Diabtes Mellitus Flashcards
Which hormones promote insulin release after eating?
State the half life of insulin
- Incretins (GLP-1, GIP)
- 5mins
Why is Insulin secreted into blood even during fasting?
To prevent receptor downregulation
List the 3 characteristic features of Type 1 DM
List 3 others
- Weight loss
- Polydipsia
- Polyuria
- Fatigue/ lethargy
- General weakness
- Blurred vision
What are the 2 plasma glucose requirements for classification of hyperglycaemia
Fasting plasma glucose: 6.9mM or higher
Random plasma glucose: 11mM or higher
(HbA1c: 6.5% or higher)
(Can’t diagnose diabetes with a single raised plasma glucose reading WITHOUT symptoms)
How do Glucose and HbA1c readings differ?
Glucose: Immediate measure of glucose in blood
HbA1c: % of RBCs with a ‘sugar coating’, reflects average blood sugar over last 10-12 weeks
Diabetic Ketoacidosis is a triad of what 3 signs?
More common in Type 1 DM
- Hyperglycaemia (may not be present)
- Ketonaemia (Urine or Blood)
- Acidosis
How do you treat DKA?
IV fluids with K+, then IV insulin
Why can’t Insulin be given Orally?
How is it given routinely?
Is a protein, so would be digested in gut
Subcutaneous (IV if in emergency)
List 3 possible preparations of Insulin
- 100 units/ ml
- 300 units/ ml
- 500 units/ml
(Latter 2 were created due to obesity and insulin resistance)
State 2 types of Natural insulins
- Bovine
- Porcine
What are 3 methods of slowing Insulin absorption?
- Addition of a Protamine/ Zinc complex with NATURAL insulins
- Use of Insulin analogues (a few amino acid changes, no change to Pharmcodyanmics)
- Use of Soluble/ Neutral insulin;
- Forms hexamers, so delayed absorption
When is [plasma] greatest after giving Soluble Insulins?
When are they often prescribed?
After 2-3 hours
15-30 mins before meals
List 2 examples of Insulin Analogues
Compare their;
- Onset of action
- Duration
- Class (rapid/ short/ long etc)
Insulin aspart;
- OoA: 10-20 mins
- D: 3-5hrs
- Rapid
Insulin glargine;
- OoA: 60-90 mins
- D: 20-24 hrs
- Long
For Soluble Insulin, list the;
- Onset of Action
- Duration
- Class
OoA: 30-60 mins
D: 5-8 hrs
Class: Short
For NPH (Isophane insulin), list the;
- Onset of Action
- Duration
- Class
OoA: 60-120 mins
D: 18-24 hrs
Class: Intermediate
Insulin can be made in mixtures of Long and Short acting, so combinations are often prescribed by Brand name.
Suggest and describe a dosing regimen that’s often used in young patients with Type 1 DM
Basal-Bolus dosing;
Mix of Rapid acting bolus and Long acting basal insulin throughout the day
E.g 3 Boluses before meals + 2 Basal injections
Suggest 2 ADRs of Insulin therapy
- Hypoglycaemia
- Lipodystrophy (Lipohypertrophy or Lipoatrophy)
Suggest a contraindication of Insulin therapy
Renal impairment (risk of hypoglycaemia due to decreased Insulin clearance)
Suggest an important Drug-Drug Interaction (DDI) of Insulin
Dose needs increasing with systemic steroids (e.g cortisol)
How can Lipodystrophy be minimised during Insulin therapy
Can reduce adherence
Rotate site of administration around abdomen
What is Diabulimia?
When a Type 1 DM patient stops/ reduces their insulin to control their weight
Pharmacological treatment of Type 2 DM involves use of what drugs before insulin?
Hypoglycaemic drugs (e.g metformin)
List 6 Hypoglycaemic agents used to manage Type 2 DM
- Sulphonylureas
- Biguanides
- Thiazolidinediones/ Glitazones
- DPP4 Inhibitors/ Gliptins
- SGLT2 Inhibitors/ Gliflozins
- GLP1 Receptor Agonists/ Incretin mimetics
What drug class is Metformin
How do these drugs work?
How do they affect weight?
