Diabetes

Question 1

Examples of short duration insulin therapy…

Answer 1

Insulin aspart, Insulin glulisine, Insulin lispro

Question 2

• Form of Insulin therapy
• Rapid onset of 30-60 mins
• Peak action 2-4 hours
• Injected before or after food
• Hypoglycemia, injection site reactions, weight gain, swelling in arms and legs

Answer 2

Short duration insulin therapy

Question 3

• Form of Insulin therapy
• Intermediate acting insulin
• Longer duration 16-35 hours
• Onset is 1-2 hours
• Peak action 4-12 hours
• Hypoglycaemia, dizziness, chills, weakness, headache, fainting

Answer 3

Intermediate/ Longer acting insulin therapy

Question 4

Examples of intermediate/ longer acting insulin therapy…

Answer 4

Insulin determir, Insulin glargine, Insulin zinc suspension, Isophane Insulin, Protamine zinc insulin

Question 5

Examples of Biphasic insulin prep therapy…

Answer 5

Biphasic insulin apart, Biphasic insulin lispro, biphasic isophane insulin

Question 6

• Mix of intermediate and fast-acting insulins

- Rapid onset and long-lasting actions

Answer 6

Biphasic insulin prep therapy

Question 7

• Glucagon broken down into glucose when blood levels are low (glycogenolysis)
• Promotes gluconeogenesis and lipolysis
• First aid treatment for severe hypoglycaemia
• Headache and nausea

Answer 7

Glucagon therapy

Question 8

e. g. Metaformin
- Agonist of AMP- activated prokein kinase receptors (AMPK)
- Prevents hepatic glucose production
- Overcomes insulin resistance by decreasing sensitivity
- Does not cause weight gain= best for patients with heart failure

Answer 8

Biguanides

Question 9

e. g. Sitagliptin, Vildagliptin
- Increase GLP-1 by inhibiting DPP-4
- DPP4 breaks down GLP-1
- Stimulates insulin release
- 1/2 life of serum GLP-1
- GI upset infection, hypoglycaemia, erectile dysfunction

Answer 9

DPP4 inhibitors

Question 10

e. g. Diazoxide
- Activate kATP situated in pancreas to stimulate insulin release
- Increases blood insulin levels causing glucose uptake in cells
- GI disturbances, hyperuricaemia, anorexia, hypotension, oedema, tachycardia, arrhythmia

Answer 10

kATP channel activators

Question 11

e. g. Glitazones
- Activate PPAR a protein involved in transcription of insulin sensitive genes
- Increases risk of heart disease so is banned in some countries
- Long-term use associated with bladder cancer

Answer 11

Thiazolidines

Question 12

e. g. Acarbose
- Inhibits a-glucosidase
- Converts oligosaccharides to glucose
- Reduces speed of which starchy foods are absorbed
- Rising blood glucose is slowed
- GI effects, liver problems, oedema, skin disorders

Answer 12

a- Glucose inhibitors

Question 13

e.g. Canaglifozin, Dupaglifozin
- Causes excess glucose to be eliminated
- reduces hyperglycaema,
It’s sodium coupled by glucose transporter
- UTI, hyperglycaemia, thrush, thirst, polyuria, low BP, vaginal itching

Answer 13

SGLT2 inhibitors