CPT S4 - Diabetes Flashcards
Give some types of diabetes
Type I - >insulin deficiency >autoimmune or non-autoimmune Type II - >insulin deficiency & insulin resistance Genetic defects of beta cell Genetic defects of insulin action Drug-induced diabetes Associated with other hormone disorders
What treatments are available for type two diabetes?
Insulin sensitisers Beta cell stimulators Appetite suppressants Weight loss agents Urinary glucose eliminators Insulin
What diet and lifestyle advice can be given for diabetes?
Encourage complex carbohydrates Limit alcohol Limit salt Stop smoking Exercise Reduce overall energy intake if overweight
Name some types of non-insulin diabetes drugs
Biguanides Sulphonylureas Meglitinides Thiazolidinediones Alpha-glucosidase inhibitors Glucagon-like peptide 1 (GLP1) analogues Dipeptyl-peptidase 4 (DPP4) inhibitors Sodium glucose cotransporter 2 inhibitors
Give the actions and mechanism of action of biguanides?
Only one in use is metformin
Reduces insulin resistance by increasing insulin receptor sensitivity
Inhibits hepatic gluconeogenesis
Decreased glucose absorption from gut
Stimulates glucose uptake in muscle and adipose
Weight neutral
No action on islet cells
Give some contraindications for metformin
Do NOT give in cardiac, respiratory, renal or hepatic failure due to increased risk of lactic acidosis
Give some ADRs of metformin
High incidence of GI symptoms
May have slight weight gain
Describe the pharmacokinetic activity of metformin
4 hour half life
Not metabolised
Renal elimination
Give some examples of sulphonylureas
Gliclazide
Glimeprazide
Glipizide
What is the mechanism of action of sulphonylureas?
Stimulates beta cells, so requires some residual function
Specific receptor on beta cell
Give some ADRs for sulphonylureas
Hypoglycaemia, especially in the elderly, with missed meals or with excess alcohol
Weight gain
However, CAN be given in renal failure
Describe meglitinides
Eg repaglinide & nateglinide
Site of action is a K ATPase channel on beta cells
Distinct from sulphonylureas as different receptors, but similar pharmacological action
Shorter half life
More rapid action than sulphonylureas
Taken immediately before meals
Give the actions and mechanisms of actions of thiazolidinediones
Insulin sensitisers
Stimulate nuclear peroxisome proliferator activated receptor gamma
So regulate adipose, muscle and liver gene expression
Increased glucose utilisation
Decreased glucose production
Suppresses gluconeogenesis in liver
What are some problems with thiazolidinediones, aka glitazones
Pioglitazone only available agent Weight gain and oedema Contraindicated in heart failure Fractures in post menopausal women Bladder cancers Rarely used now
Describe DPP4 inhibitors
Aka gliptins
Increases postprandial active GLP1 concentrations
Side effects include GI symptoms and ?pancreatitis
Low hypoglycaemic risk
Weight neutral
Modest HbA1c reduction
Describe α glucosidase inhibitors
Inhibits α glucosidase activity in gut
Overall carbohydrate absorption unchanged
Delays glucose load into blood
Excreted unchanged in faeces
What are some problems with αglucosidase inhibitors?
Flatulence and diarrhoea
Elevated ALT
Rarely used in UK
Describe SGLUT2 inhibitors
Basically increase the glucose excreted in the urine
So many problems eg polydipsia, polyuria, thrush, UITs
No long term studies as new agents
Give some roles of insulin
Stimulates uptake of glucose into liver, muscle and adipose
Inhibits gluconeogenesis
Inhibits glycogenolysis
Promotes uptake of fats
What are the main insulin categories?
Short acting Rapid acting Intermediate acting Long acting Very long acting
Describe short acting insulin
Starts to work in 30-60 minutes Inject 15-30 minutes before eating Peaks at 2-3 hours Duration 8-10 hours Needs to be injected several times per day to cover meals
Describe rapid acting insulin
Starts working in 5-15 minutes
Inject just before eating
Peaks 30-90 minutes
Duration 4-6 hours
Describe intermediate acting insulin
Onset 2-4 hours
Peaks 4-8 hours
Duration 12-20 hours
Describe long and very long acting insulin
Onset 2-6 hours
Duration up to 24h in long and can be over 50 in very long
Give some ADRs for insulin
Hypoglycaemia
Lipodystrophy
Painful injections
Allergy
