Diabetes Flashcards
Describe the role of insulin. (3)
Stimulates the uptake of glucose into the liver, muscle and adipose.
Descrease hepatic glucose output by inhibiting gluconeogenesis.
Inhibits glycogenolysis.
Describe the two main types of insulin that can be given in type one diabetes. (2)
Animal - porcine and bovine
Human recombinant - modified structure to change delivery rate.
Describe the 6 main analogies of insulin. (6)
Ultrafast, rapid acting, short acting, intermediate acting, long acting, very long acting.
Describe the ultrafast analogue of insulin. (3)
Onset: 5-10 minutes
Peak: 30 minutes
Duration: 2h
Describe the rapid acting analogue of insulin. (3)
Onset: 5-15 minutes
Peak: 1h
Duration: 4-6h
Name two rapid acting analogues of insulin. (2)
Aspart, Lispro
Describe the short acting analogue of insulin. (3)
Onset: 30-60min
Peak: 2-3h
Duration: 8-10h
Name a short acting analogue of insulin. (1)
Actrapid
Describe the intermediate acting analogue of insulin. (3)
Onset: 2-4h
Peak: 4-8h
Duration: 12-20h
Name one intermediate acting analogue of insulin. (1)
Insulatard
Describe the long acting analogue of insulin. (3)
Onset: 1h
Peak: plateau 2-20h
Duration: 24h
Name one long acting analogue of insulin. (1)
Glargine
Describe the very long acting analogue of insulin. (3)
Onset: 1h
Peak: plateau 1-40h
Duration: over 42h
Name one very long acting analogue of insulin. (1)
Degludec
Explain why insulin prescribing errors are common. (2)
There are so many different types, strengths and delivery methods.
Describe and explain the adverse effects of insulin therapy. (10)
Hypoglycaemia - too much insulin
Hyperglycaemia - too little insulin
Lipodystrophy - lipohypertrophy around injection sites.
Painful injections - need to vary sites.
Insulin allergies - rare, often preservative related.
Describe the treatments available for type two diabetes treatment (3)
Lifestyle changes - diet management, exercise
Non-insulin therapies
Bariatric surgery
Describe the aim of treatments of type 2 diabetes. (1)
HbA1c of 6.5-7.5 %
Describe metformin. MoA (2) Other outcomes (2) Side effects (3) Contraindications (1) Advantages (1)
Reduced insulin resistance, reduced hepatic gluconeogenesis.
Limits weight gain, reduced CVS events.
GI symptoms, lactic acidosis (serious), B12 deficiency (rare)
Not to be used in CKD
Low cost.
Describe sulphonylureas.
MoA (2)
ADRs (2)
Advantages (2)
Stimulates beta cells to produce more insulin, limits microvascular complications.
Side effects include Weight gain and hypoglycaemia.
Advantages of sulphonylureas include low cost and hepatic metabolism meaning can be given in CKD.
Give the two names that are associated with the same drug that causes an increase in insulin sensitivity. (2)
Thiazolidinediones
Glitazones
Describe the ADRs of glitazones. (5)
Weight gain Fluid retention Heart failure Bladder cancer Bone metabolism issues
Describe glucagon-like peptide-1 therapies. (2)
Increases insulin secretion from beta cells and reduces glucagon production from alpha cells.
Describe dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors).
MoA (3)
Disadvantage (1)
Increase the activity of GLP-1 (glucagon-like peptide-1) to increase insulin secretion from beta cells, and reduces glucagon production from alpha cells.
Expensive
Describe the ADRs of GLP-1 therapies and DPP-4 inhibitors. (4)
Explain why the ADRs are similar in these drugs. (3)
Nausea and diarrhoea, reflux, hypoglycaemia, avoid in low GFR.
Both of these drugs have similar mechanisms of action because they both increase the activity of GLP-1 to increase insulin and reduce glucagon.
Name the common feature of all names of DDP-4 inhibitors. (1)
-liptin
Describe the other name for glifozins. (1)
Describe the MoA. (2)
Describe the ADRs. (2)
Sodium-glucose cotransporter 2 inhibitors.
Selective inhibition of SGLT2 in PCT to increase urinary excretion of glucose.
LUTI and polyuria.
Describe the main treatment for very severe hypoglycaemia. (1)
Glucagon therapy.
