5. Diabetes therapy Flashcards
describe the general management of T1DM
- dietary management and regular exercise
- monitoring of plasma glucose levels (finger prick and BM stick and reader)
- INSULIN THERAPY
how does insulin affect plasma glucose levels
Acts at tyrosine kinase Rs on target cell membranes to DECREASE plasma glucose levels by:
- stimulate glucose uptake by skeletal muscle and adipose cells (GLUT4 translocation)
- inhibit hepatic gluconeogenesis
- stimulate hepatic and muscle glycogenesis
how does insulin affect plasma lipids and amino acids
Decreases plasma lipids by:
- increase hepatic/adipose lipogenesis and decrease lipolysis
- increase lipoprotein lipase activity in capillary beds, e.g. of adipose
Decrease plasma amino acids by:
- increasing amino acid uptake and protein synthesis in liver, muscle and adipose
- decreasing proteolysis in liver, skeletal and cardiac muscle
name the 6 main insulin categories
Different formulations influence rate of absorption:
- ultrafast acting
- rapid acting
- short acting
- intermediate acting
- long acting
- very long acting
describe 3 different types of insulin regimen
- 1, 2 or 3 injections/day: injections of short- or rapid-acting insulin mixed with intermediate-acting insulin (e.g. NovoMix 30)
- multiple daily injection basal-bolus: injections of short- or rapid-acting insulin before meals with 1+ separate daily infections of intermediate- or long-acting insulin to cover basal requirement
- continuous subcutaneous insulin infusion (insulin pump): programmable pump and insulin storage reservoir that gives regular or continuous amount of insulin (rapid or short acting) via subcutaneous needle or cannula
name the possible adverse effects of insulin
- hypo- or hyperglycaemia
- lipodystrophy at injection site: lipohypertrophy or lipoatrophy
- painful injections
- insulin allergies (very rare)
name 2 factors that result in poor adherence to diabetes therapy
- (perceived) risk of hypoglycaemia
2. (fear of) weight gain
what is the general target for HbAc1 in T2DM Ps
6.5-7.5%
describe the 1st line therapy for T2DM - what is the MOA of this drug?
- dietary management (bariatric surgery/very low calorie diet) + regular exercise
- METFORMIN
- reduces insulin resistance (increased glucose use by tissues)
- reduces hepatic gluconeogenesis
if plasma glucose is not being controlled by metformin alone, what are the next steps
- metformin + other drug (SU/pioglitazone/GLP1/DPP-4i/glifozins)
- metformin + other drug (SU/pioglitazone/GLP1/DPP-4i/glifozins) + insulin
what is the MOA of sulphonylureas?
stimulate insulin release from B cells
name 2 possible side effects of sulphonylureas
- weight gain
2. hypoglycaemia
what is the mode of action of pioglitazone and why is this rarely used now
Bind and activate peroxisome proliferator activated receptors (PPARs):
- increase insulin sensitivity in muscle and adipose
- decrease hepatic gluconeogenesis
Rarely used as concerns with weight gain, fluid retention, heart failure, bone metabolism effects & bladder cancer
what is the MOA of glucagon-like peptide 1 (GLP1)?
Enzyme with similar effects to insulin:
- increases insulin synthesis and secretion from B cells
- decreased glucagon secretion from a cells
- decreases hepatic gluconeogenesis (indirect)
- increases glucose uptake in muscle (indirect)
- decreases gastric emptying and food intake (satiety)
what is the MOA of DPP-4 inhibitors (gliptins)
break down enzyme that inhibits GLP1
