Insulin And Hypoglycaemics Flashcards
What do SGLT2 Inhibitors promote?
Glucose loss
Name two insulin sensitisers?
Thiazolidinediones
Biguanides
What do alpha glucosidase inhibitors delay?
Glucose absorption
What are three insulin secretagogues?
DPP4 inhibitors, GLP-1 receptor agonists, sulphonylureas/megtinides.
What are the 7 stages of cellular insulin release?
Glucose uptake Glucose metabolism Potassium channel opening Depolarisation Calcium channel opening Calcium influx Insulin release
What are six functional effects of insulin?
Increase conversion of glucose to glycogen
Increases the break down of amino acids to protein
Increases the breakdown of glucose to fat
Decreases gluconeogenesis
Decreases glycogen break down
Increases glucose and amino acid transport into cells
Where is glucagon released from?
Pancreatic alpha cells
Which hormones in the small intestine stimulate insulin release?
GLP 1
GIP
Which nerves in the small intestine stimulate insulin release?
Enteric
NS
Which is more effective oral or IV glucose?
Oral
What is impaired glucose regulation?
Pre diabetes (type 2)
Name 6 less common types of diabetes
Gestational diabetes
Transient neonatal diabetes
Permanent neonatal diabetes
Maturity onset diabetes of the young
Maternally inherited diabetes and deafness
Associated with syndromes - wolfram, alstrom…
What type of disease is DM Type 1?
An auto immune disease
What causes DM type 1?
Destruction and damage of beta cells
What are four risk factors of DM Type 2?
Obesity, family history, ageing, ethnicity
What are the two main complications of type 1 DM
?
Decreased insulin signalling
Elevated glucose
What are the three main complications of type 2 DM?
Elevated glucose
Elevated lipids
Insulin resistance
What are the broad treatment plans for type 1 DM?
Lifelong insulin, healthy diet, regular exercise.
What are the broad treatment palms for type 2 DM?
Lifestyle changes - weight, diet, activity.
Hypoglycaemic therapy and/or insulin.
Give three examples of short acting insulin
Insulin aspart
Insulin glulisine
Insulin lispro
When should you inject short acting insulin and how long does it take to work?
Before, with or just after food.
30-60 mins. Lasts 8 hours (peak 2-4)
Give five examples of intermediate/longer duration insulin
Insulin detemir Insulin glargine Insulin zinc suspension Isophane insulin Protamine zinc insulin
Where is zinc found?
Pamcreatic B cells
How often should insulin be injected?
Subcutaneous 3-4 times daily
Which insulin is a mixture of intermediate and fast acting drug and has a rapid onset with long - lasting actions?
Biphasic insulin preparations eg biphasic insulin aspart
When would you give glucagon therapy?
First aid treatment for severe hypoglycaemia when oral glucose is not possible
How do secretagogues work?
Close the potassium channel - boost insulin release by enhancing aspects of normal physiology of glucose stimulated insulin secretion.
Name two short acting sulphonylureas
Gliclazide and tolbutamide
Name two long acting sulphonylureas
Chlorpropamide
Gibenclamide
What do long acting sulphonylureas increase the risk of especially in the elderly?
Hypoglycaemia
What are the three types of secretagogues?
Sulphonylureas
Meglitinides
Diazoxides
Name two short acting megnitilides
Repaglinide
Nateglinide
What is diazoxide used to treat?
Congenital hyperinsulnism, insulinomas, transient hypoglycaemia.
What are the side effects of diazoxide?
Anorexia, nausea, vomiting, hyperuricaemia, hypotension, oedema, tachycardia, arrhythmias, extrapyramidal effects.
Name two GLP1 receptor agonists?
Exenatide
Liraglutide
Which enzyme rapidly breaks down GLP 1?
DPP4
What do DPP4 inhibitors do?
Preserve GLP 1 levels
Gilptins are a type of what?
DDP4 inhibitor
Name 3 gilptins
Sitagliptin
Vildagliptin
Saxagliptan
How do insulin sensitisers work?
Improve the sensitivity of target organs to insulin
How do biguanides work?
Activate enzymes - agonist of AMPK
Name a biguanide
Metformin
Metformin is also available in…
Combination
Give an example of a thiazolidnedione?
Rosiglitizone
Name an alpha glucosidase inhibitor
Acarbose