Diabetes Flashcards
Insulin
Indication: type 1 diabetic/ late stage type 2
Rapid acting = novorapid (starts 10 mins, lasts 4 hrs)
Short acting = actrapid (starts 30 mins, lasts 8hrs)
Intermediate = insulatard (starts 1hr, lasts 16hrs)
Long acting = lantus/levemir (starts 1 hr, lasts 24hr)
Combination = humalog/novomix (rapid and intermediate)
Adverse effects:
- weight gain - anabolic hormone
- hypoglycaemia
- lipodystophy (rotate site of administration)
Warning: renal impairement - hypoglycaemia risk
Interactions:
- systemic steroids - need to increase insulin dose
- other hypoglycaemic agents
Other:
- protein so must be given paraenterally to avoid digestion
- short half life so slow absoprtiom via soluble insulin or insulin analogues
Metformin
Indication: hyperglycaemia
Class: biguanides
Hypoglycaemia: no
Weight: supress apetite
Route: oral
Action:
- reduces hepatic glucose by inhibiting gluconeogenesis and glycogenolysis
- decrease insulin resistance
- increase glucose uptake in target tissues
Adverse effects:
GI upset - nausea, vomiting, diarrhoea
Lactic acidosis
B12 deficiency
Warnings:
- stop if eGFR <30 - excreted unchanged by the kidneys so can quickly accumulate
- alcohol intoxication
Interactions:
- ACEi, NSAIDs, diuretics - may impair renal function
- loop and thiazide can increase glucose so reduce metformin action
Mneumonic: BIGuanide - big liver - inhibits gluconeogenesis, big interactions
Gliclazide
Indication: hyperglyceamia
Class: sulfonylureas
Hypoglycaemia: yes
Weight: increased - anabolic effecrs of insulin
Route: oral
Action: stimulate pancreatic insulin secretion by blocking ATP-dependant K+ channels
Adverse effects: GI upset
Warnings:
- hepatic and renal disease
- increased risk of CVD and MI when monotherapy
Interactions:
- other hypoglycaemic agents
- loop and thiazide can increase glucose so reduce SU action
Mneumonic: sulfonylureas - 3S’s - stimulate insulin secretion
Pioglitazone/rosiglitazone
Indication: hypergylycaemia
Class: glitazone
Hypoglycaemia: yes
Weight: increased - fat cell differentiation
Route: oral
Action:
- enhanced insulin sensitivty and utilisation
- decreased liver production of glucose
Adverse effects:
- GI upset
- fluid retention
- fracture risk
- bladder cancer
- heart failure
- anaemia
Warnings: heart failure because of fluid retention
Interactions: other hypoglycaemic agents
Mneumonic: clitazone - insulin sensitisation, zone - transcription zone (PPAR)
Dapagliflozin/canagliflozin
Indication: hyperglycaemia
Class: SGLT-2 inhibitors - used in patients with CVD
Hypoglycaemia: no
Weight: decrease
Route: oral
Actions: reduce glucose reabsorption
Adverse effects:
- UTI
- genital infection
- thirst and polyuria
- diabetic ketoacidosis
- lower limb amputation
Warnings:
- hypovolaemia - possible hypotension due to osmotic diuresis
- do not give in CKD
Interactions: antihypertensives and other hypoglycaemic agents
Mneumonic: starts with G, ends in S, flo in the middle - glucose sodium inhibitor
Sitagliptin/saxagliptin
Indication: hyperglycaemia
Class: DPP-4 inhibitor
Hypoglycaemia: no
Weight: reduce apetite
Route: oral
Action: prevent incretin degradation - promote insulin secretion and supress glucagon release
Adverse effects:
- GI upset
- pancreatitis
- URTI symtpoms
Warnings:
- pregnancy
- pancreatitis
Interactions:
- other hypoglycaemic agents
- drugs which increase glucose oppose gliptin action e.g thiazides
Mneumonic: 5P’s - prevent incretin breakdown, increase plasma conc, promote insulin secretion, pancreatitis, pregnancy
Exenatide/liraglutide/semaglutide
Indication: hyperglycaemia
Class: GLP-1 receptor agonist - CVD patients
Hypoglycaemia: no
Weight: weight loss
Route: SUBCUTANEOUS
Actions: increase glucose dependent synthesis of insulin
Adverse effects:
- GI upset
- decreased apetite with weight loss
- dizziness
Warnings: renal impairment
Interactions: other hypoglycaemic agents
