Diabetes Flashcards
What is the half Life of insulin?
5 mins
How long before a meal should you inject insulin?
15-30mins prior
What are the warnings and contraindications associated with insulin?
Hypoglycaemia
Lipohypertrophy
Lipoatrophy
Renal impairment
What is Aspart?
A rapid acting bolus of insulin
What is a Glargine?
A long acting dose of insulin - basal
Name a biguanide
Metformin
How does the biguanide metformin work?
It decreases hepatic glucose output
Increases glucose utilisation in skeletal muscle
Suppresses appetite
What warnings and contraindications are associated with metformin?
Nausea and vomiting
Diarrhoea
Lactic acidosis
What interactions should be taken into consideration when prescribing biguanides such as metformin?
ACEi
Diuretics
NSAIDs
Any drug that impairs renal function
What is Gliclazide
A Sulfonylureas
Name a sulfonylureas
Gliclazide
Gliclazide stimulates what cells and to what effect?
B cells of the pancreas to stimulate insulin secretion
Gliclazide, a sulfonylureas blocks what type of channel
ATP dependent K+ channel
What is a side effect of sulfonylureas?
Weight gain
What are the warnings and contraindications associated with sulfonylureas?
Mild GI upset - nausea and vomiting
Diarrhoea
Hypoglycaemia
Hypersensitivity
What interactions and considerations are associated with Gliclazide, a sulfonylureas
Other hypoglycaemic agents
Hepatic impairment
Renal impairment
Thiazide diuretics
Name 2 Glitazones
Pioglitazone
Rosiglitazone
What are pioglitazone and rosiglitazone?
Glitazones
What is the mechanism of action for Glitazones such as pioglitazone?
Insulin sensitisation
Activation of PPAR - gene transcription
What is a side effect of Glitazones?
Weight gain
What warnings and contraindications are associated with Glitazones?
GI upset Fluid retention Fracture risk CVD concerns Bladder cancer
What are the interactions and considerations associated with Glitazones?
Other hypoglycaemic agents
Dapagliflozin and canagliflozin belong to which class?
Gliflozins
Name the gliflozins
Dapagliflozin
Canagliflozin
Which drug class are SGLT-2 inhibitors ?
Gliflozins
What is the activity of Gliflozins?
Competitive reversible inhibition of SGLT-2 in the proximal convoluted tubule
There is decreased glucose absorption from tubular filtrate, increased excretion
What are the warnings and contraindications associated with Gliflozins such as Dapagliflozin?
UTI
Genital infection
Thirst
Polyuria
What interactions and considerations are associated with Gliflozins such as Canagliflozin?
Anti-hypertensives and other hypoglycaemic agents
GLP-1 receptor agonists are what type of mimetic?
Incretin mimetics
What are incretins?
A group of metabolic hormones that stimulate a decrease in blood glucose levels. They are released after eating.
Why is weight gain a side effect of gliclazide, a sulfonylureas?
It stimulates the secretion of insulin and insulin has anabolic effects
Why do thiazide like diuretics reduce the action of sulfonylureas?
Because thiazide like diuretics increase the blood glucose
What body tissues become sensitised to insulin when taking Glitazones?
Muscle and adipose tissue
What is unusual about the half life of Glitazones?
It’s not related to its duration of action
What can be used to modify the absorption of insulin
Protamine
Zinc
Protamine with zinc
Why does the injection site of insulin require rotation?
To avoid lipodystrophy
Why must insulin be given parentally?
To avoid digestion in the gut as it is a protein
What is a problem associated with porcine and bovine derived insulins?
Immunogenicity
What drug is often first line in diabetes treatment?
Metformin
Why is it important to stop taking metformin if eGFR is <30ml/min?
Because it gets excreted unchanged by the kidneys
How do Glitazones cause weight gain?
Due to fat cell differentiation
When are Gliflozins used in diabetes, Tye 1 & 2?
Type 1 - when there is a diabetic ketoacidosis risk.
Type 2 - as an add on therapy
Why do Gliptins have a low hypoglycaemic risk?
Their actions are glucose dependent so works post prandially. They do not stimulate insulin secretion at normal blood glucose
What classes of drugs oppose the action of Gliptins and why?
Thiazide like drugs and loop diuretics as these increase blood glucose
How are GLP-1 receptor agonists (incretin mimetics) administered?
Subcutaneous injection
What is triple therapy for diabetes?
Giving the patient 3 drugs when struggling to control their blood sugar, e.g.
Metformin
Pioglitazone
Sulfonylureas
Why would metformin be contraindicated?
If risk factors for acute metabolic acidosis are present
If renal impairment is present - eGFR <30L/min
