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Clinical Pharmacology > 6.1.1 Diabetes Type I > Flashcards

6.1.1 Diabetes Type I Flashcards

1
Q

What is insulin?

A

Protein secreted by beta cells

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2
Q

When is insulin secreted?

A

Increased glucose concentration

Incretin release e.g. glucagon like peptide (GLP-1) and gastric inhibitory peptide (GIP)

Parasympathetic activity via M3 receptors

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3
Q

What is the half-life of insulin?

A

5 minutes in plasma

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4
Q

What is insulin release inhibited by?

A

Low plasma glucose concentration

Cortisol

Sympathetic activity via alpha 2 receptors

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5
Q

What is the role of insulin?

A

Decrease hepatic glucose output via inhibition of gluconeogenesis and glycogenolysis- increases glycogen stores

Promotes glucose uptake into tissues- muscles and adipose especially

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6
Q

Why is insulin secreted into the blood even during fasting?

A

Prevents receptor down-regulation

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7
Q

When does insulin concentration increase?

A

Just after meals

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8
Q

What are the symptoms of type 1 diabetes?

A

Polyuria
Polydipsia
Weight loss
Fatigue/lethargy
Generalised weakness
Blurred vision

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9
Q

What are the diagnostic factors of type 1 diabetes?

A

Hyperglycaemia fasting glucose >6.9mmol/L
Random plasma glucose >11mmol/L

Plasma or urine ketones in presence of hyperglycaemia

HbA1c >48mmol/mol

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10
Q

Outline plasma glucose vs HbA1c

A

Glucose
Immediate measure of glucose levels in blood mmol/L

HbA1c
Glycated haemoglobin, percentage of RBCs with sugar coating

Reflects average blood sugar over last 10-12 weeks, mmol/mol

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11
Q

What is the biochemical triad for diabetic ketoacidosis?

A

Hyperglycaemia
Ketonaemia
Acidosis

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12
Q

When do you suspect DKA?

A

Blood glucose >11mmol/L
AND:
- Pear drop/acetone breath
- Vomiting + diarrhoea
- Confusion
- Visual disturbance
- Abdominal pain

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13
Q

How do you test for DKA?

A

Ketones in urine or blood
Venous pH < 7.3
HCO3 < 15mmol/L

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14
Q

What are the precipitating factors for DKA?

A

Infection
Trauma
Non-adherence to insulin treatment
Drug to drug interactions

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15
Q

How do you treat DKA?

A

IV fluids first
IV soluble insulin
K+ correction in additional fluids

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16
Q

What is the problem with bovine or procine insulin?

A

Difference in number of amino acids

Caused immune reaction as recognised as foreign to the body

17
Q

Why must you give insulin paraenterally?

A

Protein

If given orally would be digested in the gut

18
Q

What is the usual format of insulin?

A

100 units/ mL

In obesity and insulin resistance can be 300 and 500 units/mL

19
Q

How is insulin administered?

A

Sub-cutaneous injection into upper arms, thighs, buttocks or abdomen

IV infusion for emergencies

20
Q

Why do you want to slow down insulin absorption?

A

To allow insulin to circulate in the body, otherwise would get absorbed at injection site

21
Q

How do you slow down absorption of insulin?

A

Protamine and/or zinc complex with natural insulins

Soluble insulins form hexamer, delays absorption from site of injection

Plasma concentration greatest 2-3 hours after dosing

Doses usually 15-30 minutes before meal

22
Q

What is different about insulin analogues?

A

Different pharmacokinetics

Pharmacodynamics is still the same

Effect of drug is faster

Used in emergency IV infusions

23
Q

Why do you need to rotate injection sites?

A

Limit lipodystrophy- loss of adipose tissue in the area

24
Q

Why is non-adherence such an issue with insulin injections?

A

Need to take SEVERAL injections daily

Painful to inject

25
Q

Why is insulin measured in units/ml?

A

Biological substance, cannot quantify

26
Q

Complete the table

A
27
Q

When do you use insulin analogues?

A

Emergency, e.g. ketoacidosis

28
Q

Label the graph of different insulin profiles

A
29
Q

How are insulin combinations often prescribed?

A

By brand name

30
Q

What is the common dosing schedule used for insulin?

A

Basal-bolus dosing

via syringe, pens or pumps

31
Q

What is basal-bolus dosing?

A

Dosing regiment which allows flexibility for more active patients

Rapid acting insulin at times of meals, long-acting insulin for background effect, 2x daily

32
Q

What are the adverse effects of using insulin?

A

Hypoglycaemia
Lipodystrophy

33
Q

When should you not use insulin?

A

Renal impairment

Risk of hypoglycaemia

34
Q

Important drug to drug interactions with insulin?

A

Dose needs increasing with systemic steroids

Caution with other hypoglycaemic agents

35
Q

What is diabullimia?

A

When type 1 diabetics stop or reduce their insulin to control their weight

Clinical Pharmacology (45 decks)

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