Diabetes Management

Question 1

Describe the method of action and ADRs of thiazolineinediones (TZDs)

Answer 1

E.g. Rosiglitazone
MOA - upregulate genes with products important in insulin signalling, decrease gluconeogenesis, increase glucose uptake into muscle
ADRs - weight gain, oedema

Question 2

Describe the method of action and ADRs of sulphonylureas

Answer 2

E.g. Tolbutamide
MOA - antagonise B cell Na/K+ ATP channel activity –> depolarisation –> increased calcium –> increased fusion rate of insulin vesicles
ADRs - weight gain, hypoglycaemia, GI disturbances

Question 3

Understand the use of the main categories of insulin analogues and how they are used in type 1 and 2 diabetes

Answer 3

Intermediate/long lasting insulin supplemented with fast acting/short acting insulin injected with meals 
Ultra rapid - 3-4h
Short acting - 6-12h 
Intermediate - 16-24h
Intermediate/Long acting - 18-36h

Question 4

Describe the main treatment steps used in type 2 combination therapy

Answer 4

No drug (lifestyle/diet) –> (biguanides) metformin –> DPP-4i (gliptin)/(sulphonylureas) tolbutamide/(TZDs) rosiglitazone –> insulin

Question 5

Describe the method of action and ADRs of the main types of anti-obesity agents

Answer 5

E.g. Orlistat
MOA - gastric and pancreatic lipase inhibitor
Lowers fat –> glycerol and fatty acids
ADRs - steatorrhoea, flatus
E.g. Sibutramine
MOA - inhibits NA and 5-HT reuptake –> appetite suppression
ADRs - increased heart rate, blood pressure

Question 6

Describe the method of action and ADRs of biguanides

Answer 6

E.g. Metformin
MOA - increase sensitivity to insulin, enhance skeletal and adipose glucose uptake, inhibit hepatic gluconeogenesis
ADRs - GI disturbances
Contraindicated in patients with compromised heart, renal or hepatic function or respiratory disease

Question 7

Describe the method of action and ADRs of DPP-4 inhibitors

Answer 7

E.g. Gliptin
MOA - inhibit breakdown of incretins –> more insulin, less food intake
ADRs - GI symptoms

Question 8

Describe the method of action and ADRs of a-glucosidase inhibitors

Answer 8

Inhibits breakdown of complex carbohydrates –> lower post prandial glucose levels
ADRs - flatulence, loose stools, diarrhoea

Question 9

Describe the method of action and ADRs of SGLUT-2 inhibitors

Answer 9

Selectively inhibits SGLUT-2 in renal PCT –> inhibit kidney ability to reabsorb glucose
ADRs - LUTI symptoms, infection, thrush, polyuria