Diabetes Flashcards
what is the normal body reaction to glucose
insulin produced, binds to receptor, glucose enters the cell
what is the body reaction with insulin resistance
receptor is less responsive to insulin, less glucose enters the cell = build up of glucose in the blood
what are the beta cells initial response to insulin resistance
initial compensation
step 1 of type 2 diabetes treatment
diet and exercise
step 2 of type 2 diabetes treatment
oral therapy
step 3 of type 2 diabetes treatment
oral combination therapy
step 4 of type 2 diabetes treatment
injectable and oral therapies
first line oral therapy
Biguanide - Metformin
how does metformin help hyperglycaemia management?
reduces HbA1c by 15-20mmol/mol
what effect does metformin have on cholesterol?
reduces triglycerides and LDL
side effects of metformin
GI side effects, interferes with B12 and folate absorption, lactic acidosis, liver failure and rash
name the first generation sulphonylureas, are these still used?
chlorpropramide and tolbutamine, rarely used now
what makes first generation sulphonylureas different from 2nd generation
first generation are shorting acting
first sulphonylurea of choice and dose
Glicazide 40mg OD or 160mg BD
do SUs prevent macrovascular complications?
no
what is the only thiazolidinedione (TZD) still used on the market?
Pioglitazone
what pathway do SGLT2 inhibitors work on? and give an example
The incretin pathway, Dapagliflozin
what is incretin?
intestinal secretion of insulin
what is GIP and where is it secreted from?
Gastric inhibitory polypeptide, secreted from K cells
what is GLP-1 and where is it secreted from?
Glucagon like peptide, secreted from L cells
give an example of an GLP-1 receptor agonist
Exenatide
where do GLP-1 receptor agonists work?
act on hypothalamus
what are the benefits of GLP-1 receptor agonists
promote insulin secretion without hypoglycaemia, suppress glucagon, decrease gastric emptying
DPP-4 inhibitors are given by what route? and how do they work
orally active, less effect that GLP-1 mimetics, they can only work on what hormone is already in the body
benefits of DPP4s
promote insulin secretion with hypo, suppress glucagon, neutral effect on weight
SGLT2 inhibitors end in what?
-LIFLOZIN
How do SGLT inhibitors work?
they decrease the uptake of sugar by 1/4
disadvantages of using SGLT inhibitors?
more sugar in urine = more thrust and more urine infections
where do SUs bind? and what is the effect of this?
to SUR1, close the Katp channel causing depolarisation and insulin release.
