Diabetes & Drugs

Question 1

Which process in the liver does insulin promote?

Answer 1

Insulin promotes glycogenesis (glucose –>glycogen)

Question 2

What are the 5 types of diabetes?

Answer 2

1. Type 1 - autoimmune, no insulin
2. Type 2 - insulin resistance
3. Gestational - during pregnancy
4. Maturity onset of the young - inherited gene mutation
5. Secondary diabetes - from another condition, e.g. CF

Question 3

What tests are performed to diagnose diabetes?

Answer 3

Symptoms of diabetes, plus one of the tests:

1. Fasting BG of >7mmol/L
2. Random BG of >11.1mmol/L
3. OGTT after a sugary drink
4. HbA1c >48mmol/mol

Question 4

What are some non-pharmacological treatments of diabetes?

Answer 4

1. Diet/exercise
2. Smoking cessation
3. Education
4. Foot/eye/kidney screenings

Question 5

How can type 1 diabetes be managed?

Answer 5

1. Basal-bolus insulin regime
2. Insulin pump
3. BG sensor, or testing BG x4 a day

Question 6

What is the difference between a basal and bolus dose?

Answer 6

Basal: long-acting insulin for periods of fasting, e.g. sleeping
Bolus: short-acting insulin taken before meals to avoid spikes in BG

Question 7

What is an advantage of a basal-bolus regime?

Answer 7

It mimics the body’s normal physiology

Question 8

What are the stages of initiating mono/dual/triple therapy in a type 2 diabetic?

Answer 8

1. Gradually starting metformin (to avoid side effects)
2. If HbA1c >58mmol/mol, then dual therapy started
3. Triple therapy initiated if above treatment is ineffective
4. Insulin treatment, refer to diabetic specialist

Question 9

When is metformin given and how does it work?

Answer 9

It is 1st line for type 2 diabetes.

It increases sensitivity & uptake of insulin by muscles, and decreases hepatic glucose production (glycogenolysis)

Question 10

What are the benefits of using metformin?

Answer 10

No hypos can occur.

Weight loss as a side effect

Question 11

What function of a patient do you need to check before giving them metformin?

Answer 11

Metformin is renally cleared, so check renal function of patient.

Question 12

What are some examples of sulphonylureas, and how do they work?

Answer 12

• Gliclazide, glipizide

- They stimulate insulin secretion by blocking K+ channels in B cells

Question 13

What can be lowered when using sulphonylureas?

Answer 13

HbA1c

Question 14

What is a patient at risk of if they are taking sulphonylureas?

Answer 14

Hypos and increased risk of renal/hepatic impairment

Question 15

What are some examples of DPP-4 inhibitors and how do they work?

Answer 15

• Linagliptin, sitagliptin
• Delays GLP-1 inactivation
• GLP-1 is responsible for increased insulin after meals & decreases glucagon release

Question 16

What does SGLT-2 inhibitor stand for, and how do they work?

Answer 16

SGLT-2: Sodium glucose co-transporter protein 2 inhibitors

- They inhibit renal absorption of glucose, so it is urinated out

Question 17

What is an example of a SGLT-2 inhibitor?

Answer 17

Dapagliflozin

Question 18

What is an example of a thiazolidinedione (also called glitazones), and how do they work?

Answer 18

• Pioglitazone
• They modulate gene transcription for glucose metabolism
• It also decreases insulin resistance & increases insulin sensitivity

Question 19

Who should NOT take thiozolidinediones, and why?

Answer 19

Not used in CV patients, as it can cause weight gain & oedema.

Question 20

What are some examples of GLP-1 agonists, and how do they work?

Answer 20

• Exenatide, liraglutide

- They increase insulin after a meal & decrease glucagon release

Question 21

In which patients are GLP-1 agonists most used for, and why?

Answer 21

If their BMT is >35, as GLP-1 agonists delay gastric emptying & aid in weight loss

Question 22

How are GLP-1 agonists given?

Answer 22

Via injection

Question 23

What side effects can occur during insulin therapy?

Answer 23

1. Lipohypertrophy
2. Hypoglycaemia
3. Weight gain

Question 24

What hepatic process does insulin therapy decrease?

Answer 24

Gluconeogenesis (formation of glucose from non-carb sources, e.g. proteins)