Diabetes Drugs Flashcards
Name a rapid acting insulin
Insulin aspart (Novorapid)
Name a short acting insulin
Soluble insulin (Actrapid, Humulin S)
Name an intermediate acting insulin
Isophane insulin (NPH)
Name a long acting insulin
Insulin degludec
Insulin glargine
What are some side effects of insulin?
Hypoglycaemia - renal impairment increases risk
Lipohypertrophy
Lipoatrophy
When a patient is on steroids, what should you do with the insulin dose?
Increase it
Name a biguanide
Metformin
How does metformin work?
Decreases hepatic glucose output (gluconeogenesis, glycogenolysis)
Increases glucose utilization in skeletal muscle
Does metformin cause weight gain? Why?
No because it suppresses appetite
What are side effects of metformin?
GI upset
What are some contraindications/warnings with metformin?
If eGFR<30 as excreted unchanged by kidneys
ACEi, diuretics, NSAID’s can impair renal function
Thiazides can cause hyperglycaemia
Name a sulphonylurea
Gliclazide
How do sulfonylureas work?
Stimulate B cell pancreatic insulin secretion blocking ATP dependent K+ channels
Do sulfonylureas cause weight gain and hypoglycaemia?
Yes because of anabolic effects of insulin
What are side effects of gliclazide?
Mild GI upset
Hypersensitivity
What are some warnings with gliclazide?
Caution with other hypoglycaemic agents, hepatic or renal impairment
Thiazide like diuretics cause hyperglycaemia
Name two thiazolidinediones/glitazones
Pioglitazone
Rosiglitazone
How do thiazolidinediones/glitazones work?
Increase insulin sensitivity of muscle and adipose by activating PPAR-y
Do glitazones cause weight gain and hypoglycaemia?
Yes because of fat cell differentiation
Yes they cause hypoglycaemia
What are the side effects of glitazones?
GI upset Fluid retention Fracture risk CVD concerns Bladder cancer
Name two SGLT-2 inhibitors
Dapaglifozin
Canaglifozin
How do SGLT-2 inhibitors work?
They decrease glucose absorption in the kidneys and excrete it out in the urine
Do SGLT-2 inhibitors cause weight gain?
No, weight loss
What are the side effects of SGLT-2 inhibitors?
UTI
Genital infections
Thirst
Polyuria
What are some warnings with SGLT-2 inhibitors?
Antihypertensives
Other hypoglycaemic agents
Name 2 DPP-4 inhibitors
Sitagliptin
Saxagliptin
How do DPP-4 inhibitors work?
They prevent GLP-1 degradation
Do DPP-4 inhibitors cause weight gain or hypoglycaemia?
No - GLP-1 is glucose dependent so postprandial action, insulin wont be stimulated at low blood sugar levels
No - Suppresses appetite
What are the side effects of DPP-4 inhibitors?
GI upset
Pancreatitis risk
Avoid in pregnancy
What are cautions with DPP-4 inhibitors?
Other hypoglycaemic agents
Drugs that oppose - thiazide, loop diuretics
Name two GLP-1 receptor agonists
Exenatide
Liraglutide
How do GLP-1 receptor agonists work?
Increase glucose dependent synthesis of insulin secretion from B-cells by activating the GLP-1 receptor
How is exenatide/liraglutide given?
SC injection
Do GLP-1 receptor agonists cause weight gain?
No as promote satiety
What are side effects of GLP-1 receptor agonists?
GI upset
GORD
What are contraindications to GLP-1 receptor agonists?
Stop if eGFR<30
What is the guideline for treating type 2 diabetes?
- If HbA1c rises to 6.5% on lifestyle measures, offer standard release metformin to a target of 6.5%
- If HbA1c rises to 7.5%, add DPP-4i/glitazone/SU/SGLT-2i. Aim for target of 7%
- If HbA1c rises to 7.5%, consider triple therapy. Aim for a target of 7%
