insulin and hypoglycaemics Flashcards
name 4 types of parenteral insulin
short duration intermediate
long lasting
mixed intermediate and fast action
name 3 short duration insulins, what is their time of onset and duration?
insulin aspart insulin glulisine insulin lispro onset - 30-60 mins duration 3hrs
name an intermediate insulin
isophene insulin
name 4 long lasting insulins, what is their time of onset and duration?
insulin detemir insulin glargaine insulin zinc suspension protamine zinc insulin onset: 1-2hrs peak: 4-12hrs duration: 16-35hrs
name 3 mixed intermediate and fast acting insulins
biphasic insulin aspart
biphasic insulin lispro
biphasic isophene insulin
name the 7 classes of hypoglycaemic therapies used in type 2 diabetes
K ATP channel inhibitors GLP-1 receptor agonists DDP-4 inhibitors biguanides (insulin sensitizer) thiazolidinediones alpha -glucoside inhibitors SGLT2 inhibitors
name two types of K ATP channel inhibitors
Sulponylureas
meglitinides
name 2 short acting sulponylureas
gliclazide
tolbutamide
name 4 long lasting sulponylureas
chlorpropamide
glibenclamide
glipizide
glimepiride
name 2 meglitinides
repaglinide
nateglinide
what is the mechanism of action of K ATP channel inhibitors?
- small molecule antagonist of K atp channels
boost release of insulin; enhance normal physiology of glucose-stimulated insulin release
(mimic action of glucose)
what is the mechanism of action of GLP-1 receptor agonists
peptide agonist of GLP-1
increasing GLP-1 serum levels which release increatin hormones thus boosting insulin release
(increatin mimetic)
why can GLP-1 not be used to increase GLP-1 serum levels?
it is broken down by endogenous enzyme DPP-4
name 2 GLP-1 receptor agonists
exenatide
liraglutide
name 2 DPP-4 inhibitors
sitagliptin
vildagliptin
what is the mechanism of action of DPP-4 inhibitors?
inhibits enzyme DPP-4 which breaks down GLP-1, thus increasing GLP-1 serum levels and promoting insulin release
(incretin mimetic)
what are the side effects of DPP-4 inhibitors?
vomiting dyspepsia gastritis oedema headache dizziness fatigue upper resp. infection UTI gastroenteritis
name a biguanide (insulin sensitizer)
metformin
what is the mechanism of action of biguanides?
agonist of AMP -activated protein kinase (AMPK)
prevents hepatic production of glucose
overcomes insulin resistance by improving insulin sensitivity
name 2 types of insulin sensitizer
biguanides
thiazolindinediones
name 3 thiazolindinediones (insulin sensitizers)
pioglitazone
rosiglitazone
glimepiride
describe the mechanism of action of thiazolindinediones
activates PPARy (a regulatory protein involved in transcription of insulin-sensitive genes which regulate glucose and metabolism)
what is the main target of thiazolindinediones?
adipose tissue
name an alpha - glycosidase inhibitor
acarbose
describe the mechanism of action of acarbose
(alpha-glucosidase concerts oligosaccharides to glucose)
by inhibiting alpha-glucosidase absorption of starchy food is slowed down (slowing rise in blood glucose)
provides closer alignment of insulin output and glucose intake
what are the side effects of acarbose?
flatulence diahorrea abdo pain N & V indigestion liver func. impairment
name 3 SGLT2 inhibitors
dapagliflozin
canagliflozin
empagliflozin
what is the mechanism of action of SGLT2 inhibitors?
SGLT2 (sodium-coupled glucose transporter) - glucose reabsorption
SGLT2 inhibitors cause excess glucose to be eliminated in urine; reducing hyperglycaemia
what are the advantages of using SGLT2 inhibitors?
weight loss
insulin independent
low risk of hypoglycaemia
reduced hypertension
