Diabetes Flashcards
PRAMLINTIDE - mechanism of action in diabetes
This is amylin which has been changed by two peptides to resemble rat amylin that cannot form fibrils. When injected with amylin, helps to normalise fluctuating glucose levels to a greater degree than insulin alone. Helps with weight loss. Normal beta cells produce amylin (IAPP= islet amyloid polypeptide) along with insulin- may help to smooth control
somatostatin released from…
delta cells
Somatostatin effect
reduces insulin and glucagon secretion
stimulated by meal ingestion and gastric acid secretion
GLP-1 released from…
L cells in jej and ileum
stimulates insulin release and inhibit glucagon release
What is alpha cell anarchy
Where blunting of hyperglycaemia/postprandial suppression of glugagon
How does DPP4 inhib work?
Inhibits DPP4 which usually breaks down GLP1–>higher GLP 1 levels
Side effects/limitations of SGLT2 inhibitors
Inhibits glucose reuptake in high capacity SSGLT2 transporters in tubule- beyond capacity of later SGLT1 reabsorption in distal tubule.
NO increase risk UTI
polyuria
genital infection
cannot use in renal impairment as not enough filtration of glucose and not working properly anyway
Impaired Glucose tolerance define
asting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
Define diabetes
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.
a HbA1c of greater than or equal to 6.5% (48 mmol/mol) is diagnostic of diabetes mellitus, but less than 6.5 does not exclude
What is Impaired fasting glucose
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
Where is glucose resorbed in the kidney?
SGLT1
- 10% load
- S2/S3 segment of proximal tubule
SGLT2
- 90% load
- S1 segment of proximal tubule
Secondary causes of hyperlipidaemia- cholesterol predominant and TAG predominant?
Cholesterol- hypothyroidism, cholestasis, nephrotic syndrome
TAG- diabetes, obesity, alcohol, chronic renal failure, liver disease, unopposed oestrogen, thiazides, nonselective beta blockers
Incretins actions
(GLP-1 and GIP)-
increase insulin reduce glucagon slow gastric emptying improve insulin sensitivity reduce food intake increase beta cell mass and maintain beta cell function
What is exenatide?
GLP-1 receptor agonist
BD sub cut injection
Results in modest weight loss
GI side effects, acute pancreatitis
What is sitagliptin and linagliptin?
DPP-4 inhibitors Reduce break down of GLP1 oral agents main side effect nasal stuffiness, allergy, headache Hypos with sulfonylureas weight neutral
Linagliptin NO dose reduction in CKD
Sigagliptin dose reduce.
