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Year 3: Medicine Block ENDOCRINOLOGY > Diabetes > Flashcards

Diabetes Flashcards

1
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
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2
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
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3
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
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4
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
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5
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
  • Weight neutral
  • Decrease In cardiovascular events
  • Can be combined with all other diabetes medications
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6
Q

What are some side effects of Metformin?

A
  • GI symptoms
  • Lactic acidosis rare
  • Vitamin B12 deficiency
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7
Q

What are contraindications to Metformin?

A
  • CKD <30ml/min

- Metabolic acidosis

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8
Q

What are some examples of Sulfonylureas?

A
  • Glicazide

- Glimepiride

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9
Q

What are the effects of Sulfonylureas?

A
  • Stimulate beta cells to release insulin

- Extensive use decreases macrovascular risk

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10
Q

What are the side effects of Sulfonylureas?

A
  • Weight gain

- Hypoglycaemia

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11
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
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12
Q

What are the side effects of Acarbose?

A
  • Flatulence
  • Loose stools
  • Diarrhoea
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13
Q

What are the types of Glucagon like peptide 1 receptor agonists?

A
  • Exanatide
  • Liraglutide
  • Lixisenatide

injectable

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14
Q

What are the physiological effects of Glucagon-like peptide-1 receptor agonists? (Exanatide, Liraglutide, Lixisenatide)

A
  • Decrease food intake through increase satiety
  • Decrease gastric emptying
  • Increase insulin biosynthesis
  • Increase glucose uptake in muscle
  • Decrease glucose producton from liver
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15
Q

What are the side effects of Glucagon-like peptide-1 receptor agonists?

A
  • Gastrointestinal symptoms, nausea, loose stools or diarrhoea
  • Gastro oesophageal reflux
  • Low risk of hypoglycaemia
  • Occasional painful to inject
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16
Q

When are Glucagon-like peptide-1 receptor agonists not used?

A

-Avoid if eGFR <30ml/min

17
Q

What are the general effects of Glucagon-like peptide-1 receptor agonists?

A
  • Increase insulin secretion from beta cells

- Decreases production of glucagon from alpha cells

18
Q

What are the effects of Gliptins or DPP-4 inhibitors?

A
  • 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
19
Q

What are the side effects of Gliptins or DPP-4 inhibitors?

A
  • GI symptoms

- Low risk of hypoglycaemia

20
Q

What are the effects of Glifozins?

A
  • 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
21
Q

What are the side effects of Glifozins?

A
  • Increased risk of lower urinary tract symptoms including genital and urinary symptoms especially in women
  • Polyuria
  • Hypoglycaemia risk low
22
Q

What are the effects of Glitazone?

A
  • 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
23
Q

What are some common side effects of Piogliatozone?

A
  • CVS concerns
  • Weight gain
  • Fluid retention
  • Heart failure
  • Bone metabolism
  • Bladder cancer
24
Q

What are examples of Glitazones?

A
  • Rosiglitazone

- Pioglatizone

Year 3: Medicine Block ENDOCRINOLOGY (9 decks)

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