9 - Diabetes and Drugs Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What causes the secretion of insulin and what is it inhibited by?

A
  • Protein secreted by B cells which is why it has to be injected not orally

- Stimulated by: increased glucse, glucagon, incretins (GLP-1 and GIP), parasympathetic activity (M3)

- Inhibited by: lowered glucose, cortisol, sympathetic activity (a2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different functions of insulin in the body?

A

- Stimulates uptake of glucose into liver, muscle and adipose tissue

- Inhibits gluconeogenesis

- Inhibits glycogenolysis

- Promotes fat uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some drugs that can be a risk factor for the development of type 2 diabetes? (drug induced diabetes)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some symptoms of type 1 diabetes?

A
  • Hyperglycaemia
  • Polyuria
  • Polydipsia
  • Weight loss
  • Fatigue/lethargy

Raised plasma glucose without symptoms not sufficient for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is insulin absorbed and administered?

A
  • Absorbed into the blood stream by subcut injection e.g upper arms, buttocks
  • Given 15-30 mns before eating as plasma concentration highest 2-3 hours after giving and short half life
  • Given IV if emergency
  • Has to be straight to blood stream as it is a protein so would be broken down enterally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What substances can be given with insulin to modify its absorption?

A

- Protamine: makes insulin short acting, broken down quicker

- Zinc: makes insulin long acting, longer time to absorb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some side effects of injecting insulin?

A
  • Hypoglycaemia
  • Lipodystrophy if using same sites constantly
  • Allergies
  • Painful injections
  • Lipoatrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fill in the following table regarding different formulations of insulin.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Provide an example of the following and when they need to be administered:

  • Rapid acting insulin
  • Short acting insulin
  • Intermediate acting insulin
  • Long/very long acting insulin
A

- Insulin aspart (Novorapid): inject just before eating

- Soluble Insulin (Actrapid or Humulin S): inject at least 15-30 minutes before eating several times daily to cover meals

- Isophane Insulin (NPH)

- Insulin degludec or insulin glargine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some contraindications for the use of insulin?

A
  • Increase dose of insulin if patient using steroids
  • Be careful with other hypoglycaemic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the key challenges for patients with Type 2 diabetes in terms of patient adherence and quality of life?

A
  • Weight gain (or fear of weight gain)
  • Risk of hypoglycaemia (or perceived risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is basal bolus dosing?

A
  • Injection at each meal, attempts to roughly mimic how a non-diabetic person’s body delivers insulin and then a basal dose constantly
  • Mimics insulin levels in healthy patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should you suspect a DKA and how would you treat it?

A
  • First give fluids as diuresis from glucose
  • Then give IV insulin
  • Give glucose and K as can turn hypokalemic from insulin even though appear hyperkalemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are three different regimens that can be used for insulin injections?

A

- Basal: inject a long acting insulin so you have the same basal level of insulin at all times

- Basal-Bolus: use a long acting insulin but before eating you inject a fast/short acting insulin so insulin levels increase when eating

- Intermediate: 2 injections a day of combined intermediate and short acting

Can get a insulin pump but very expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pathophysiology of type 2 diabetes and how can it be treated in general terms?

A
  • Decrease in sensitivity of insulin receptors initially overcome by increased pancreatic insulin secretion
  • Glucotoxicity from fatty acids and ROS lead to B cell dysfunction

- Treat: change lifestyle, hypoglycaemic agents and eventually insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the NICE guidlines for type II diabetics needing glucose lowering therapy?

A

- HbA1c >6.5% use metformin, if can’t tolerate use DPP-4i or SGLT2i OR a modified release metformin

- HbA1c>7.5% consider dual therapy and if not responding then triple therapy and if still not responding think about insulin therapy

SEE PICTURE FOR DETAILS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the mechanism of action of metformin? (biguanide)

A

FIRST LINE THERAPY

- Decrease hepatic glucose output by decreasing gluconeogenesis and glycogenolysis

- Increases glucose utilisation in skeletal muscle by decreasing insulin resistance

- Suppresses appetite so limits weight gain

- Decrease insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some side effects of metformin?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Vitamin B12 deficiency (uncommon)
  • Lactic acidosis (rare

USE MODIFIED RELEASE TO LIMIT SIDE EFFECTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some contraindications for the use of metformin?

A

- Any drugs that may impair renal function: ACEi, NSAIDs, diuretics

- Thiazide like diuretics as they increase gucose so can reduce metformin action

20
Q

What is the mechanism of action of suphonylureas and what is an example of this class of drug?

A

- Gliclazide

  • Added on if metformin isn’t working

- Stimulates beta cells to secrete insulin by blocking ATP dependent K channels but need residual pancreatic function for this

  • Decreased microvascular risk
21
Q

What are the side effects of sulphonylureas?

A
  • Weight gain due to anabolic effects of insulin
  • Mild GI upset
  • Hypoglycaemia (less risk than in metformin)
  • Hypersensitivity reactions (rare)
22
Q

When do you need to use suphonylureas with caution?

A
  • Other hypoglycaemic agents
  • Hepatic impairment
  • Renal impairment (not so much as metabolised hepatically)
23
Q

What is the mechanism of action of glitazones and what are some examples?

