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Endocrine > diabetes treatment > Flashcards

diabetes treatment Flashcards

1
Q

Treatment of diabetes 1

5

A
  1. at dx start insulin immediately
  2. structured education programme
  3. DAFNE- dose adjustment for normal eating
  4. diet modify: restrict refined sugars+ saturated fats but calorific intake not reduced
  5. exercise
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2
Q

diabetes 2 general treatment escalation

5

A
  1. diet +exercise
  2. oral monotherapy
  3. oral combination
  4. oral + insulin
  5. Insulin
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3
Q

contraindication for oral monotherapy

A

ketoacidosis

severe intercurrent illness

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4
Q

indications for insulin therapy with type 2 diabetes

3

A
  1. persistently elevated blood glucose and HBA1C on maximum doses of anti-diabetic drugs (secondary failure to anti-diabetic drugs)
  2. symptoms of hyperglycemia and/or infections (eg candidiasis) (severe intercurrent illness)
  3. metabolic complications (non-fasting ketonuria and hyperosmolar state)
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5
Q

3 classes of anti-diabetic drugs

mechanism

A
  1. augment supply of insulin on pancreatic beta cells
  2. enhance insulin action and reduce resistance-liver, fat & muscle
  3. delay carbohydrate absorption- gut
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6
Q

4 drugs that augment insulin supply

A
  1. sulfonylureas eg -zide
  2. prandial glucose receptors (end in glinides)
  3. incretin mimics (-tide, exenatide)
  4. gliptins: DPP4 inhibitors so incretin increased
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7
Q

2 drugs that enhance insulin action and reduce resistance at liver, fat and muscle

A
  1. biguanide eg metformin

2. thiazolidineoides (eg pioglitazone)

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8
Q

3 drugs that delay carb absorption

A
  1. alpha glucosidase inhibitors (eg acarbose, miglitol)
  2. incretin mimics
  3. glicretics, SGLT2 inhibitors
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9
Q

what is gliplizide

A

sulphonylurea

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10
Q

how does gliplizide work

A

stimulates secretion of endogenous insulin by closing the K-ATP channel

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11
Q

pros of gliplizide

A

reduces blood glucose level

well tolerated generally

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12
Q

cons of gliplizide

A
  • promotes weight gain
  • need reduced dose in renal impairment
  • risk of hypoglycaemia
  • increased appetite
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13
Q

action of metformin

A

biguanide

decreases hepatic glucose production and increases sensitivity of insulin in muscle

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14
Q

pros of metformin

A

encourage weight loss
old and cheap
good at controlling blood glucose

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15
Q

what anti-diabetic drug is first line

A

metformin

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16
Q

cons of metformin

A

nausea

diarrhoea

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17
Q

when is metformin contraindicated

A

in renal impairment (risk of lactic acidosis <30 egfr)

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18
Q

when is gliplizide contraindicated

A

hepatic failure

but also reduce dose in renal impairment

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19
Q

what are the 2 glucose prandial regulators

A

repaglinide (meglitinide)

notglinide (amino acid derivative)

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20
Q

what is the action of repaglinide

A

insulin secreatogogues-direct effect on beta cells they stimulate rapid endogenous insulin release when given with meals

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21
Q

side effects of repaglinide

A

weight gain

hypoglycaemia but lower risk than sulfonylurea

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22
Q

how does acarbose work

A

alpha-glucosidase inhibitors, delay digestion of carbohydrates and slow down postprandial absorption of glucose

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23
Q

cons of acarbose and miglitol

A

limited weight efficacy but can be used in combination

  • Bloating
  • flactulence
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24
Q

how does miglitol

A

inhibitors, delay digestion of carbohydrates and slow down postprandial absorption of glucose

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25
Q

how does pioglitazone work

A

thiazolidenoides

  • activates PPAR gamma nuclear receptors on adipose tissue
  • reduces insulin resistance in liver and muscle by lowering plasma FFA and increases adiponectin
  • enhances actions of endogenous insulin
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26
Q

what does PPAR

A

peroxisome proliferated activated receptors= family of nuclear transcription factors regulating expression of genes involved in lipid and carbohydrate metabolism

