Diabetes Flashcards
High blood sugar levels quantified
fasting >7mM, random glucose test >11mM
T1DM classified
- Early onset
- Low serum insulin
- Auto-immune disease
- Insulin dependent
- Prone to ketoacidosis
T2DM classified
- Usually presents after 50
- Can have high serum insulin
- Diet, drugs or insulin for treatment
Insulin Preparations used in T1DM (Short Acting)
Short acting - Insulin lispro, aspart and glulysine
Issues with insulin treatment
Hypoglycaemic episodes
Weight Gain
Lipohypertrophy at injection site
Drugs used in T2DM and MOA (6 Drugs)
Sulphonylureas (increase insulin secretion by closing ATP K channels)
Biguanides (promotes muscle G uptake + decreases hepatic G production)
Thiazolenediones (glitazones, sensitise muscle/adipose to insulin)
alpha-glucosidase inhibitors (slows complex carb breakdown to reduce postprandial G rise)
Incretin analogues (activate incretin/GLP-1 receptors + increase insulin release)
Gliptins (inhibit DPP-4)
Sulphonylurea used when
Used in close to ideal weight patient failing to control hyperglycaemia with just diet
Meglitinides MOA and drug name
Same MOA as sulphonylureas but faster dissociation
Includes Rapaglinide
Biguanides MOA
Metformin reduces hepatic glucose production + increases peripheral G uptake
Thiazolenediones (glitazones) drugs
Pioglitazone and Rosiglitazone
alpha-glycosidase inhibitors MOA and use
Acarbose inhibits intestinal enzyme so complex carb metabolism is slowed to prevent sharp G rise
Taken with meals
Incretin analogues MOA
Exenatide/liraglutide are GLP-1 analogues, GLP-1R activation increases insulin release
DPP-4 inhibitors (gliptins) names
Sitagliptin, Vildagliptin, Saxagliptin
T2DM obese treatment lines
Obese: Diet+weight loss -> metformin -> metformin + sulphonylureas -> insulin/glitazones/gliptins/exenatide
Insulin Preparations used in T1DM (Intermediate Acting)
Intermediate - insulin-zinc suspension
Insulin Preparations used in T1DM (Long Acting)
Long-acting - insulin-zinc preparation (crystalline), glargine, detemir
T2DM non-obese treatment lines
Non-obese: Diet+weight loss -> sulphonylureas -> metformin + sulphonylureas -> insulin/glitazones/gliptins/exenatide
Sulphonylureas (drug names and when used)
Glipizide and Gliclazide tried first, short half lives like Tolbutamide
Glibenclamide has longer duration, lower beta cell K channel specificity than gliclazide
Sulphonylureas SE
SE: weight gain, hypos
Thiazolenediones (glitazones) MOA
Pioglitazone and Rosiglitazone work by increasing insulin sensitivity via PPAR-gamma binding, derepression of insulin sensitive genes
Thiazolenediones (glitazones) SE
SE: weight gain, water retention, sight problems, increased bladder cancer/CV events
Thiazolenediones (glitazones) Uses
Given to patients who can’t tolerate metformin/sulphonylurea combos
Biguanides Used when
Used first line for overweight patients, avoid in heart/renal failure
Biguanides SE
SE: nausea, diarrhoea, vomiting, very rarely lactic acidosis
alpha-glycosidase inhibitors SE
SE: flatulence, GI disturbance
Incretin analogues administration
Given subcutaneously with metformin/sulphonylureas
Incretin analogues SE
SE: Weight loss, expensive, nausea
DPP-4 inhibitors (gliptins) MOA
Sitagliptin, Vildagliptin, Saxagliptin inhibit enzyme which inactivates GLP-1
DPP-4 inhibitors (gliptins) administration
Taken orally
DPP-4 inhibitors (gliptins) SE
SE: DPP-4 has other uses in gut too, and not very specific to just DPP-4, other DPPs affected too