Biguanide
- Inhibit gluconeogenesis, thus reducing hepatic glucose production
- Suppress appetite> LIMIT weight gain
Can Biguanides cause hypoglycaemia?
How are they administered?
How are they incorporated into a prescription?
- No
- Orally
- 1st line, can be taken with other hypoglycaemic agents
List an ADR and contraindication of using Biguanides
- GI upset (nausea, vomit, diarrhoea)
- Alcohol intoxication, eGFR<30 (excreted without being metabolised)
List important DDIs of Biguanides
- Don’t use with drugs that can impair renal function (ACEi, Diuretics, NSAIDs)
- Loop & thiazide diuretics increase glucose so can reduce action
What drug class is Glicazide
How do these drugs work?
How do they affect weight?
- Sulphonylureas
- Stimulate pancreatic insulin secretion
- Due to anabolic effects of insulin-> Increased
Can Sulphonylureas (SU) cause hypoglycaemia?
How are they administered?
How are they incorporated into a prescription?
- Yes
- Orally
- 1st line if Metformin is contraindicated, can be taken with other hypoglycaemic agents
List an ADR and contraindication of using SU drugs
- GI Upset
- Hepatic or renal disease
List important DDIs of SU drugs
Loop and thiazide diuretics can reduce SU action
What drug class is Pioglitazone/ Rosiglitazone?
How do these drugs work?
How do they affect weight?
- Glitazone/ Thiazolidinedione
Enhanced;
- Insulin sensitivity
- Glucose utilisation
- Cause fat cell differentiation-> Increased
Can Glitazones cause hypoglycaemia?
How are they administered?
How often are they incorporated into a prescription?
- Yes
- Orally
- Used much less frequently than other agents (due to chance of bladder cancer and fracture)
List ADRs and a contraindication of using Glitazones
- GI Upset
- Fluid retention
- Fracture risk
- Bladder cancer
- Heart failure due to fluid retention
What drug class is Canagliflozin/ Dapagliflozin
How do these drugs work?
How do they affect weight?
- SLGT2 Inhibitor/ Gliflozin
- Reduced glucose reabsorption
- Cause weight loss
Can Gliflozins cause hypoglycaemia?
How are they administered?
How are they incorporated into a prescription?
- No
- Orally
- In addition to Insulin in Type 1, add on in Type 2
List 4 ADRs of Gliflozins
- UTI and genital infection
- Thirst and Polyuria
- Risk of DKA in Type 1 DM
- Possible hypotension
List important DDIs of Gliflozins
- Antihypertensives (as they can cause hypotension)
What drug class is Saxagliptin/ Sitagliptin?
How do these drugs work?
How do they affect weight?
- DDP4 Inhibitor/ Gliptin
- Prevent incretin degradation
- Suppress appetite-> Weight neutral
(These drugs are glucose dependant, so mainly after eating?)
Can Gliptins cause hypoglycaemia?
How are they administered?
- No
- Orally
List 2 ADRs and contraindications of Gliptins
- GI upset
- Small risk of pancreatitis
- Pregnancy
- History of pancreatitis
List important DDIs of Gliptins
Thiazides and loop diuretics can reduce action
DPP4 normally degrades GLP-1.
Does it degrade GLP-1 Receptor Agonists?
No
Can Incretin Mimetics cause hypoglycaemia?
How are they administered?
How are they incorporated into a prescription?
- No
- Subcutaneously
- Add on if triple therapy is ineffective
List 2 ADRs and a contraindication of Incretin Mimetics
- GI upset
- Reduced appetite-> weight loss
- Renal impairment
What drug class is Exenatide/ liraglutide?
How do these drugs work?
How do they affect weight?
- GLP-1 Receptor Agonist/ Incretin Mimetic
- Increased glucose-dependent insulin synthesis
- Promote satiety (possible weight loss?)
For Glitazones, is half life related to duration of action?
Why?
How long does it take to get a benefit?
- No
- Because it works by altering gene transcription, which takes time to develop (effects can even happen after the drug is no longer present)
- 6-8 weeks
What are 2 side effects of Metformin?
What is 1 good thing about this drug?
- GI Upset
- Lactic acidosis (Inhibits gluconeogenesis so Pyruvate accumulates-> Lactic acid)
- Doesn’t cause hypoglycaemia
