Diabetes Flashcards
Insulin - pharmacokinetics, what is used to modify absorption, why rotate site of injection, different types, warnings and contraindications
usually given by SC injection - upper arms, thighs, buttocks, abdomen
ivi for emergency
protamine and zinc modify absorption by changing the way the hexamers join
need to rotate site due to lipodystrophy
insulin aspart, soluble insulin, NPH, insulin glargine (fast to slow)
hypoglycaemia, lipohypertrophy, lipoatrophy, renal impairment causes hypoglycaemia risk
increase dose with steroids, caution with other hypoglycaemic agents
Describe basal bolus dosing
prescribe rapid acting after mealtimes e.g. aspart and a long acting insulin as a basal dose e.g. glargine
What steps would you take in DKA? What are the key signs?
fluids priority, then insulin. Later on give glucose and potassium
hyperglycaemia, acidosis, ketonaemia - suspect with blood glucose of >11mmol/L and a sign of infection, trauma, poor adherence, ADRs and ketosis
Biguanides - name, mechanisms, weight gain? side effects, contraindications
metformin
decreases hepatic glucose output and increases glucose utilisation in skeletal muscle, also supresses appetite.
mild GI upset and low GFR as excreted by kidneys
any drugs which impair renal function - ACEi, diuretics, NSAIDS, thiazide-like increase glucose so impair action
Sulfonylureas - name, mechanism, weight gain?, side effects, contraindications
glicazide
stimulate beta cell insulin secretion by blocking ATP-dependent K+ channels (causing depolarisation, increased Ca2+ and insulin secretion), you need residual pancreatic function and weight gain can occur through anabolic effects of insulin
mild GI upset, hypoglycaemia
other hypoglycaemic agents, hepatic/renal impairment, thiazide-like
Glitazones - names, mechanisms, weight gain?, side effects, contraindications
pioglitazone, rosiglitazone
increased insulin sensitivity in muscle and adipose, deceased hepatic glucose output. Works on PPAR-y to cause gene transcription. Can cause weight gain through fat cell differentiation.
GI upset, fluid retention, fracture risk, CVD concerns, bladder cancer
other hypoglycaemic agents
SGLT-2 inhibitors - other name, uses, mechanism, weight gain? side effects, contraindications
gliflozins
used in type 1, and type 2 as an add on
decrease glucose absorption from tubular filtrate, increase urinary glucose excretion and competitive reversible inhibition of SGLT-2 in PCT
modest weight loss, hypoglycaemic risk is low
UTI, genital infection, thirst, polyuria
antihypertensives and other hypoglycaemic agents
What does GLP1 do and where is it secreted from?
it is glucose dependant and increases insulin from pancreas, decreases glucagon, increases satiety, decreases glucose production from liver, increases glucose uptake in skeletal muscle, and decreases gastric emptying.
it is secreted from the intestine
Dipeptidyl peptidase-4 (DPP-4) inhibitors - names, mechanism, weight gain?, side effects, contraindications
sitagliptin, saxagliptin
prevents GLP-1 degradation in increase plasma GLP-1 (incretin) levels, action is post-meal as incretins are glucose dependent therefore lower hypoglycaemic risk, supresses appetite so weight neutral.
GI upset, small pancreatitis risk, avoid in pregnancy
other hypoglycaemic agents, drugs that increase glucose oppose glisten action so thiazide like and loop diuretics
GLP-1 receptor agonists - names, mechanism, weight gain?, side effects, contraindications
exenatide, liraglutide
increase glucose dependent synthesis of insulin, sc injection, promote satiety therefore weight loss.
GI upset, GORD, stop if eGFR <30ml/min
other hypoglycaemic agents