27
Q

pros of pioglitazone

A
  • effective
  • rare hypo
  • sustained improvements in HbA1C
  • potential benefits in fatty liver
28
Q

cons of pioglitazone

A
  • slow onset of action 2-3 months
  • promotes weight gain
  • redistributes body fat to reduce visceral deposits
  • fluid retention- oedema
  • bladder cancer increase risk
29
Q

contraindication of pioglitazone

A

ci in cardiac failure and hepatic failure as may cause fractures

30
Q

what is the action of exenatide and liraglutide

A

mimics Glucagon like peptide 1
incretin mimic
potent insulinotrophic hormone is released in response to meals, but lower in IGT
stimulate glucose-dependent insulin secretion, suppresses glucagon secretion, slow gastric emptying, reduces food intake and improves insulin sensitivity

31
Q

how is exenatide given

A

injected

32
Q

pros of exenatide

A
  • promotes weight loss
  • reduces appetite as feel fuller for longer
  • reduces risk of cardiac disease
33
Q

cons of exenatide

A
  • nausea
  • hypo risk but rare unless given with SU
  • risk of pancreatitis
  • only available as injection
34
Q

how do gliptins work

A

DPP4 inhibitors
dipeptidyl pepitdase enzyme
so get more GLP-1 so enhance action on insulin

35
Q

what are gliptins given with

A

metformin

36
Q

what is exenatide often given with

A

metformin and SU

37
Q

Pros of gliptins

A

weight neutral
safe in renal impairment
modest reduction in HBa1C
oral taken

38
Q

cons of gliptins

A

minimal hypo

39
Q

what action empaglifozin, canglifozin have

A

act at kidney to prevent glucose resorption

SGLT2 inhibitors

40
Q

pros of empaglifozin

A 
weight loss
BP reduction 
not assoc. to hypos
CV mortality improved
moderately effective
41
Q

cons of canglifozin

A
  • can’t be used if eGFR <45 or >60
  • polyuria
  • care with hypoloaemia/ loop diuretics
  • glycosuria: leads to UTI and genital infections
42
Q

contraindication of canglifozin

A

> 85

43
Q

what are the ultra short acting drugs insulin

A

novorapid
humalog
apidra

44
Q

how long are ultra short acting drugs

A

4 hours

45
Q

what are the short acting drugs

A

actrapid, humulin s, hypurin neutral

46
Q

what length are short acting drugs

A

6 hours

47
Q

what are the intermediate acting insulin drugs

A

insulatard
humulin I
hypurin
isophane

48
Q

how long are intermediate acting insulin drugs

A

12 hours

49
Q

what are the fixed mixed insulin drugs

A

humulin M3
novomix 30
humalog mix 25
humalog mix 50

50
Q

what are the long acting insulin drugs

A

glargine (lantus)
levemir (detemir)
degludec

51
Q

long acting insulin drugs how long

A

18-36 hours

52
Q

what is an insulin analogue

A

substitution of single amino acid in insulin chain
alters absorption characteristics of insulin
time-action profile is modified by amino acid

53
Q

sick day rule

A

take 10% of insulin every 2 hours when ill

54
Q

what regimens of insulin are there

A
  • basal-bolus (multiple injections) : short or fast acting insulin before meals then intermediate or long acting once daily
  • Twice daily: soluble or fast acting and isophane (NPH) insulins combined; free or fixed mix
  • once daily: intermediate or long acting insulin with diabetic drug
55
Q

when is intraperitoneal insulin used

A

in dialysate or renal failure

56
Q

complications of insulin

A

lipohypertrophy at insulin site

57
Q

side effects on insulin

A 
hypoglycaemia
weight gain
lipohypertrophy
peripheral oedeam
insulin antibody form
local allergy
58
Q

when is islet transplantation used

A

-impaired awareness of hypo in 1dm

59
Q

how is islet transplantation done

A

double donor transplants

60
Q

benefits of islet transplantation

A

insulin independence

establish awareness of hypos and glycaemic stability

61
Q

what add’s have the highest efficacy

A

insulin 1st

SU, tzd, glp1

62
Q

highest hypo risk

A

insulin then su

63
Q

highest weight gain

A

insulin, SU, TZDs

Endocrine (14 decks)

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