Diabetes Flashcards
What is the role of insulin in the body?
- 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
What is the profile of type 1 diabetic?
- Poorly controlled diabetes
- Has a high variability of glucose concentration even with treatment
- Insulin can be given post-prandially or generally through the day
What are the types of insulin available?
- Human short acting insulins
- Human rapid acting insulin analogues
- Isophane intermediate acting insulin
- Long acting basal analogue insulins
- Very long acting basal analogue insulins
What are the 6 main insulin categories?
- 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
What are some adverse effects of insulin?
Hypoglycaemia - too much insulin Hyperglycaemia - too little insulin Lipodystrophy (lipohypertrophy or lipoatrophy) Painful injections Insulin allergies
Why does blood glucose rise?
- Inability to produce insulin due to beta cell failure and/or
- Insulin production adequate but insulin resistance prevents insulin working effectively
How is Type 2 diabetes treated?
- 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
What is the target HbA1c in diabetes treatments?
6.5% - 7.5%.
What are the effects of metformin?
- 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
What are some side effects of Metformin?
- GI symptoms
- Lactic acidosis rare
- Vitamin B12 deficiency
What are contraindications to Metformin?
- CKD <30ml/min
- Metabolic acidosis
What are some examples of Sulfonylureas?
- Glicazide
- Glimepiride
What are the effects of Sulfonylureas?
- Stimulate beta cells to release insulin
- Extensive use decreases macrovascular risk
What are the side effects of Sulfonylureas?
- Weight gain
- Hypoglycaemia
What are the effects of Acarbose?
- Inhibits breakdown of carbohydrate to glucose by blocking action of the enzyme alpha Glucosidase
- Modest reduction in HbA1c
- Rarely used
What are the side effects of Acarbose?
- Flatulence
- Loose stools
- Diarrhoea
What are the types of Glucagon like peptide 1 receptor agonists?
- Exanatide
- Liraglutide
- Lixisenatide
What are the physiological effects of Glucagon-like peptide-1 receptor agonists? (Exanatide, Liraglutide, Lixisenatide)
- Decrease food intake through increase satiety
- Decrease gastric emptying
- Increase insulin biosynthesis
- Increase glucose uptake in muscle
- Decrease glucose producton from liver
What are the side effects of Glucagon-like peptide-1 receptor agonists?
- Gastrointestinal symptoms, nausea, loose stools or diarrhoea
- Gastro oesophageal reflux
- Low risk of hypoglycaemia
- Occasional painful to inject
When are Glucagon-like peptide-1 receptor agonists not used?
-Avoid if eGFR <30ml/min
What are the general effects of Glucagon-like peptide-1 receptor agonists?
- Increase insulin secretion from beta cells
- Decreases production of glucagon rom alpha cells
What are the effects of Gliptins or DPP-4 inhibitors?
- Inhibition of DPP-4 enzyme activity increasing post prandial active GLP-1 concentrations that is naturally occurring due to less breakdown of GLP-1
- Weight neural
- Modest HbA1c reduction
What are the side effects of Gliptins or DPP-4 inhibitors?
- GI symptoms
- Low risk of hypoglycaemia
What are the effects of Glifozins?
- Reversibly inhibits sodium-glucose co-transporter 2 in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
- Can be used for patients with Type 1 and Type 2 diabetes as add on therapy
What are the side effects of Glifozins?
- Increased risk of lower urinary tract symptoms including genital and urinary symptoms especially in women
- Polyuria
- Hypoglycaemia risk low
What are the effects of Glitazone?
- Increased sensitivity in muscle and adipose tissue
- Decreased hepatic glucose output
- Bond to and activate one or more peroxisome proliferator-activated receptors
- Can be used in combination with other oral agents
- Cardiovascular concerns with Rosiglitazone
What are some common side effects of Piogliatozone?
- CVS concerns
- Weight gain
- Fluid retention
- Heart failure
- Bone metabolism
- Bladder cancer
What are examples of Glitazones?
- Rosiglitazone
- Pioglatizone
