Insulin and Hypoglycaemics

Question 1

What drugs are included in Insulin and Hypoglycaemics?

Answer 1

• Parental Insulin
• Biguanides - metformin
• Thiazolidinediones (glitazones) - Pioglitazone
• Sulphonylureas - Glibenclamide, Tolbutamide.
• Prandial glucose regulators - Nateglinide
• Alpha Glucosidase Inhibitor - Acarbose
• DPP-4 inhibitors (Gliptins) - Sitagliptin, Vildagliptin
• SGLT2 inhibitors (flozins) - Dapagliflozin, Canagliflozin.

Question 2

Explain short-acting insulin (type 1 diabetes)

Answer 2

• Rapid onset; 30-60 mins
• Peak action - 2-4 hours
• Duration - 8 hours.
• Injecte just before, with or just after food and only lasts long enough for the meal at which it is taken.
• Insulin Aspart
• Insulin Glulisine
• Insulin Lispro

Question 3

Explain intermediate/long acting insulin (type 1 diabetes)

Answer 3

• Onset - 1-2 hours
• Peak action - 4-12 hours
• Duration - 16-35 hours.
• Insulin Determir
• Insulin Glargine
• Isophane insuline
• Insulin zinc suspension
• Protamine zinc insulin

Question 4

What are Biphasic Insulin Preparations? (type 1 diabetes)

Answer 4

• A mixture of intermetiate and fast-acting insulins.
• Rapid onset- long-lasting actions
• Biphasc Insulin Aspart
• Biphasic Insulin Lispro
• Biphasic Isophane Insulin

Question 5

What is glucagon therapy? (type 1 diabetes)

Answer 5

• Hyperglycaemia-inducing
• First-aid treatment for servere hypoglycaemia when oral glucose is not possible or desired.
• Route: IM, IV, SC.
• Must be reconstitutred prior to use.
• Acturely raises plasma glucose levels.
• Side effects - headache and nausea.

Question 6

How are Seratogogues I used to treat Type-2 Diabetes.

Answer 6

Boost insulin release; enhance the normal physiology of glcose-stimulated insulin secretion. Small molecule antagonists of the Katp channel. Oral (once or twice daily).

• Sulphonylureas - short acting (gliclazide** & **tolbutamide) long-lasting (chlorpropamide, glibenclamide, glipizide** & **glimepiride). Risk of hypoglycaemia.
• Meglitinides** - short acting (Repaglinide** & Nateglinide). Decreased risk of hypoglycaemia compared to SU’s.

Question 7

How are Seratogogues II used to treat Type-2 Diabetes?

Answer 7

• Incretin mimetics - boost insulin release by enhancing the normal physiology of incretin mediated insulin secretion.
• Peptide agonists of the GLP-1 receptor and not broken down by DPP-4.
• Exenatide** & **Liraglutide
• Injectable SC - combined with other therapies.
• Reduced risk of hypoglycaemia compared to SU’s
• Side Effects - GI disturbance (N+V), diarrhoea, dyspepsia, gastro-oesophageal reflux, decreased appetite, headache, dizziness, agitation, increased sweating.

Question 8

How are Seratogogues III used to treat Type-2 Diabetes?

Answer 8

• Incretin mimetic - same as seratogogues II
• Inhibitors of DDP-4, raises half life of serum GLP-1
• Can be combined with other meds.
• Sitagliptin** & **Vildogliptin
• Side Effects - GI upset (N+V+D), peripheral oedema, fatigue, increased respiratory tract infections, gastroenteritis, sinitus, nasopharyngitis.

Question 9

What hyperglycaemic therapies are used to treat Type-2 Diabetes?

Answer 9

• Small molecule antagonist of the Katp channel
• Diazoxide - Oral, given with chlorothiazide
• Side Effects -anorexia, N+V, hyperuricaemia, hypotension, oedema, tachycardia, arrhythmias.

Question 10

What are insulin sensitizers used in Type-2 Diabetes?

Answer 10

• Improve the sensitivity of organs to insulin.
• Act in dfferent ways
• Activating enzymes - Biguanides
• Modifying the transcription of genes- Thiazolidinediones

Question 11

How do biguanides work in the treatment of type-2 diabetes? (insulin sensitizers)

Answer 11

• Prevent hepatic production of glucose
• Overcomes insulin resistance by improving insuli sensitivity
• Metformin - children and teenagers up to 3x a day with or after a meal.
• No weight gain - good for patients with heart failure.
• Metformin-combinational therapies
• Pioglitazone
• Glipizide
• Glibenclamide
• Sitagliptin
• Repaglinide

Question 12

How do Thiazolidinediones work in the treatment of Type-2 Diabetes? (insulin sensitizers)

Answer 12

• Activates PPARy (a regulatory protein involved in the transcription of insulin-sensitive genes which regulate glucose and fat metabolism).
• Principle target > adipocytes.
• Rosiglitizone
• Pioglitazone

Question 13

What drugs are used to modify glucose breakdown? (Type 2 Diabetes, alpha glucosidase inhibitors)

Answer 13

• Acarbose prevents alpha-glucosidase converting oligosachcharides into glucose.
• Absorption of starchy foods is slowed, thereby slowing-down rises in the blood glucose following a meal.
• Side Effects - flatulence, NVD, abdominal pain, indigestion, liver function problems, oedema, blood disorders, allergic skin reactions.

Question 14

What drugs are used to enhance blood glucose? (Type-2 diabetes, SGLT2 inhibitors)

Answer 14

• SGLT2 (sodium-coupled glucose transporter) inhibitors cause excess glucose to be eliminated in the urine;reducing hyperglycaemia.
• Promotes weight loss, insulin independance, decreased risk of hypoglycaemia, osmotic diuresis reduces hypertension.
• Dapagliflozin
• Canagliflozin
• Empogliflozin

Question 15

Which of the following is an insulin-secretagogue used in the treatment of diabetes?

Answer 15

Glibenclamide

Question 16

Exenatide works by:

Answer 16

Activating the glucagon-like peptide 1 (GLP-1) receptor

Question 17

Which of the following is NOT a principal target for the actions of insulin?

Answer 17

The brain