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Endocrine > Diabetes treatment > Flashcards

Diabetes treatment Flashcards

1
Q

What is first line oral therapy for type 2 DM and what class of drug is it?

A

Metformin - Biguanide

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2
Q

What is the main method of action of Metformin?

A

Inhibition of gluconeogenesis by the liver (by stimulating AMP-activated protein kinase)

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3
Q

What are the main benefits to Metformin being used in T2DM?

A
  • Reduces HbA1c by 15-20mmol/mol (lowering insulin resistance)
  • weight loss ss
    prevention of micro- & macrovascular complications
  • may be combined with other agents
  • No risk of hypoglycaemia
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4
Q

What is the maximum dose of metformin?

A

1g bd

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5
Q

When should the dose of metformin be lowered and when should it be stopped?

A

Lowered (halved) - eGFR 30-45ml/min

Stopped eGFR <30ml/min

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6
Q

Give some SE of metformin.

A

GI upset - anorexia, nausea, D&V, taste disturbance
Interference with Vit B12 and folic acid absorption
Lactic acidosis
Liver failure
Rash

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7
Q

Are there any contraindications to metformin?

A 
Renal failure 
Hepatic disease 
Cardiac failure 
Alcoholism 
Chroni lung disease 
Mitochondrial myopathy 
Any serious current illness
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8
Q

In what liver pathology may Metformin be useful in?

A

NAFLD

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9
Q

Give 3 examples of Sulphonlyureas.

A

Glicazide
Glibenclamide
Glimepiride

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10
Q

In diabetes when are SUs used?

A

In patients who are not overweight but have intolerance or contraindications to meformin

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11
Q

Are SUs used in type 1 DM?

A

No - need functioning beta-cells for these to work

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12
Q

Briefly describe the method of action of SUs.

A
  • displace ADPMg from SUR1 subunit closing the KATP channel
  • tonic, hyperpolarizing effect of potassium occurs and the cell membrane is depolarized
  • Voltage gated Ca channels open
  • Rise in intracellular calcium leads to increased secretion of (pro)insulin
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13
Q

What are the effects of SUs?

A

Reduces HbA1c by 15-20mmol/mol (increasing insulin secretion)
Preventio of microvascular complications
Weight gain

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14
Q

Do sulphonylureas prevent from macrovascular complications?

A

No

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15
Q

Give some SE of SUs.

A

Hypoglycaemia
GI: anorexia, nausea, vomiting, diarrhoea, abdo pain
Weight gain
Headache

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16
Q

In what conditions should SUs b avoided in?

A

Severe renal or hepatic failure

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17
Q

What drugs can impede the effects of sulphonylureas?

A

corticosteroids

thiazide diuretics

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18
Q

What is Pioglitazone an example of?

A

Thiazolidinediones

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19
Q

What is the method of action of TZDs?

A

Binds to PPARgamma (whihc is already associated with RXR)
Activated PPARgamma-RXR complex binds to DNA to promote the expression of genes encoding several proteins involved in insulin signalling

20
Q

What are the positive effects of TZDs?

A
  • reduces HbA1c by 15-20mmol/mol by increasing insulin sensitivity
  • Promote fatty acid uptake and storage in adipocytes, rather than skeletal muscle and liver
  • Reduced hepatic glucose output
21
Q

What are the disadvantages of the effects of TZDs?

A

Weight increase is inevitable (increased sucut fat and fluid retention)
Increased risk of heart failure (fluid retention)
Risk of fracture

22
Q

Where exactly is GIP and GLP1 released from?

A

GIP - K cells in intestine

GLP1 - L cells in intestine

23
Q

What is the method of action of GLP1 receptor agonists?

A

Binds to GPCR GLP1 receptors and increase cAMP concentration -> promoting insulin from pancreas without hypoglycaemia

24
Q

Give 2 examples of GLP1 receptor agonists.

A

Exenatide and Liraglutide

25
Q

When are GLP1 receptor agonists used?

A

Improve glycaemic control in obese adults with T2DM who are already on metformin and/or SU
(3rd line agent)

26
Q

What are the effects of GLP1RA on weight?

A

Decrease gastric emptying - early satiety

act on hypothalamus to reduce appetite resulting in weight loss

27
Q

Give 2 examples of DPP4 inhibitors.

A

Sitagliptin

Vildagliptin

28
Q

What are the main effects of DPP4 inhibitors?

A

Promote insulin secretion from pancreas without hypoglycaemia
Suppresses glycagon
Weight neutral

29
Q

What is the possible but rare side effect of DPP4 inhibitors?

A

Pancreatitis

30
Q

What do SGLT2 inhibitors block and give some examples of this class of drug?

A

Sodium-glucose co-transporter-2 inhibitors

Dapaglifozin, Canagliflozin

31
Q

Briefly describe the method of action of SGLT2 inhibitors.

A

Selectively block reabsorption of glucose at the SGLT2 channels (proximal tubule of the kidney nephron) deliberately causing glucosuria - enhance glucose excretion by the kidneys and lowers blood glucose

32
Q

Does weight loss occur in the use of SGLT2 inhibitors?

A

yes up until a point when it plateaus

33
Q

What are common side effects of SGLT2 inhibitors and why does this happen?

A

Thrush and urine infections caused by urinating more glucose

34
Q

How does the glinide class of drug work?

A

Binds to SUR1 to close the KATP channel and trigger insulin release

35
Q

Are glinide drugs fast or slow acting?

A

rapid onset/offest kinetics making them less likely to cause hypoglycaemia than SUs

36
Q

Give examples of glinide drugs.

A

Repaglinide

Nateglinide

37
Q

Why do alpha-glucosidase inhibitors work?

A

Theyd elay absorption of glucose thus reducing postprandial increase in blood glucose

38
Q

When are alpha-glucosidase inhibitors used?

A

IN T2DM patients inadequately controled by lifestyle measures or other drugs

39
Q

What are the side effects of alpha-glucosidase inhibitors?

A

Flatulence
Loose stools/ diarrhoea
Abdominal pain
Bloating

40
Q

Compare when insulin is brought into ise in T1 and T2 DM

A

First drug choice in T1DM

Last option for T2DM

41
Q

Should Metformin and SUs be continued when on insulin?

A

Yes - to maintain or improve glycaemic control

42
Q

How is insulin most commonly administered?

A

Subcutaneous injection

43
Q

Breifly describe the idea of a basal bolus regimen.

A

Aims to mimic normal endogenous insulin prduction
Underlying basal injection that lasts the full day
Bolus insulin injections at meals

44
Q

For a basal bolus regimen in a newly diagnosed diabetic, what is the dosage of insulin that is started?

A

0.3units/kg body weight

divide it 50% bolus 50% basal

45
Q

Give some sie effects of insulin therapy.

A 
Hypoglycaemia 
Hyperglycaemia 
Local reaction at injection site (acute)
Loss of fatty tissue at injection site (chronic)
Insulin resistance
46
Q

If a patient with diabetes also has renal failure, does their insulin dose increase or decrease?

A

Decrease - insulin is excreted by the kidneys

Endocrine (18 decks)

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