A

Pioglitazone and Rosiglitazone

- PPARy receptor agonist which is a transcription factor that increases the sensitivity of fat cells to insulin

  • Decrease hepatic glucose output by activating PPARy receptor
24
Q

Describe the side effects for the following glitazone drugs:

  • Rosiglitazone
  • Pioglitazone
A

- Rosiglitazone – CVS concerns

- Pioglitazoneweight gain, fluid retention, heart failure, effects on bone metabolism so fracture risk and bladder cancer

  • Be careful using these when also using other hypoglycaemic drugs
25
Q

What are the mechanism of action of gliflozins (SGLT2 inhibitors) and what are some examples of these drugs?

A

- Prevent uptake of glucose in the PCT so more glucose in the urine

  • Used in type 1 and type 2 diabetes as an add on theray

- Dapagliflozin and Canagliflozin

26
Q

What are some side effects of gliflozins and when should they be used with caution?

A
  • UTI risk
  • Polyuria and polydipsia
  • Be careful when using with antihypertensives and other hypoglycaemic agents
27
Q

What are the effects of GLP-1 (glucagon like peptide) in the body?

A
  • Increase insulin secretion from the beta cells
  • Decreases production of glucagon from alpha cells
28
Q

What is the mechanism of action of GLP-1 agonists and what are some examples of this type of drug?

A
  • Increase glucose dependent synthesis of insulin from B cells by activating the GLP-1 receptor. These agonist can’t be degraded by DDP-4

- Decrease production of glucagon

  • Promote sateity as slow gastric emptying so possible weight loss

- Exenatide and Liraglutide

29
Q

What are the side effects of using GLP-1 agonists and when should you be careful prescribing them?

A
  • GI upset
  • GORD
  • Painful to inject (subcut injection)
  • Small pancreatitis/pancreatic carcinoma risk
  • Don’t take if eGFR<30ml/min
  • Be careful when patient taking other hypoglycaemic agents
30
Q

When would you prescribe a GLP-1 agonist?

A

If triple therapy is ineffective, prescribed at really late stage

31
Q

What is the mechanism of action of gliptins and give a few examples of this type of drug?

A
  • DPP4 inhibitor therefore stopping the degradation of GLP1 so increase plasma incretin levels and therefore increased insulin
  • First line option if metformin not tolerated
  • Supresses appetite so weight neutral

- Sitagliptin and Saxagliptin

32
Q

What are the side effects of using DDP4 inhibitors and when should you be careful prescribing them?

A
  • GI upset
  • Pancreatitis risk
  • Not as much risk of hypoglycaemia as with GLP1 agonists as not directly making insulin
  • Avoid in pregnancy
  • Thiazide like/Loop diuretics
  • Hypoglycaemic agents
  • Drugs that increase glucose
33
Q

When giving a modified release tablet what do we need the patient to do?

A

SWALLOW THE TABLET WHOLE - as the coating makes it modified release

34
Q

What are the pros and cons of giving two oral hypoglycaemic agents in the same drug?

A
  • Increases adherance as only one pill
  • Hard to change dosage of just one pill so difficult to finely tune drug regimen
35
Q

What is diabulimia?

A

An eating disorder in which people with type 1 diabetes deliberately give themselves less insulin than they need or stop taking it altogether for the purpose of weight loss

36
Q

How is insulin release controlled at the site of injection?

A
  • By the other substances injected with it, e.g zinc
  • As it is made soluble this delays absorption as soluble insulins form hexamers at the site of injection to delay absorption
37
Q

Why do DPP-4 inhibitors have a low risk of hypoglycameia when administer alone?

A
  • Prevents hypoglycaemia via increased glucagon counterregulation through the incretin hormone glucose-dependent insulinotropic polypeptide (GIP)
  • INCRETINS DON’T HAVE AN EFFECT AT LOW GLUCOSE!!! (Don)
38
Q

Why do sufonylureas promote weight gain?

A

They cause increased insulin release which has anabolic effects

39
Q

What is the target cholesterol value once statins have been started?

A
  • Total<4mmol/L for secondary prevention
  • LDL<2mmol/L
40
Q

How would you diagnose myalgia due to the use of statins?

A

Blood CPK would be more than ten times the normal limit

41
Q

Why do thiazide like diuretics increase glucose levels?

A

Hypothesis believes they may cause worsening of insulin resistance, inhibition of glucose uptake, and decreased insulin release

42
Q

What class of oral hypoglycaemic agent provides long term redution in vascular complications?

A

SGLT2 inhibitors!!!! (not DDP-4)

43
Q

If a patient can only tolerate a low dose statin, what else should they be given?

A

Ezetimibe (only in the enterohepatic circulation, not the systemic)

44
Q

What diabetic drugs are good to use in renal impairment?

A

Glicazides as they are hepatically metabolised

45
Q

What non-pharmacological intervention would be recommended upon diagnosing type II diabetes and what considerations should be discussed when initiating therapy?

A
  • Managed weight reduction
  • Warn them about weight gain and hypoglycaemia