Diabetes Mellitus Flashcards
What is the role of insulin?
Stimulates uptake of glucose into liver, adipose and muscle tissue
Decreases hepatic glucose output - inhibition of gluconeogenesis
Inhibits glycogenolysis
Promotes uptake of fats
What are the main insulin categories?
Ultrafast acting Rapid acting Short acting Intermediate acting Long acting Very long acting
What is an example of an ultrafast acting insulin?
Insulin aspart
What are some examples of rapid acting insulins?
Humalog
Novorapid
What should rapid acting insulin be injected?
Just before eating
Onset ~ 5-15 mins
What are some examples of short acting insulin?
Actarapid
Humulin S
When should short acting insulin be injected?
~15-30 mins before eating
Onset of ~30-60 mins
What are some examples of intermediate acting insulin?
Insulatard
Humulin I
When should intermediate insulin be used?
Between meals and overnight
Onset of ~2-4 hrs
What is an example of a long acting insulin?
Glargine
What is an example of a very long acting insulin?
Degludec
What are some adverse effects of insulin?
Hypoglycaemia
Hyperglycaemia
Lipodystrophy - continuous injections in one place
Painful injections
Allergies to preservatives in the solution
What are the effects of metformin?
Decreased insulin resistance => increased glucose uptake
Decreased hepatic gluconeogenesis => decreased hepatic glucose output
Decreased CVS events via lowering cholesterol and TAG
What are some side effects of metformin?
GI Sx
Lactic acidosis
Vit B12 deficiency due to accelerated bowel movements
How do sulphonylureas act in DM?
Stimulates β cells to release insulin
Decreased microvascular release
What are some side effects of sulphonylureas?
Weight gain
Hypoglycaemia
How does acarbose exert its effects in DM?
Inhibits α-glucosidase therefore inhibits breakdown of carbohydrates
What are some side effects of acarbose?
Flatulence
Loose stools
Diarrhoea
How do glitazones exert their effects in DM?
Increase insulin sensitivity in muscle and adipose
Decrease hepatic glucose output
How do glucagon like peptide therapies act in DM?
Increase insulin secretion
Decrease glucagon production
What are some ADRs of GLP?
GI Sx - nausea, loose stools, diarrhoea
GORD
Hypoglycaemia
How do glifozins exert their effects?
Inhibition of SGLT2 in renal PCT => excess excretion of glucose in urine
Can be used as add on therapy in pts w/ T1DM or T2DM
What are some side effects of glifozins?
Lower urinary tract Sx - including infections, more common in women
Polyuria
Low risk of hypoglycaemia