Diabetes Flashcards
1
Q
What is the role of insulin in the body?
A
- Stimulates uptake of glucose into liver, muscle and adipose tissue
- Decreases hepatic glucose output via inhibition of gluconeogenesis
- Inhibits glycogenolysis
- Promotes uptake of fats
- Ideal insulin treatment would be to reinstate the normal daily insulin profile to prevent bot hyperglycaemia and hypoglycaemia
2
Q
What is the profile of type 1 diabetic?
A
- Poorly controlled diabetes
- Has a high variability of glucose concentration even with treatment
- Insulin can be given post-prandially or generally through the day
3
Q
What are the types of insulin available?
A
- Human short acting insulins
- Human rapid acting insulin analogues
- Isophane intermediate acting insulin
- Long acting basal analogue insulins
- Very long acting basal analogue insulins
4
Q
What are the 6 main insulin categories?
A
- Ultrafast acting
- Rapid Acting: rapid onset of action 5-15 mins. Inject just before eating and peaks around 60 mins. Duration is between 4 to 6 hours.
- Short Acting: starts to work 30-60 mins. Need to inject at least 15-30 mins before eating several times daily to cover meals Peaks 2-3 hours. Duration is 8-10 hours
- Intermediate Acting: slower onset 2-4 hours. Peaks 4-8 hours. Duration up to 12-20 hours.
- Long Acting: slow onset 2-6 hours. Duration is up to 24 hours.
- Very Long Acting: Very long up to 50+ hours
5
Q
What are some adverse effects of insulin?
A
Hypoglycaemia - too much insulin Hyperglycaemia - too little insulin Lipodystrophy (lipohypertrophy or lipoatrophy) Painful injections Insulin allergies
6
Q
Why does blood glucose rise?
A
- Inability to produce insulin due to beta cell failure and/or
- Insulin production adequate but insulin resistance prevents insulin working effectively
7
Q
How is Type 2 diabetes treated?
A
- Lifestyle methods plus non-insulin therapies such as Biguanides, Sulphonylureas, Thiazolidinedione, DPP4 inhibitors, Alpha Glucosidase inhibitors, SGLT2s, GLP1 analogues and Insulin
- Weight gain and hypoglycaemia are important factors in patient adherence and quality of life. Compliance to treatment is a massive issue
8
Q
What is the target HbA1c in diabetes treatments?
A
6.5% - 7.5%.
9
Q
What are the effects of metformin?
A
- Anti-hyperglycaemic effect by lowering basal and postprandial blood-glucose concentrations
- Decreases gluconeogenesis (hepatic glucose production)
- Acts In the presence of endogenous Insulin
- Decrease insulin resistance leading to increased glucose use by tissues
- Decrease weight gain
- Decrease In cardiovascular events
- Can be combined with all other diabetes medications
10
Q
What are some side effects of Metformin?
A
- GI symptoms
- Lactic acidosis rare
- Vitamin B12 deficiency
11
Q
What are contraindications to Metformin?
A
- CKD <30ml/min
- Metabolic acidosis
12
Q
What are some examples of Sulfonylureas?
A
- Glicazide
- Glimepiride
13
Q
What are the effects of Sulfonylureas?
A
- Stimulate beta cells to release insulin
- Extensive use decreases macrovascular risk
14
Q
What are the side effects of Sulfonylureas?
A
- Weight gain
- Hypoglycaemia
15
Q
What are the effects of Acarbose?
A
- Inhibits breakdown of carbohydrate to glucose by blocking action of the enzyme alpha Glucosidase
- Modest reduction in HbA1c
- Rarely used
