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Endocrine > Drug Treatment of Diabetes > Flashcards

Drug Treatment of Diabetes Flashcards

1
Q

Basic class of treatments use for:

A. T1DM

B. T2DM

A

A. T1DM -> insulin

B. T2DM -> oral hypoglycaemic agents, noninsulin injectable therapies, insulin

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2
Q

Target of fasting and pre-meal capillary blood glucose readings

A

4 - 7 mmol/l

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3
Q

The target of HbA1c (glycated hemoglobin) - for a diabetic person

A

48-53 mmol/mol

(but should be individualized - e.g. more tight for a young person with many years ahead to live with diabetes)

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4
Q

short-acting insulin: (times)

  • duration of action
  • onset of action
A

Duration: 3-5 hrs

Onset: 30 mins

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5
Q

Rapid-acting insulin (times):

  • duration of action
  • onset of action
A

Duration 3-5 hrs

onset 15 mins

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6
Q

Intermediate-acting insulin (times):

  • duration of action
  • onset of action
A

Duration: 12-16 hrs

Onset: 1-3 hours

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7
Q

Long-acting insulin - times:

  • duration of action
  • onset
A

Duration: 20-24 hrs

Onset: 1hr

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8
Q

Pre-mixed insulin (times)

  • duration of action
  • onset
A
  • duration 12-16 hours
  • onset 30 mins
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9
Q

What types of insulin are mixed in pre-mixed insulin? (2)

A

rapid + intermediate

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10
Q
A
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11
Q

What are the characteristics of rapid-acting insulin?

A

Act faster and have shorter lasting effects (than soluble insulin)

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12
Q

What’s a basal-bolus regimen?

A
  • rapid/short-acting ‘bolus’ insulin before meals

WITH

  • intermediate/long-acting ‘basal’ insulin once or twice daily
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13
Q

What is a typical therapy with insulin?

A

Basal-bolus

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14
Q

(2) names of rapid-acting insulin

A
  • insulin aspart: NovoRapid
  • insulin lispro: Humalog
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15
Q

(2) names of short - acting insulin

A

soluble insulin examples:

  • Actrapid
  • Humulin S
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16
Q

(1) type of immediate - release insulin

A
  • isophane insulin
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17
Q

(2) names of long-acting insulin

A
  • insulin determir (Levemir): given once or twice daily
  • insulin glargine (Lantus): given once daily
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18
Q

What pre-mixed preparations contain in general?

A

combine intermediate-acting insulin with either a rapid-acting insulin analogue or soluble insulin

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19
Q

Name (4) examples of pre-mixed preparations

A
  • Novomix 30
  • Humalog Mix25
  • Humulin M3
  • Insuman Comb 15
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20
Q

Possible routes of administration of insulin

A
  • SC- the majority of the patients, I rotate injection sites to prevent lipodystrophy
  • Insulin pumps - ‘continuous subcutaneous insulin infusions’ which delivers a continuous basal infusion and a patient-activated bolus dose at meal times
  • Intravenous insulin - used for patients who are acutely unwell (e.g. DKA) w
  • Inhaled insulin is available but not widely used
  • Oral insulin analogues are in development but have considerable technical hurdles to clear
21
Q

What are (2) insulin regimens used in the management of diabetes type 1 - general names of regimens

A
  • twice daily (rarely)
  • basal bolus
22
Q

What insulins are used in once daily insulin regimen

A
  • long acting
  • intermediate acting
23
Q

What insulins are used in twice daily insulin regiment? (1)

A

Pre-mixed (with breakfast and main evening meal)

24
Q

What insulin is used in a basal-bolus insulin regimen?

A
  • Basal - once daily (rarely twice daily)
  • Bolus - with each meal
25
Q

What’s the disadvantage of twice daily insulin?

A

Twice daily insulin = pre-mixed insulin

Disadvantage: patient needs to have 4 regular meals, roughly at the same time, every day without fail

26
Q

How much insulin do you give in ‘carbohydrate counting’

A

Carbs counting - possibly with basal-bolus

1 unit of insulin with 10 units of carbs

27
Q

Do we worry about kidney in the insulin Rx?

A

Yes, in AKI, then we need dose reduction (otherwise hypoglycaemia) due to reduced excretion by kidney

28
Q

Do we need to worry about LFTs in insulin use?

A

No

(the only contraindication to insulin use is if someone is allergic to insulin)

29
Q
A
30
Q

What med belongs to biguanide class?

How does it work?

A

Metformin

MoA: reduces insulin resistance

31
Q

SEs of Metformin use (3)

A
  • GI upset
  • lactic acidosis
  • B12 deficiency
32
Q

What meds belong to Sulphonylurea class? (3)

A
  • Gliclazide
  • Glimepiride
  • Glibenclamide
33
Q

MoA of Sulphonylureas

A

Increase insulin secretion

34
Q

SE (1) of sulphonylureas

A

hypos

35
Q
A
36
Q

What drug belongs to Thiazolidinedione class?

A

Pioglitazone

37
Q

MoA of Pioglitazone

A

decrease insulin resistance

38
Q

SEs of Pioglitazone (2)

A
  • fluid overload
  • fractures
39
Q

Drugs that belong to DPP4 inhibitors class (3)

A
  • Sitagliptin
  • Saxagliptin

Linagliptin

40
Q

How do DPP4 inhibitors work?

A

Decrease incretin hormone degradation (so more incretins as a result)

41
Q

What drugs belong to class SGLT2 inhibitors? (3)

A
  • Dapagliflozin
  • Canagliflozin
  • Empagliflozin
42
Q

SEs of SGLT2 inhibitors (3)

A
  • UTI
  • Trush
  • DKA
43
Q

What class of drugs is a non-insulin injectable therapy?

A

GLP-1 agonist

e.g. exenatide, lixisenatide etc

44
Q

MoA of GLP-1 agonist

A

Example: GLP-1 agonist is Exenatide

MoA: Mimic incretin hormone (GLP-1)

so: increase in insulin, decrease in glucagon, decrease in gut motility, decrease food intake

45
Q

Benefits of use of Exenatide (2)

A
  • cardioprotective
  • weight loss
46
Q

Exenatide

  • SEs
  • cautions
A
  • GI disturbance
  • caution: bowel disease, liver disease
47
Q

What are NICE criteria for initiation of Exenatide

A

poor control + BMI >35

OR

BMI <35 but: weight loss would be beneficial, occupational consideration

AND continuation of targets (different flashcard)

48
Q

What are targets for continuation of Exenatide Rx

A

HbA1c reduction of 11 mmol/mol + weight loss 3% in 6 months

49
Q
A

Endocrine (11 decks)

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