Diabeetus Flashcards
What is the difference between Type 1 and 2
Type 1: Unable to make insulin
Type 2: unable to respond to insulin properly
Both result in the lack of glucose uptake into cells and storage
Alpha and Beta Cells Secrete?
Alpha: Glucagon
Beta: Insulin
Two ways blood glucose levels are monitored
Oral Glucose Tolerance Test OGTT
Finger Prick Test
Type 1 Diabetes Management
Non-Drug- Lifestyle and Diet
Drug- Insulins
T1DM or T2DM
Mechanism, increases or restores ability to metabolise glucose
Types of Insulin Administered Type 1 and Adverse Affects
Insulin Aspart:
Quick acting (mins) given just before a meal. Lasts 3-5 hours
Insulin Glargine:
Onset 1-6 hours. Duration 24+ hours. Given once Daily
Cannot be delivered orally
Adverse effects:
Hypoglycemia, Weight Gain (inhibits lipolysis) local reactions, Lipodystrophy
Type 2 Management
Non-drug: Diet, Low GI foods and low Sugar intake. Weight loss 5-10%, regular physical activity
Drug: Oral and Injectable Formulations (including insulin)
Rationale is symptom relief (polyuria, polydipsia) Prevent hyperglycemia. prevention or delay of long term complications. Lower CV risk and slowing progression of kidney disease
Drugs for Type 2
Oral: Biguanides, SGLT2 inhibitors, DPP-4 inhibitors (Incretin), Sulfonylureas
Parenteral: Insulins, GLP-1 analogues (incretin)
Biguanides
Metformin
Mechanism- Increases sensitivity of tissues to insulin
reduces gluconeogenesis
Increases peripheral glucose uptake
Doesn’t cause hypoglycemia when used alone
Adverse Effects- Nausea/Vom/Diarrhoea (excreted by kidneys: rarely lactic acidosis)
Sulfonylureas
Drug- gliclazide
Mechanism- Binds to SUR1 subunit of K+/ATP channel causing closure and membrane depolarisation. Stimulates beta cell secretion. Can Lower insulin resistance. Requires residual beta cell activity.
Adverse effects, hypoglycemia, weight gain (storing more glucose)
SGLT2 Inhibitors (Flozins)
Sodium-Glucose co-transporter 2
Drug- Dapagliflozin
Mechanism- Inhibits glucose reabsorption at PCT, increases glucose excretion.
Adverse effects- Weight loss (osmotic diuretic, dehydration, genitourinary infections.
GLP-1
Glucagon-like-peptide 1
Drug- Semaglutide
Mechanism- Mimics effects of endogenous GLP-1 (incretin hormon) Lowers BGLs by increasing glucose dependent insulin secretion, suppresses inappropriate glucagon secretion, delays gastric emptying, decreases appetite.
Adverse effects- Nausea and Vomiting, Weight loss, injection site reactions
DPP-4 inhibitors
(dipeptidyl peptidase 4)
Drug- Linagliptin
Mechanism- usually degrades GLP-1, prevents breakdown of GLP-1 and prolongs GLP-1 circulation, increasing insulin secretion, lowering glucagon production. Therefore combining DPP-4 inhibitor and GLP-1 analogue is not recommended as they act on same pathway, no extra benefit.
