Diabetes Flashcards
What is Metformin used for?
1st line Diabetes Mellitus II
What is the main function of Metformin?
Increases sensitivity to insulin
How does Metformin work?
- Muscle = increases glucose uptake
- Liver = suppress glycogenolysis and gluconeogenesis
- Gut = Decrease gluocose absorption and increases GLP-1
How does GLP-1 work to lower bgl?
- Glucagon-like protein
- Increases insulin secretion/synthesis
- Decreases glucagon secretion
- Increases B-cell proliferation
- Decreases B-cell apoptosis
How else can GLP-1 be beneficial in DM II
- Decreases appetite
- Decreases gastric emptying/motility
- Increases glucose uptake and storage in muscles/fat
- Decreases glucose production
Where is metformin metabolised?
The kidney
When is metformin contra-indicated?
ANY RENAL DAMAGE/IMPAIRMENT
How does Gliclazide work?
- Sulphonylurea
- Blocks K+ channels on B-cell membrane causing depolarisation via increase in Ca2+
= Insulin vesicles move to membrane and secrete
Where are sulphonyleureas metabolised?
The liver
What are gliptins?
DPP-4 inhibitors
How do gliptins function?
Inhibitor DPP-4 which increases GLP-1
When are thiazolidinediones indicated?
Type II DM overweight patients/intolerant to metformin
What is the made thiazolidinedione?
Pioglitazone
What are serious adverse effects of TZs?
Oedema and cardiac failure, particularly when prescribed with insulin
How does insulin function?
- Released from B-cells
- Binds the RTK insulin receptors
- Stimulates PI3-K pathway
- Stimulates production of GLUT-4 = glucose ion channel
- Increases uptake of glucose into cell
- Decreases blood glucose levels
