Hypoglycaemic Flashcards
Use of blood glucose…
energy
What is Glucosuria?
Elevated glucose levels saturate glucose reuptake mechanisms in kidney. Leads to osmotic diuresis, high thirst and urine production and dehydration.
Hyperglycaemia homeostasis…
Food intake/ glucose production > rise blood glucose > insulin release beta cells > insulin action, liver muscle adipocytes > lower blood glucose.
Hypoglycaemia homeostasis…
Fasting > fall in blood glucose > glucagon release alpha cells > raise blood glucose.
Pancreatic islets of langerhans…
1-2% human pancreas mass. Alpha cells - release glucagon Beta cells - release insulin O cells - release somatostatin E cells - release gherkin PP cells - release pancreatic polypeptide.
Glucose stimulated insulin release…
Molecules closing K channel mimic actions of glucose trading hyperglycaemia.
Molecules opening K channel inhibit action of glucose treating hypoglycaemia.
Role of insulin…
Uptake, storage and utilisation of glucose.
Protein/Triglyceride synthesis.
Gene expression/growth.
Decreases proteolysis, lipolysis and lipid oxidation.
T1DM…
Autoimmune destruction of Bcell producing insulin. Detected by anti-islet antibodies presence.
Starts in childhood.
T2DM…
tissues insensitive to insulin, decrease of absence of glucose, high concentration of insulin.
Risk factors; age, obesity, ethnicity, genes and polygenic disorder.
Aims of diabetic treatment…
Achieve normoglycemia, return BP/cholesterol to normal and adopt a healthy lifestyle.
Insulin Therapy (T1)…
Insulin apart / glusine/ lisper = Given 30-60 minute of onset to last 8 hours, injected with food.
Isoprene insulin = lasting 16-35 hours.
Protamine Zinc / Biphasic insulin = long lasting.
Glucagon Therapy (T1)…
For severe hypoglycaemia.
Reconstituted prior to use.
Acutely raises plasma glucose to promote glycogenolysis, gluconeogenesis and lipolysis.
Hypoglycaemic Therapy (T2)….
Oral/injectable peptide agents that stimulate Bcell release to improve insulin sensitivity and slow rate of glucose absorption.
Secretagogues I (T2)…
Boost insulin release and enhance normal physiology of glucose stimulated insulin secretion.
Examples of Secretagogues I…
Sulphonylureas -Small molecule antagonists of K channel.
Gliclazide / Diamicron / Tolbutamide / Orinase / meglintides - short acting.
Chlorpropamide / Diabinese / Glibenclamide/ Glipizide / Glucotrol / Glimepride / Amaryl - long lasting.
Secretagogues II (T2) Incretin Mimetics…
Eventide / Liraglutide / Byetta / Victoze. Injectable.
GLP-1 breakdown by DPP4
Side Effects of Secretagogues II…
GI disturbance, N&V, diarrhoea, dyspepsia, abode pain, distention, gastro-eoso reflux, loss appetite, headache, dizziness, agitation, asthenia, sweating, antibody formation.
Secretagogues III…
Glistens, Sitagliptin and Bildagliptin.
Side effects of Secretagogues III…
Vomit, dyspepsia, gastritis, peripheral oedema, headache, dizziness, fatigue, uti, upper resp infection, gastroenteritis, sinusitis, nasopharyngitis, hypoglycaemia, myalgia, cyslipiaemia, hypertpolyeridaemia, erectile dysfunction, arthralgia, rashes.
Mechanism of Diazoxide…
Treats congenital hyperinsulinism in infancy, insulinomas and severe transient hypoglycaemia.
Small molecule agonist of K channel.
Side effects of Diazoxide…
Anorexia, N&V, hyperuricaemia, hypotension, oedema, tachycardia, arrhythmia, extrapyramidal effects, hypertrichosis.
Mechanism of Insulin sensitisers…
Improve sensitivity of target organs to insulin.
Examples of Insulin sensitisers…
Biguanides (Proglitazone, Glipzide, Glibenclamide, Sitagliptin) = prevent hepatic production of glucose and overcome insulin resistance by increasing sensitivity.
Thiazolidinediones/Glitazones - activate PPARy protein in insulin sensitive gene transcription to regulate glucose/fat metabolism.
Mechanism of A-Glucodase inhibitors…
Concert oligosaccharides to glucose.
Acarbose inhibits this slowing absorption of starch and blood glucose rise.
Examples of A-Glucodase inhibitors…
Acarbose and Glucobay
Side effects of A-Glucodase inhibitors…
flatulence, diarrhoea, abode pain, N&V, indigestion, liver function problems, oedema, blood disorders, allergic skin reactions, intestinal problems.
SGLT2 inhibitor action…
Glucose reabsorption, eliminating excess glucose from urine = weight loss an osmotic diuresis to reduce hypertension.
Examples of SGLT2 inhibitors…
Dapaglifozin, Canaglifozin and Empaglifozin.
