Chapter 5-diabetes Flashcards
Does glycemic control worsen over time?
YES
Name a biguanide
Metformin
How does metformin work
Decreases gluconeogensis
Increases peripheral utilisation of glucose
Does metformin work in the presence of insulin?
Yes acts only in the presence of insulin
What’s the rate but potentially fatal side effect of metformin
Lactic acidosis
Why can lactic acidosis occur with metformin
Because metformin reduces hepatic uptake of lactate
What are the symptoms of lactic acidosis
Insidious onset with vague and non specific symptoms: Anorexia Lethargy Nausea Respiratory distress
How do sulfonylureas work
Stimulate insulin release by the beta cells of the pancreas
What do sulfonylureas need in order to work
Require functioning beta cells
Why do you need to take sulfonylureas with food?
To prevent hypoglycaemia
How do meglitinides work?
Stimulate insulin secretion but only in the presence of food
Do meglitinides work quickly and how long for?
Rapid onset and short duration of action
Which has a lower risk of hypoglycaemia:
Sulfonylureas
Meglitinides
Meglitinides
What class of drugs prevent intestinal absorption of starch and sucrose
Alpha-glucosidase inhibitors
When a patient is on alpha-glucosidase inhibitors should they use sucrose to treat hypos?
NO USE GLUCOSE
How do thiazolidinediones work?
Enhance tissue sensitivity to insulin
What does GLP-1 stand for?
Glucagon-like peptide
What is GLP-1 glucagon like peptide?
It’s a neuropeptide it increases insulin excretion from the pancreas in a glucose dependant manner
define incretin
Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels
Name two incretin based therapies
DPP-4 inhibitors
GLP-1 receptor agonists
When is GLP-1 secreted
Upon the ingestion of food
Two benefits of DPP-4 inhibitors
Weight neutral
Low risk for causing hypos
How do you administer GLP-inhibitors?
Subcutaneous injection
Key benefit of GLP-1?
Weight loss woo
what does SGLT2 stand for?
Sodium-glucose co-transporter-2
How do SGLT-2 inhibitors work?
Work by helping the kidneys to lower blood glucose levels- they inhibit reabsorption at the proximal tubule
List 4 ways in which insulin works
Removes glucose from circulation
Helps tissues (muscles) to uptake glucose
Promotes glucose to be stored as glycogen
Helps body make fat and protein
How do WHO diagnose diabetes?
Random venous glucose >11.1mmol/l or
Fasting venous >7mmol/l or
2hour venous conc>11.1mmol/l 2hrs after 75g anhydrous glucose in an oral glucose tolerance test
Name the types of insulin
Short/rapid acting
Intermediate
Long acting
Biphasic
First line insulin should be what?
OD or BD human insulin e.g humulin insulatard
What is phentermine
The first anti obesity drug acts my stimulating catecholamine release thus fight or flight reducing appetite, now a controlled drug
What is fenfluramine
Weight loss drug withdrawn from market after reports of hypertension, it acted by increasing serotonin levels and caused a sensation of fullness
What is rimonabant?
Is a cannabinoid CB1 receptor antagonist that after centrally on the brain, decreasing appetite
Why was rimonabant withdrawn?
Links to serious psychiatric disease and suicidal behaviour
What’s sibutramine
Centrally acting serotonin-NA reuptake inhibitor structurally related to amphetamines
Why was sibutramine withdrawn?
Cardiovascular events and strokes
How does orlistat work?
Acts peripherally where it inhibits an enzyme involved in the breakdown of fat causing it to be excreted rather than digested
List 5 obesity drugs
Phentermine Fenfluramine Rimonabant Sibutramine Orlistat
What’s leptin
A signalling molecule secreted from the adipocyte cell found from the ob gene
Mouse with the Db/db gene had what?
Obesity and diabetic
What BMI is a healthy weight
18.5-24.9
What BMI is overweight
25-29.9
What BMI is obese class 1
30-34.9
What BMI is obese class 3
40+
What BMI is obese class 4
50+
What waist circumference in women is associated with an increased risk of for type 2 diabetes?
> 35inches
Above what waist circumference is associated with an increased risk of diabetes in men?
> 40
Name the 9 types of drug in T2DM
Biguanides Sulfonylureas Meglitinides Alpha-glucosidase inhibitors Thiazolidinediones DPP4 inhibitors GLP-1 agonists SGLT2 inhibitors Insulin
