Diagnosis and Treatment of Type II Diabetes Flashcards
Which body shape type is most prone to type II diabetes?
The apple shape body type (with fat heavily deposited around the waist)
What does metformin do? Which is better to prevent type II diabetes: lifestyle changes or metformin?
. Metformin is a biguanide used to treat T2D by decreasing liver glucose production (decrease gluconeogenesis) and by increasing glucose usage by skeletal muscle (some B-pancreatic cells still need to be present)
. Lifestyle changes were proven to be better than treatment with metformin
Is type 2 diabetes reversible?
Evidence has suggested that it is reversible with lifestyle changes to alter the visceral fat levels in the body
Name 4 types of drug that stimulate insulin secretion.
Sulphonylureas, meglitinides, DPP4-inhibitors, GLP-1 analogues
Name 2 types of drug that decrease insulin resistance.
Biguanides (e.g. metformin) and Glitazones
What does alpha glucosidase inhibitors do?
Inhibit alpha-glucosidase, which usually converts oligosaccharides and disaccharides to monosaccharides. This reduces the uptake of glucose in the small intestine.
What do GLP-analogues do?
They stimulate insulin secretion, suppress appetite, and delay gastric emptying
What do SGLT2 inhibitors do?
Inhibit SGLT2 transporters so more glucose is excreted in the urine
What are biguanides? Give an example of a biguanide.
Biguanides decrease insulin resistance by decreasing hepatic glucose output and increasing glucose uptake by skeletal muscle
What do Sulphonylureas do?
Stimulate insulin secretion
What do meglitinides do?
Stimulate insulin secretion
What does Pioglitazone do?
Binds to specific receptor on muscle and adipocyte cells, which promotes the expression of genes involved in carbohydrate and lipid metabolism (glycolysis and lipolysis)
What does GLP-1 stand for? What does it do?
GLP-1 is glucagon-like peptide. Incretin hormone that stimulates insulin secretion.
What are incretin hormones? Give an example of an incretin hormone.
Hormones that stimulate insulin secretion in response to meals. An example is GLP-1.
What are DPP-4 inhibitors and what do they do?
Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) stimulate insulin secretion
Which is the most effective hypoglycaemic agent for controlling blood glucose? At what stage in treatment of T2D is it used?
Insulin is the most effective hyperglycaemic agent. It is usually the final addition to the drug regimen when oral drugs can’t control blood glucose sufficiently.
Give the main negatives seen in drugs used to treat type II diabetes.
Not tolerated well, avoid if have renal disease, can induce weight gain, increased risk of CVD, weak agents, fluid retention, increased risk of bone fractures and bladder cancer
Give one key benefit of using GLP-1 agonists.
They have a consistent effect on lowering blood pressure.
What happens to SGLT2 receptors in diabetics?
The SGLT2 receptors are up-regulated, which increases glucose absorption
What are SGLT2 transporters?
Channel proteins used to co-transport glucose from the kidney nephron tubules with sodium ions. (SGLT1 is in intestines)
Describe SGLT1 channels. Where are they found?
. Low capacity, high affinity
. Found in the intestine
Describe SGLT2 channels. Where are they found?
. High capacity, low affinity
. Found in kidneys
What is the difference between basal and prandial insulin? Which is more effective?
. Basal insulin is long-acting whereas prandial insulin is short-acting
. Basal is injected once/twice a day to keep blood glucose constant when not eating, prandial insulin taken at mealtimes
. Basal insulin is more effective at controlling blood glucose
What is the usual combination of drugs given to type II diabetics?
Insulin and metformin
Which drugs increase risk of weight gain?
(Think jiggly, siggly, SIGG) . S- sulphonylureas . I- insulin . G- glitazones . G- glinides
Which drugs increase risk of hypoglycaemia?
(Think SIG)
. S- Sulphonylureas
. I- insulin
. G- glinides
Which drug can be used even if the patient has renal disease?
Pioglitazones
What do pioglitazones do?
Promotes metabolism of carbohydrates and fats (glycolysis and lipolysis)
