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Met3b > Insulin and hypoglycaemic agents > Flashcards

Insulin and hypoglycaemic agents Flashcards

1
Q

What blood glucose level should a diabetic patient be aiming for pre- and post-prandial?

A

Pre-prandial: ~4-7 mmol/L

Post-prandial: ~5-9 mmol/L

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2
Q

What is the MOA of Metformin?

A
  • Increases insulin sensitivity
  • Decreases hepatic gluconeogenesis
  • 1st line in T2DM
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3
Q

When should Metformin be offered to patients?

A

If HbA1c continues to rise ot 48 mmol/mol (6.5%) on lifestyle interventions

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4
Q

What are the potential side effects of Metformin? When is Metformin contraindicated?

A

Side effects:

  • GI upset
  • Lactic acidosis

Contraindication:
- Patients with an eGFR <30 ml/min

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5
Q

What is the MOA of sulfonylureas?

A
  • Stimulate pancreatic B cells to secrete insulin
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6
Q

When are sulfonylureas indicated in the management of T2DM?

A

If HbA1c has risen to 58 mmol/mol (7.5%) then a second drug (along with metformin) should be added
- sulfonylureas are one of those drugs

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7
Q

Give examples of sulfonylureas.

A

Gliclazide and glimepiride

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8
Q

What are the potential side effects of sulfonylureas?

A
  • Hypoglycaemia
  • Weight gain
  • Hyponatraemia
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9
Q

What is the MOA of Thiazolidinediones?

A
  • Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake
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10
Q

When are thiazolidediones indicated?

A
  • Can be used as 2nd line, in combination with metformin

- Can be used in triple therapy with metformin + sulfonylurea/SGLT2 inhibitor

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11
Q

What are the potential side effects of thiazolidinediones? When are they contraindicated?

A

Side effects:

  • weight gain
  • fluid retention
  • increased risk of bladder cancer
  • liver impairment

Contraindicated in heart failure

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12
Q

What is the MOA of DPP-4 inhibitors/gliptins?

A
  • Increase incretin levels which inhibits glucagon secretion
  • Inihibtion of glucagon promotes insulin secretion
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13
Q

When are DPP-4 inhibitors indicated?

A
  • Can be used 2nd line, in combination with metformin

- Can be used in triple therapy with metformin + sulfonylurea

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14
Q

What are the potential side effects of gliptins?

A
  • increased risk of pancreatitis (but generally well tolerated)
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15
Q

What is the MOA of SGLT2-inhibitors?

A
  • Inhibits reabsorption of glucose in the kidneys

- Excess glucose excreted via the urine

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16
Q

When are SGLT2-inhibitors indicated?

A
  • Can be used 2nd line, in combination with metformin

- Can be used in triple therapy with metformin + sulfonylurea/thiazolidinediones

17
Q

What are the potential side effects of SGLT-2 inhibitors?

A
  • UTI (increased glucose in urine)
  • Normoglycaemia (if pt’s body becomes used to hyperglycaemia, normoglycaemia may be interpreted as hypoglycaemia)
  • Ketoacidosis
  • Increased risk of LEA

*Typically will result in weight loss

18
Q

What is the MOA of GLP-1 agonists?

A
  • Incretin mimetic whcih inhibits glucagon secretion
19
Q

When are GLP1 agonists/mimetics indicated?

A
  • If triple therapy is not effective, not tolerated, or contraindicated
  • Use in combination with metformin + sulfonylureas
  • if:
    (i) BMI ≥35 + specific psychological/medical problems associated with obesity
    (ii) BMI <35 + insulin would have significant occupational implications
    (iii) weight loss would benefit other significant obesity-related comorbidities
20
Q

What are the potential side effects of GLP-1 agonists?

A
  • N+V

- Pancreatitis

21
Q

What are the indications for insulin therapy in T2DM?

A
  • inadequate glycaemic control
  • contraindications to tablets
  • symptomatic hyperglycaemia
  • pregnancy
  • infection/foot ulcers
22
Q

Describe the different types of insulin available.

A
  1. Human insulin
    - short acting (Humulin S)
    - intermediate (Humulin I)
    - biphasic → mixture of short + intermediate (Humulin M3)
  2. Analogue insulin
    - rapid acting (Novorapid, Lispro)
    - long acting (basal insulin → Lantus, Levemir)
    - biphasic (Novomix 30)
23
Q

List the sites whwre insulin can be injected from fastest to slowest absorption.

A

Abdomen
Thighs
Buttocks

24
Q

Describe the once-daily insulin regime.

A
  • once daily intermediate or lnog acting insulin, given in addition to tablets
  • usually given before bed, or first thing in the morning
25
Q

Describe the twice daily insulin regime.

A
  • contains basal and shorting-acting component

- given once before breakfast, and again before dinner

26
Q

Describe the basal-bolus insulin regime.

A
  • 3 injections of rapid acting, 1 injectin of long acting
  • mimics norma physiology
  • 3 rapid acting given before each meal
  • long-acting given at bed-time
27
Q

What are the potential side effects of insulin therapy?

A
  • hypoglycaemia

- diobulimia

Met3b (21 decks)

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