Diabetes

Question 1

What is the half Life of insulin?

Answer 1

5 mins

Question 2

How long before a meal should you inject insulin?

Answer 2

15-30mins prior

Question 3

What are the warnings and contraindications associated with insulin?

Answer 3

Hypoglycaemia
Lipohypertrophy
Lipoatrophy
Renal impairment

Question 4

What is Aspart?

Answer 4

A rapid acting bolus of insulin

Question 5

What is a Glargine?

Answer 5

A long acting dose of insulin - basal

Question 6

Name a biguanide

Answer 6

Metformin

Question 7

How does the biguanide metformin work?

Answer 7

It decreases hepatic glucose output
Increases glucose utilisation in skeletal muscle
Suppresses appetite

Question 8

What warnings and contraindications are associated with metformin?

Answer 8

Nausea and vomiting
Diarrhoea
Lactic acidosis

Question 9

What interactions should be taken into consideration when prescribing biguanides such as metformin?

Answer 9

ACEi
Diuretics
NSAIDs
Any drug that impairs renal function

Question 10

What is Gliclazide

Answer 10

A Sulfonylureas

Question 11

Name a sulfonylureas

Answer 11

Gliclazide

Question 12

Gliclazide stimulates what cells and to what effect?

Answer 12

B cells of the pancreas to stimulate insulin secretion

Question 13

Gliclazide, a sulfonylureas blocks what type of channel

Answer 13

ATP dependent K+ channel

Question 14

What is a side effect of sulfonylureas?

Answer 14

Weight gain

Question 15

What are the warnings and contraindications associated with sulfonylureas?

Answer 15

Mild GI upset - nausea and vomiting
Diarrhoea
Hypoglycaemia
Hypersensitivity

Question 16

What interactions and considerations are associated with Gliclazide, a sulfonylureas

Answer 16

Other hypoglycaemic agents
Hepatic impairment
Renal impairment
Thiazide diuretics

Question 17

Name 2 Glitazones

Answer 17

Pioglitazone

Rosiglitazone

Question 18

What are pioglitazone and rosiglitazone?

Answer 18

Glitazones

Question 19

What is the mechanism of action for Glitazones such as pioglitazone?

Answer 19

Insulin sensitisation

Activation of PPAR - gene transcription

Question 20

What is a side effect of Glitazones?

Answer 20

Weight gain

Question 21

What warnings and contraindications are associated with Glitazones?

Answer 21

GI upset
Fluid retention
Fracture risk
CVD concerns
Bladder cancer

Question 22

What are the interactions and considerations associated with Glitazones?

Answer 22

Other hypoglycaemic agents

Question 23

Dapagliflozin and canagliflozin belong to which class?

Answer 23

Gliflozins

Question 24

Name the gliflozins

Answer 24

Dapagliflozin

Canagliflozin

Question 25

Which drug class are SGLT-2 inhibitors ?

Answer 25

Gliflozins

Question 26

What is the activity of Gliflozins?

Answer 26

Competitive reversible inhibition of SGLT-2 in the proximal convoluted tubule There is decreased glucose absorption from tubular filtrate, increased excretion

Question 27

What are the warnings and contraindications associated with Gliflozins such as Dapagliflozin?

Answer 27

UTI Genital infection Thirst Polyuria

Question 28

What interactions and considerations are associated with Gliflozins such as Canagliflozin?

Answer 28

Anti-hypertensives and other hypoglycaemic agents

Question 29

GLP-1 receptor agonists are what type of mimetic?

Answer 29

Incretin mimetics

Question 30

What are incretins?

Answer 30

A group of metabolic hormones that stimulate a decrease in blood glucose levels. They are released after eating.

Question 31

Why is weight gain a side effect of gliclazide, a sulfonylureas?

Answer 31

It stimulates the secretion of insulin and insulin has anabolic effects

Question 32

Why do thiazide like diuretics reduce the action of sulfonylureas?

Answer 32

Because thiazide like diuretics increase the blood glucose

Question 33

What body tissues become sensitised to insulin when taking Glitazones?

Answer 33

Muscle and adipose tissue

Question 34

What is unusual about the half life of Glitazones?

Answer 34

It’s not related to its duration of action

Question 35

What can be used to modify the absorption of insulin

Answer 35

Protamine Zinc Protamine with zinc

Question 36

Why does the injection site of insulin require rotation?

Answer 36

To avoid lipodystrophy

Question 37

Why must insulin be given parentally?

Answer 37

To avoid digestion in the gut as it is a protein

Question 38

What is a problem associated with porcine and bovine derived insulins?

Answer 38

Immunogenicity

Question 39

What drug is often first line in diabetes treatment?

Answer 39

Metformin

Question 40

Why is it important to stop taking metformin if eGFR is <30ml/min?

Answer 40

Because it gets excreted unchanged by the kidneys

Question 41

How do Glitazones cause weight gain?

Answer 41

Due to fat cell differentiation

Question 42

When are Gliflozins used in diabetes, Tye 1 & 2?

Answer 42

Type 1 - when there is a diabetic ketoacidosis risk. | Type 2 - as an add on therapy

Question 43

Why do Gliptins have a low hypoglycaemic risk?

Answer 43

Their actions are glucose dependent so works post prandially. They do not stimulate insulin secretion at normal blood glucose

Question 44

What classes of drugs oppose the action of Gliptins and why?

Answer 44

Thiazide like drugs and loop diuretics as these increase blood glucose

Question 45

How are GLP-1 receptor agonists (incretin mimetics) administered?

Answer 45

Subcutaneous injection

Question 46

What is triple therapy for diabetes?

Answer 46

Giving the patient 3 drugs when struggling to control their blood sugar, e.g. Metformin Pioglitazone Sulfonylureas

Question 47

Why would metformin be contraindicated?

Answer 47

If risk factors for acute metabolic acidosis are present | If renal impairment is present - eGFR <30L/min