Endocrinology Flashcards
Describe how carbohydrates are metabolised
Carbohydrates ingested
Carbohydrates digested by enzymes in stomach and intestine to release glucose
Glucose absorbed into blood stream stimulates pancreas to release insulin
Glucose is then stored in fat, muscle and in the liver
What is insulin?
Hormone which acts like a key to unlock the body’s cells and let glucose in which is then converted to energy
What is diabetes mellitus?
A syndrome of chronic hyperglycaemia due to reactive insulin deficiency, resistance or both
What is the optimum blood glucose level before a meal?
4-7 mmol/L
What is the optimum blood glucose level 2 hours after a meal?
<10mmol/L
What advice can you give someone with T2DM?
Lifestyle interventions
CV risk reduction
When is HBA1C not an appropriate way of measuring diabetic control?
Young
Pregnant
T1DM
Diabetes symptoms <2 months
Medication causing a rapid rise in glucose such as steroids and antipsychotics
Acute pancreatic damage including surgery
Genetic and haematological factors
Describe treatment intensification for the management of T2DM
Initial drug therapy - Monotherapy - Non insulin blood glucose therapy
First intensification - Dual therapy - Non insulin blood glucose therapy
Second intensification - Triple therapy - Non insulin blood glucose therapy + any combination with insulin
Describe how muscle and fat affect the glucose level in T2DM
Insulin resistance
Describe how the pancreas affects the glucose level in T2DM
Beta cell dysfunction
Describe how the gut affects the glucose level in T2DM
Glucose absorption
Describe how the liver affects the glucose level in T2DM
Hepatic glucose overproduction
What T2DM drugs target the pancreas?
Sulfonylureas
Meglitinides
DPP4 inhibitors
GLP1 analogs
Which T2DM drugs target the liver?
Metformin
Thiazolidinediones
DPP4 inhibitors
GLP1 analogs
Which T2DM drugs target the gut
Alpha glucosidase inhibitors
GLP 1 analogs
Pramlintide
Which T2DM drugs target muscle and fat?
Thiazolidinediones
Metformin
Which is the most common first line treatment for T2DM?
Metformin
List the side effects of metformin
Anorexia, GI disturbance, metallic taste, metabolic acidosis, decreased vitamin B12 absorption
What happens to peoples weight as a result of metformin?
Remains neutral
Where does metformin target?
Liver and muscle
Where do sulfonylureas target?
Pancreas
Name some sulfonylureas
Glipizide Gliclazide Tolbutamide Glimepiride Glibenclamide
List the side effects of sulfonylureas
Hypos - inform DVLA
GI disturbance
Weight gain
Deranged LFTS
Where do thiazolidinediones act?
Liver
Pancreas
Fat cells
Muscle cells
Name a thiazolidinedione
Pioglitazone
What are thiazolidinediones associated with?
Increased risk of HF, bladder cancer and fractures
How long does it take thiazolidinediones to take full effect?
8 weeks
List the side effects of thiazolidinediones
GI disturbance Weight gain Oedema Hypoglycemia Altered lipids
When should you continue thiazolidinediones?
If there is a reduction of at least 0.5% HbA1c in 6 months
Name some glucagon like peptide 1 receptor agonists
Exenatide
Liraglutide
Lixisenatide
When do you continue GLP1 agonists?
If beneficial metabolic response in 6 months
How are GLP 1 agonists administered?
SC injection
Who should you be cautious of giving GLP1 agonists to?
Elderly and those with renal problems
What interactions should patients be aware of when taking GLP1 agonists
Take other medications 1 hour before or 2 hours after injections
List the side effects of GLP 1 agonists
GI disturbance Weight loss Hypoglycemia Pancreatitis AKI
Name some dipeptidyl peptidase 4 inhibitors
Alogliptin Linagliptin Saxagliptin Sitagliptin Vildagliptin
When should sitagliptin and vildagliptin be continued?
If reduction is at least 0.5% HbA1c in 6 months
What must you do when prescribing DPP4 inhibitors in liver and renal impairment?
Reduce the dose
List the side effects of DPP4 inhibitors?
GI disturbance
Peripheral oedema
Pancreatitis
Where are sodium glucose co transporter 2s located?
Proximal tubule
What percentage of filtrate is reabsorbed by SGLT2s
90%
Name some sodium glucose co transporter 2 inhibitors
Canagliflozin
Dapagliflozin
Empagliflozin
Describe the mechanism of action of SGLT2 inhibitors
Blocks lucose reabsortption in the proximal renal tubule
When should you be cautious of prescribing SGLT2 inhibitors
Volume depletion
CVD
Liver and renal impairment
List the side effects of SGLT2 inhibitors
GI disturbance
Dyslipidaemia
Urinary symptoms
Dehydration
Which SGLT2 inhibitor is not indicated with pioglitazone?
Dapagliflozin
Name an alpha glucosidase inhibitor
Acarbose
Describe the mechanism of action of alpha glucosidase inhibitors
Delays glucose absorption from the gut after a carbohydrate meal by blocking glucosidase in the small intestine
When should you avoid alpha glucosidase inhibitors
Renal and liver impairment
List the side effects of alpha glucosidase inhibitors
Nausea and vomiting
Diarrhoea
Flatulence
Hypos
What must you monitor when prescribing alpha glucosidase inhibitors
Liver
Name some meglitinides
Nateglinide
Repaglinide
Describe the mechanism of action of meglitinides
Stimulate insulin secretion in the presence of glucose
What is the main side effect of meglitinides
Hypoglycaemia (less so than SU)
GI disturbance
Name a biguanide
Metformin
Which drug is the only one that can be used to treat gestational diabetes?
Metformin
Describe the DVLA regulation on diabetes and driving
Must inform the DVLA
Insulin, Sulfonylureas, meglitinides
Test blood glucose a maximum of 2 hours before driving and every 2 hours during driving
