Anti diabetics (4) Flashcards
Where does amylin function? What does it contribute to?
pancreas
Glycemic control
What is a synergistic partner to insulin?
amylin
**co-secreted
T/F the amount of insulin and amylin released is 1:1
false!
1:100 amylin: insulin
What does amylin work to do?
provide postprandial glucose control
Native amylin is single chain peptide of ____ AA
37
t/f human amylin can be given
false!!
highly amyloidogenic and potentially toxic
How can you give amylin to a patient?
rat amylin is used for analogs
**not amyloidogenic
amylin AKA
IAPP (islet amyloid polypeptide)
What is a new adjunct treatment for T1D and T2D?
amylin
What do IAPP result in?
- weight loss
- use less insulin
- lower average BG levels
ADE of IAPP
severe hypoglycemia (esp T1D)
How do SGLT2 inhibitors work?
improve glycemic control by increasing urinary excretion of glucose
Who can use SGLT2 inhibitors?
T2D
Which SGLT is in S3 segment of proximal tubule and contributes to 10% of glucose reabsorption?
SGLT1
Which SGLT is in S1 and S2 segments of proximal tubule and contributes to 90% of glucose reabsorption?
SGLT2
how much glucose is excreted?
<1%
how much glucose is reabsorbed?
99%
What type of drugs are SGLT2 inhibitors?
gliflozins
What are SGLT2 inhibitors associated with?
increased UTIs
What could SGLT2 inhibitors lead to?
ketoacidosis
ketoacidosis
metabolic state with high concentrations of ketone bodies
structural modification of phlorizin has lead to a number of SGLT2 selective inhibitors by _____
lead optimization
(SAR) OH group on B ring of SGLT2 inhibitors
not essential for inhibition
**responsible for toxicity
What can dual therapy help with?
reduce blood glucose quicker and remain there longer
complications of DM
neuropathy
nephropathy
microangiopathy
macroangiopathy
T/f all diabetics will develop the late complications associated with the disease
true
DCCT study
T1D
- **keep BG levels under tight control
- slows progression of damage
UKPDS study
T2D
- **keep BG levels under tight control
- decreased complications
People newly diagnosed with T2D but otherwise good health, ADA suggests aiming for _____
tight control (normal) + lifestyle changes
Ideal HbA1C under tight control
6-6.5%
People who have had diabetes for awhile, HbA1C goal is
slightly higher 7.5-8%
Why would people who already have diabetes have looser blood sugar control?
- older age
- frequent bouts of hypoglycemia
- presence of other medical conditions requiring multiple meds and needing more than 2 drugs to lower BG
- limited finances
Who is tight control most worthwhile for?
healthy people who can live at least 10 more years
Who is not recommended to go on tight control?
- children **need glucose for brain development
- elderly
Ways to measure hyperglycemia
- glucose levels
- Frductosamine
- glycated hemoglobin (HbA1C
- 1,5-AG
How do you measure fructosamine?
colorimetric procedure
How do you measure HgA1C?
affinity chromatography
How do you measure glucose levels?
blood
urine
1,5-AG
naturally occurring monosaccharide
100% non metabolized
1,5 AG during hyperglycemia
decrease
1,5 AG post hyperglycemia
return to normal
