diabetes drugs

Question 1

type 1 diabetes mellitus diagnosing factors

Answer 1

polyuria, polydipsia, weight loss, fatigue, lethargy, hyperglycemia fasting glucose ≥ 6.9 mmol/L or random plasma glucose ≥ 11 mmol/L

Question 2

HbA1c?

Answer 2

glycated haemoglobin - percentage of red blood cells with “sugar coating” – reflects average blood sugar over last 10-12 weeks

Question 3

diabetic ketoacidosis?

Answer 3

hyperglycaemia, ketonaemia, acidosis

polydypsia, polyuria, abdominal pain, V+D, lethargy, confusion, visual disturbance, acetonic breadth, symptoms of shock

Question 4

rapid acting insulin? bolus

Answer 4

insulin aspart, novorapid

Question 5

short acting insulin

Answer 5

soluble insulin, actrapid

Question 6

intermediate acting insulin

Answer 6

Isophane insulin (NPH)

Question 7

basal dosing- long acting insulin

Answer 7

Insulin glargine

Question 8

insulin

Answer 8

hypoglycaemia, lipodystrophy

Question 9

X Insulin

Answer 9

renal impairment - hypoglycaemia risk

Question 10

^ insulin

Answer 10

dose needs increasing with systemic steroids

caution with other hypoglycaemic agents

Question 11

type 2 diabetes mellitus steps

Answer 11

Insulin resistance associated with obesity
initially increased pancreatic insulin secretion but ↓insulin receptors
↓GLP-1 secretion in response to oral glucose
response reduced at β-cells
insulin production reduced

Question 12

biguanides mechanism

Answer 12

↓hepatic glucose production by inhibiting gluconeogenesis
Some gluconegenic activity remains so hypoglycaemia risk reduced
• Supress appetite so limit weight gain

Question 13

biguanides example

Answer 13

metformin

Question 14

biguanides

Answer 14

GI upset – nausea, vomiting, diarrhoe

Question 15

X biguanides

Answer 15

excreted unchanged by kidneys – stop if eGFR < 30 mL/min,

alcohol intoxication

Question 16

^ biguanides

Answer 16

ACEi, diuretics, NSAIDs – drugs that may impair renal function
loop and thiazide like diuretics ↑glucose so can reduce metformin action

Question 17

sulfonylureas mechanism

Answer 17

Stimulate β-cell pancreatic insulin secretion
blocking ATP-dependant K+ channels
Need residual pancreatic function to work
Weight gain through anabolic effects of insulin

Question 18

sulfonylureas example

Answer 18

gliclazide

Question 19

sulfonylureas

Answer 19

mild GI upset – nausea, vomiting, diarrhoea,

hypoglycaemia

Question 20

x sulfonylureas

Answer 20

hepatic and renal disease – caution, those at risk of hypoglycaemia

Question 21

^ sulfonylureas

Answer 21

other hypoglycaemic agents,

loop and thiazide like diuretics ↑glucose so can reduce SU action

Question 22

Thiazolidinediones (glitazones) examples

Answer 22

pioglitazone rosiglitazone

Question 23

Thiazolidinediones (glitazones) mechanism

Answer 23

Insulin sensitisation in muscle and adipose,
↓hepatic glucose output by activation of PPAR-γ → gene transcription
Weight gain because of fat cell differentiation

Question 24

Thiazolidinediones (glitazones)

Answer 24

GI upset, fluid retention, fracture risk , bladder cancer

Question 25

X Thiazolidinediones (glitazones)

Answer 25

heart failure because of fluid retention

Question 26

^Thiazolidinediones (glitazones)

Answer 26

other hypoglycaemic agents

Question 27

Sodium-glucose co-transporter (S G LT -2) inhibitors (gliflozins) example

Answer 27

dapagliflozin

canagliflozin

Question 28

Sodium-glucose co-transporter (S G LT -2) inhibitors (gliflozins) mechanism

Answer 28

↓↓glucose absorption from tubular filtrate,
↑urinary glucose excretion
competitive reversible inhibition of SGLT-2 in PCT
• Modest weight loss, hypoglycaemic risk is low

Question 29

Sodium-glucose co-transporter (S G LT -2) inhibitors (gliflozins)

Answer 29

UTI and genital infection, thirst and polyuria

Question 30

XSodium-glucose co-transporter (S G LT -2) inhibitors (gliflozins)

Answer 30

hypovolaemia - possible hypotension

Question 31

^Sodium-glucose co-transporter (S G LT -2) inhibitors (gliflozins)

Answer 31

antihypertensive and other hypoglycaemic agents

Question 32

GLP1 analogues

Answer 32

Exenatide, Liraglutide

Question 33

GLP1 analogues mechanism

Answer 33

↑glucose dependant synthesis of insulin secretion from β-cells
activate GLP-1 receptor – resistant to degradation by DPP-4
Subcutaneous injection • Promote satiety – possible weight loss?

Question 34

DPP-4) inhibitors (gliptins) examples

Answer 34

Saxagliptin, Sitagliptin,

Question 35

DPP-4) inhibitors (gliptins) mechanism

Answer 35

Prevent incretin degradation - ↑[plasma] incretin levels

Supress appetite ~ weight neutral

Question 36

DPP-4) inhibitors (gliptins)

Answer 36

GI upset, small pancreatitis risk

Question 37

XDPP-4) inhibitors (gliptins)

Answer 37

avoid in pregnancy, history of pancreatitis

Question 38

^DPP-4) inhibitors (gliptins)

Answer 38

other hypoglycaemic agents, drugs ↑glucose can oppose gliptin action – thiazide like and loop diuretics

Question 39

effects of GLP1

Answer 39

↑Insulin secretion (glucose dependent) 
↓Glucagon secretion
↓ food intake ↑ satiety in brain
↓Glucose production in liver
↓Gastric emptying in stomach
↑Glucose uptake by muscle

Question 40

GLP1 agonists

Answer 40

GI upset, decreased appetite with weight loss

Question 41

X GLP1 agonists

Answer 41

Renal impairment

Question 42

^ GLP1 agonists

Answer 42

other hypoglycaemic agents