Diabetes Flashcards
What is the treatment for type 1 diabetes?
- Insulin therapy
What does insulin therapy consist of?
- SC injection but and IV in emergency
- Insulin dose that is given to try lower the glucose levels in the bloodstream
Why is insulin not given orally?
- Insulin is a protein and would get broken down before absorption can even occur.
Describe basal-bolus loading
- Rapid dose that increases insulin just before meal times = bolus. Rapid acting insulin, e.g. aspart
- Basal dose is given to maintain a certain level of insulin at all times in the body. This is usually long acting insulin.
Avoid insulin therapy in patients who are:
- Hypoglycaemic
- Have renal impairment
Contraindications with insulin therapy
- Increase dose of insulin with steroids because they cause hyperglycaemia.
What is the benefit of manufacturing the insulin therapy as a soluble preparation?
- Delays absorption and overcomes short plasma half-life. Soluble insulins form hexamers at site of injection, contributing to delay in absorption.
Name a biguanide and what it is used to treat?
- Metformin
- Treats type 2 diabetes
Mechanism of action of metformin
- Suppresses appetite so limits weight gain by decreasing hepatic glucose output (decrease gluconeogenesis and glycogenolysis)
Side effects of metformin
- GI upset
Avoid the use of metformin in
- GFR < 30ml/min as metformin is nephrotoxic
Contraindications of metformin
- ACEi
- NSAIDs
- Diuretics: thiazides cause hyperglycaemia
All of these drugs are nephrotoxic.
What is the first line pharmacological treatment for type 2 diabetes?
- Metformin (biguanides)
Name a sulfonylurea and describe it’s mechanism of action
- Glicazide
- Blocks K+ATP channels so depolarisation occurs and calcium enters the cell causing insulin to be released.
- Insulin has anabolic effects = weight gain
Side effects of sulfonylureas
- GI upset
Avoid sulfanylureas in
- Hepatic and renal impairment
Contraindications of sulfonylureas
- Thiazides
- other hypoglycaemic agents
How are sulfonylureas metabolised
- Hepatically
Name some thiazolidinediones
- Pioglitazone
- Rosiglitazone
Glitazones
Mechanism of action of thiazolidinediones
- Increases insulin sensitivity
- Activates PPAR-gamma to increase adipogenesis = weight gain.
Side effects of thiazolidinediones
- GI upset
- Oedema
- CVD risk increases (HF)
- Fracture risk
Contraindications of thiazolidinediones
- Hypoglycaemic agents
Name SGLT-2 inhibitors
- Dapagliflozin
- Canagliflozin
Gliflozins
Mechanism of action of SGLT-2 inhibitor
- In PCT
- Decreases glucose in plasma so weight loss due to beta oxidation of fat.
Side effects of SGLT-2 inhibitors
- UTI
- genital infections
- Thirst
- Polyuria
Contraindications of SGLT-2 inhibitors
- Anti-hypersensitives as they cause hypoglycaemia
Name some dipeptidyl peptidase 4 inhibitors
- Sitagliptin
- Saxagliptin
Gliptins
Mechanism of action of DP4 inhibitor
- Prevents incretin degradation so increased insulin release and suppressed appetite.
Side effects of DP4 inhibitors
- GI upset
- Pancreatitis
Avoid the use of DP4 inhibitors
- Pregnancy
Contraindications of DP4 inhibitor
- Hypoglycaemic agents
- Diuretics causing hyperglycaemia
When are DP4 inhibitors used?
- First line treatment when metformin is contraindicated.
Name some glucagon-like-peptide 1 (incretin) receptor agonists. SC injection.
- Exenatide
- Liraglutide
Mechanism of action of glucagon-like-peptide 1 receptor agonist
- Increased insulin release
- Decreased glucagon release
- Promotes satiety
Side effects of GLP-1 receptor agonists
- GI upset
- GORD from delayed gastric emptying caused by GLP-1
Avoid GLP-1 receptor agonists in patients with:
- eGFR < 30ml/min
Contraindications of GLP-1 receptor agonist
- Hypoglycaemic agents
