DM

Question 1

Types of insulin preparations

Answer 1

Human analogues

• Modified insulin peptides (lispro & aspart), rapid onset but shortduration
• Pre/Post meal

Short-acting insulins

• 6-8 hrs, with peak effect at 2-5hrs. Take 15-30 misn pre-meal

Intermediate/LA insulins

• insulin+protamine=isophane insuline INTERMEDIATE
• +zinc INTERMEDIATE TO LONG ACTING
• +protamine+zinc= LA
• Cystallineinsulin zinc also LA

Question 2

Regimens

Answer 2

• Twice daily:
• Multiple dosing: medium at night. short at meals =basal-bolus regiment
• SIngle daily: mainly poorly controlled T2DM

Question 3

Insulin requirements are increased by:

Answer 3

• Stress, infection, trauma, puberty (GH), pregnancy.

Question 4

Insulin requirements decreased in…

Answer 4

Coeliac disease

Renal/hepatic impairment

Endocrine disorders e.g Addison’s

Question 5

Modes of administration

Answer 5

• IV
• SUBCUT:
• Pumps

Question 6

Management of T2DM

Answer 6

In mild or initial disease: dietary modification

• Reduce simple CHO, increase non-starch polys
• Reduce fat to reduce atherosclerosis
• Fat 30-35%, CHO 50-55
• Weight loss/exercise

If insufficient after 3 monhts, then start antidiabetic drugs

Question 7

Sulphonylureas MOA

Answer 7

Gliclzide

• incr insulin SECRETION
• inhibit K-ATP channels

Question 8

Sulphonylureas SEs

Answer 8

• Cause weight gain (+increase insulin resistance), avoided in obesity
• Awareneness may be lost when using BBs
• Associated with hypos especially in
  
  • Elderly
  • missing meals
  • with Long acting agents

Question 9

meglitidine analogues MOA

Answer 9

nateglinide, repaglinide

• KATP closure, but different site to Sulphonylurea
• Rapid onset, given at meal times to stimulate prost-prandial insulin secretion
• May be enhanced by patient having meal aka PGRs

Question 10

Biguanides MOA

Answer 10

METFORMIN

• May activate AMP-kinase
• Drug of choice in obese, does not cause weight gain
• DO NOTuse in renal impairment
• DOES NOT cause hypoglycaemia

Question 11

Thiazolindiediones (glitazones ) MOA

Answer 11

• Activate PPAR-g, results in gene-mediated insulin-like effects
• “insuline sensitizers” as they enhance glucose utilization in tissues and reduce resistance
• Reduce hepatic glucose output, increase GLUTin SKM, Increased fatty acid uptake

MONITOR LIVER FUNCTION, DO NOT COMBINE WITH OTHER

Question 12

T2DM management pathway

Answer 12

Question 13

First choice antihypertensives in diabetics

Answer 13

ACEIs,

AT1 receptor may substitute ACEI if not well tolerated

Thiazides, BBs and CCB also effective

Simastatin protects againsy cardivascular events