CPT S4 - Diabetes

Question 1

Give some types of diabetes

Answer 1

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

Question 2

What treatments are available for type two diabetes?

Answer 2

Insulin sensitisers
Beta cell stimulators
Appetite suppressants
Weight loss agents
Urinary glucose eliminators
Insulin

Question 3

What diet and lifestyle advice can be given for diabetes?

Answer 3

Encourage complex carbohydrates
Limit alcohol
Limit salt
Stop smoking
Exercise
Reduce overall energy intake if overweight

Question 4

Name some types of non-insulin diabetes drugs

Answer 4

Biguanides
Sulphonylureas
Meglitinides
Thiazolidinediones
Alpha-glucosidase inhibitors
Glucagon-like peptide 1 (GLP1) analogues
Dipeptyl-peptidase 4 (DPP4) inhibitors
Sodium glucose cotransporter 2 inhibitors

Question 5

Give the actions and mechanism of action of biguanides?

Answer 5

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

Question 6

Give some contraindications for metformin

Answer 6

Do NOT give in cardiac, respiratory, renal or hepatic failure due to increased risk of lactic acidosis

Question 7

Give some ADRs of metformin

Answer 7

High incidence of GI symptoms

May have slight weight gain

Question 8

Describe the pharmacokinetic activity of metformin

Answer 8

4 hour half life
Not metabolised
Renal elimination

Question 9

Give some examples of sulphonylureas

Answer 9

Gliclazide
Glimeprazide
Glipizide

Question 10

What is the mechanism of action of sulphonylureas?

Answer 10

Stimulates beta cells, so requires some residual function

Specific receptor on beta cell

Question 11

Give some ADRs for sulphonylureas

Answer 11

Hypoglycaemia, especially in the elderly, with missed meals or with excess alcohol
Weight gain
However, CAN be given in renal failure

Question 12

Describe meglitinides

Answer 12

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

Question 13

Give the actions and mechanisms of actions of thiazolidinediones

Answer 13

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

Question 14

What are some problems with thiazolidinediones, aka glitazones

Answer 14

Pioglitazone only available agent
Weight gain and oedema
Contraindicated in heart failure
Fractures in post menopausal women
Bladder cancers
Rarely used now

Question 15

Describe DPP4 inhibitors

Answer 15

Aka gliptins
Increases postprandial active GLP1 concentrations
Side effects include GI symptoms and ?pancreatitis
Low hypoglycaemic risk
Weight neutral
Modest HbA1c reduction

Question 16

Describe α glucosidase inhibitors

Answer 16

Inhibits α glucosidase activity in gut
Overall carbohydrate absorption unchanged
Delays glucose load into blood
Excreted unchanged in faeces

Question 17

What are some problems with αglucosidase inhibitors?

Answer 17

Flatulence and diarrhoea
Elevated ALT
Rarely used in UK

Question 18

Describe SGLUT2 inhibitors

Answer 18

Basically increase the glucose excreted in the urine
So many problems eg polydipsia, polyuria, thrush, UITs
No long term studies as new agents

Question 19

Give some roles of insulin

Answer 19

Stimulates uptake of glucose into liver, muscle and adipose
Inhibits gluconeogenesis
Inhibits glycogenolysis
Promotes uptake of fats

Question 20

What are the main insulin categories?

Answer 20

Short acting
Rapid acting
Intermediate acting
Long acting
Very long acting

Question 21

Describe short acting insulin

Answer 21

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

Question 22

Describe rapid acting insulin

Answer 22

Starts working in 5-15 minutes
Inject just before eating
Peaks 30-90 minutes
Duration 4-6 hours

Question 23

Describe intermediate acting insulin

Answer 23

Onset 2-4 hours
Peaks 4-8 hours
Duration 12-20 hours

Question 24

Describe long and very long acting insulin

Answer 24

Onset 2-6 hours

Duration up to 24h in long and can be over 50 in very long

Question 25

Give some ADRs for insulin

Answer 25

Hypoglycaemia
Lipodystrophy
Painful injections
Allergy