Diabetes Flashcards
Name 3 main target organs of insulin
- Liver
- Muscle
- Fat
Describe 2 reactions which insulin increases in the liver
- Glycolysis increased generation of ATP by oxidation of glucose
- Glycogen synthesis (increase in the storage form of glucose)
Describe 2 reactions which insulin decreases in the liver
- Gluconeogenesis from pyruvate or lactate
2. Glycogenolysis (break down of glycogen)
What is the overall effect of insulin on the liver?
Increased storage of glycogen in the liver
Describe 3 reactions which insulin increases in skeletal muscle
- Glut4 translocation
- Glycogen synthesis
- Glycolysis
Name 2 anabolic effects of insulin on skeletal muscle
- Increased amino acid uptake
2. Increased protein synthesis
Describe 2 reactions which insulin increases on adipose tissues
- Glut4 membrane translocation
2. Glycerol concentration
Describe the overall metabolic effect of insulin on the body
Fuel storage in the form of glycogen for situations where there is no food present
Name 2 types of Diabetes Mellitus
- Type 1 (insulin-dependent)
2. Type 2 (non-insulin dependent)
Describe Type 1 diabetes
- β cells in pancreas destroyed
- No insulin produced
- Early age onset
- Moderate genetic predisposition
Describe Type 2 diabetes
- Insulin stops working at target tissues
- 35+ years old onset
- Very strong genetic predisposition
- Frequently obese
How is insulin manufactured for therapy of Type 1 diabetes
Recombinant human protein in bacteria
Name 3 ways insulin can be administered
- Subcutaneously (most common)
- Intravenously
- Intramuscularly
Why is insulin not administered orally?
Insulin is degraded by GIT
What is the principle of insulin preparations?
Alter rate of absorption by increasing particle size e.g. crystallisation or complexing with zinc
What is a short acting insulin preparation?
Novorapid
Name a modified insulin preparation
Insulin Glargine (Lantus)
Describe Lantus
- Long acting insulin analogue
- Provides constant basal insulin supply
- Prolonged absorption from site of injection
- Reduces risk of night-time hypoglycaemia
Name 3 side effects of insulin therapy
- Hypoglycaemia
- Coma
- Brain damage
How is hypoglycaemia with insulin therapy reversed?
Sweet drinks or IV glucagon if person is unconscious
Name 4 factors which contribute to causation of Type 2 diabetes
- Genetic predisposition
- Obesity
- Glucocorticoids
- HIV protease inhibitors
Describe insulin resistance
- Failure of insulin to trigger its effects at target tissues
- High blood glucose levels and high insulin levels
- Can exhaust pancreas and lead to decreased insulin production
What is the pharmacological strategy in the treatment of Type 2 diabetes?
Improve sensitivity of target tissues to insulin with drugs and other factors
Describe 4 components of the therapy of Type 2 diabetes
- Reduce weight by exercise and diet
- Lower blood pressure
- Reduce cholesterol by reducing fat intake
- Oral hypoglycaemic agents
Name 6 types of drugs used for Type 2 diabetes
- Biguanides
- Sulfonylureas
- Thiazolidinediones
- Incretin drugs
- SGLT2 inhibitors
- Insulin
Name an example of a biguanides drug
Metforin
Describe the mechanism of action of metformin
Lower blood glucose levels by increasing uptake into striated muscle and inhibiting gluconeogenesis in the liver and intestinal glucose absorption
Name 4 side effects of metformin
- Nausea
- Anorexia
- Diarrhoea
- Lactic acidosis
Name 3 contra indications of metformin
- Renal disease
- Heart failure
- Pregnancy
Name an example of a sulfonylureas drug
Gliclazide
Describe the mechanism of action of sulfonylureas drugs
- Bind to K ATP receptor on β cells to mimic ATP by blocking channel
- Trigger membrane depolarisation and calcium ions to enter the cell
- Release of insulin by exocytosis
Name 1 drawback of sulfonylureas drugs
They only work if the β cells in the pancreas are still functional
Name an example of a thiazolidindione drug
Rosiglitazone
Describe the mechanism of action of thiazolidindiones
- Lower blood glucose and increase insulin sensitivity
- Decrease gluconeogenesis in the liver
- Increase glucose uptake in muscle
Name 2 types of incretin drugs
- Incretin analogues
2. Incretin enhancers
Name an example of an incretin analogue
Byetta
Name an example of an incretin enhancer
Sitagliptin
What is the overall mechanism of action for incretin drugs?
Bind to GLP-1 receptors on pancreatic β cells to increase insulin release
Name an example of an SGLT2 inhibitor
Dapagliflozin
What is the mechanism of action of dapagliflozin?
Reversibly inhibit SGLT2 in the kidney PCT decreasing glucose reabsorption and increasing urinary glucose excretion
What is the main challenge with dental problems and diabetes?
Dental treatment may interrupt normal daily routine e.g. diet / injections
Describe the relationship between diabetes and periodontal disease
- Poorly controlled T1DM patients with nephropathy most at risk
- Caused by poor white blood cell chemotaxis or vascular damage to gums
Describe the relationship between diabetes and increased risk of caries
- Decreased salivary function
- Resolved when patients have low carb diet
Describe the relationship between diabetes and xerostomia
- Reduced salivary function
- Increase in salivary gland size to compensate
- Could lead to infection e.g. candidiasis
