Diabetes Flashcards
Biguanide (metformin) mechanism
- increase insulin sensitivity on muscle, adipose, liver cells so increased glucose uptake and utilisation
- decrease hepatic glucose output
- gut-related glucose lowering effect
Adverses of metformin
Nausea
Diarrhoea
Bloating
Monitor what on metformin
U&E for kidney function
As eGFR< 30ml/min etc and serum creatinine >150micromol/L
Sulfonyurea (glicazide/glimepiride) mechanism
Bonds to sulfonyurea receptor of ATP potassium channel to block it therefore decreasing potassium efflux causing depolarisation, ca influx and insulin release which lowers glucose
Sulfonyurea interactions
Corticosteroids
Thiazides
Adverses of sulfonyureas
Hepatotoxicity Hypoglycaemia Hyponatraemia Weight gain Allergic reactions Photo sensitivity
GLP-1 (liraglutide/exantide) mechanism
Acts on beta cells to release insulin to lower glucose and alpha cells to decrease glucagon to decrease glucose synthesis
Adverses of GLP-1
- subcutaneous injection
- nausea/vomiting
- pancreatits
- pancreas/thyroid cancer risk
Cautions of GLP-1
Gastroparesis Renal disease (eGFR<30)
DPPIV inhibitors (sitagliptin) mechanism
Inhibit DPPIV so GLP1 can’t be degraded and effect is prolonged
DPPIV inhibitors adverses
- nasopharyngitis
- oedema
- headache/nausea
SGLT-2 inhibitors (empaglifozin/dapaglifozin) mechanism
Inhibit SGLT2 contrabsporter so glucose excreted
Contraindications of SGLT2 inhibitors
Diueresis drugs- diuretics, ACEin, NSAIDS, ARBS
Adverses of SGLT2 inhibitors
- polyuria/UTI
- acute injury to kidney risk increased
- ketoacifosis w/0 increase in blood glucose
- osteoporosis increased risk
- increased risk of toe amputation
When to use insulin
1-hyperglycaemia symptoms 2-decompensation of beta cells 3-renal disease 4-allergy to oral agents 5-surgery 6-pregnancy
