5.2 The Pharmacology Of Insulim Flashcards
what is the role of insulin?
- stimulates uptake of glucose into liver, muscle and adipose tissue
- decreases hepatic glucose output via inhibition of gluconeogenesis
- inhibits glycogenolysis
- promotes uptake of fats
what are the 6 main categories of insulin?
ultrafast acting rapid acting short acting intermediate acting long acting very long acting
what are rapid acting insulins? name an example.
- rapid onset of action - 5 to 15 minutes
- inject just before eating
- peaks 60 mins after
- duration of 4-6 hrs
e.g. humalog
what are short acting insulins? give an example
- start to work 30-60 mins after
- need to inject 15-30 mins before eating several times a day to cover meals
- peaks at 2-3 hrs
- duration 8-10 hrs
e.g actrapid
what are some intermediate acting insulins? give an example.
- slower onset 2-4 hrs
- peaks 4-8 hrs
- duration up to 12-20hrs
e.g insulatard
what are long and very long acting insulins? give an example.
- slow onset 2-6 hrs
- duration up to 24 hrs
- very long, up to 50+ hrs
what is insulin pump therapy?
sensor augmented pump therapy with threshold suspend
rapid acting insulin is constantly given
what are the adverse effects of insulin?
- hypoglycaemia
- hyperglycaemia
- lipodystrophy
- painful injections
- insulin allergies
how do we treat type 2 diabeties?
lifestyle changes and non insulin therapies (may eventually need to take insulin)
- insulin
- bariatric surgery
- low calorie diet
- exercise
what are the nice targets in type 2 diabeties?
HbA1c 6.5-7.5% in general
what is metformin and what does it do?
metformin
- decreases insulin resistance, leading to increased glucose taken in by tissues
- decreased hepatic glucose production
- limits weight gain
what are the ADRs of metformin?
- GI symptoms
- lactic acidosis
- vit b12 deficiency
what are sulphonylureas and what do they do?
stimulate beta cell to release insulin
what are the ADR of sulphonylureas?
weight gain
hypoglycaemia
cost low
what is acarbose and what does it do?
Acarbose = a glucosidase inhibitor
inhibits breakdown of carbohydrates to glucose by blocking action of the enzyme alpha glucosidase
this means less cholesterol is produced as less carbs are broken down
what are the side effects of acarbose?
flatulence
loose stools
diarrhoea
due to less cholesterol being absorbed = poo it straight out
rarely if every used
what are glucagon like peptide 1 therapies?
increase insulin secretion from the beta cells
decrease production of glucagon from the alpha cells
this is useful in type 2 diabetics as high glucose is present due to low insulin and high glucagon
it also
- decreases glucose production from the liver
- decreases gastric emptying
- increases glucose uptake in muscles
What is HbA1c?
HbA1c is your average blood glucose levels for the last two to three months.
A high HbA1c means you have too much sugar in your blood. This means you’re more likely to develop diabetes complications, like serious problems with your eyes and feet.
what are gliptins or DPP 4 inhibitors used for and how do they work?
e.g sitagliptin
inhibit DPP-4 activity, increasing active glycogen like peptide activity post meal
what are the side effects of gliptins and DPP-4 inhibitors?
GI symptoms pancreatitis low risk of hypoglycaemia weight neutral modest HbA1C reduction high cost
what are the adverse side effects of Glucagon-like peptide 1 (GLP-1) ?
- gastrointestinal symptoms, nausea, loose stools, diarrhoea
- gastro oesophageal reflux
- painful to Inject someties
- maybe pancreatitis??? nobody knows
what is dapaglifozin?
a type of glifozin
removes excess glucose via excretion in urine by inhibiting SGLT2 transporters that would reuptake it
what are the side effects of glifozins?
increased risk of lower urinary tract symptoms and UTI’s
polyuria
hypoglycaemia risk low
