] incretin levels
Suppress appetite - weight neutral
Name 2 DPP-4 inhibitors
Sitagliptin
Saxagliptin
What are the adverse effects of DPP-4 inhibitors?
GI upset
Small pancreatitis risk
What are the contraindications of DPP-4 inhibitors?
Avoid in pregnancy, history of pancreatitis
What are the important drug interactions with DPP-4 inhibitors?
Other hypoglycaemic agents
Drugs that increase glucose can oppose gliptin action e.g. thiazide like and loop diuretics
What is the action of GLP-1 receptor agonists?
Increase glucose dependent synthesis of insulin secretion from beta cells
Activate GLP-1 receptor - resistant to degradation by DPP-4
Name 2 GLP-1 receptor agonists
Exenatide
Liragutide
What are the adverse effects of GLP-1 receptor agonists?
GI upset
Decreased appetite with weight loss
What are the contraindications of GLP-1 receptor agonists?
Renal impairment
What are the important drug reactions with GLP-1 receptor agonists?
Other hypoglycaemic agents
