Insulin and oral diabetic agents Flashcards
type 1 diabetes pathophysiology
beta cell destruction
insulin deficient
type 2 diabetes pathophysiology
insulin resistant
beta cell dysfunction
treatment for type 1 diabetes
insulin
treatment for type 2 diabetes
antihyperglycaemic agents including insulin at later stages
what does metformin do overview
improves insulin resistance in skeletal muscle and liver through cAMP mechanism
what 3 organs does metformin act on
gut
liver
skeletal muscle
what does metformin do to the gut
prevents absorption of glucose
what does metformin do to the liver
inhibits glycogenolysis and inhibits gluconeogenesis
what does metformin do to skeletal muscle
enhances skeletal muscle glucose uptake
effect of metformin
HbA1c reduction 1%
what percentage of HbA1c is a marker of diabetes
> 6.5%
benefits of metformin (3)
weight neutral
no risk of hypoglycaemia
improves cardiovascular mortality
3 side effects of metformin
GI
Lactic acidosis
vitamin B12 deficiency
what is metformin taken with meals
GI side effects
what is sulphonylureas
insulin secretogogue (stimulates the release of insulin from beta cells)
2 types of sulphonylureas
Gliclazide
Glimepiride
side effects of sulphonylureas
weight gain
hypoglycemia
what do thiazolidinediones do
modulate the transcription of insulin sensitising genes
e.g of a thiazolidinedione
Glitazones
benefits of Glitazones
reduce HbA1c by 1%
no hypo risk
beta cell preservation?
side effect of Glitazones (3)
weight gain
oedema
bone fracture
What is the incretin effect
the increase in insulin release when glucose is given orally vs intravenously
2 incretin hormones
GLP-1
GIP
what is GLP-1
glucagon like peptide
what degrades GLP-1 and GIP rapidly
DPP-4 enzyme
where is GLP-1 released from
Intestinal L cells
what do incretins do in beta cells
stimulate beta cells to produce insulin in a glucose dependant manor
what does a glucose dependant manor mean
only stimulate the secretion of insulin if blood glucose is high
what do incretins do on alpha cells
decrease glucagon release
what organs do incretins act on
stomach
hypothalamus
pancreas
what is the incretin effects on the brain
reduces appetite
promotes satiety
incretins effect on the stomach
reduce gastric emptying
purpose of GLP-1 analogues
because GLP-1 gets degraded so quickly by DPP-4
e.g of GLP-1 analogue
liraglutide
positives of Liraglutide (any GLP-1 analogue)
Reduce HbA1-c
reduce weight
improves cardiovascular motility
side effects of GLP-1 analogues
GI
association of pancreatitis
what do DPP-4 inhibitors do
block the degradation of GLP-1
what do DPP-4 inhibitors end in
Gliptins
advantages of Gliptins (DPP-4 inhibitors)
reduce HbA1-c by 0.8%
weight neutral
oral preparation
side effects of Gliptins
mild GI
acute pancreatitis?
Increase respiratory infections
apart from diabetes what can cause blood glucose in the urine
familial renal glucosuria
what are the receptors in the kidneys that are Na/ glucose transporters
SGLT1
SGLT2
which receptor of the kidneys absorbs glucose
SGLT2
SGLT2 inhibitors end in
Gliflozin
benefits of SGLT2 inhibitors
no hypo risk
promotes weight loss
reduce cardiovascular risk
side effects of SGLT2 inhibitors
increased genitourinary infections
2 species of insulin
human
animal
2 types of animal insulin
pork
beef
types of insulin (4)
short acting
intermediate acting
Biphasic
Analogues
Facts about short acting insulin (4)
30 min onset
1-3 hours peak
duration up to 8 hours
e.g Humulin S
facts about long acting insulin
1.5 hours onset
peak 4-12 hours
up to 18 hrs duration
Humulin I
premixed insulin=
combination of short and intermediate acting insulin
another word for premixed insulin
biphasic
normal blood glucose range=
4-7mmol/l
what happens normally after BG absorption
insulin pulsed into hepatic portal vein from storage in the pancreas
in combined insulin what is the long acting for
to maintain levels of insulin throughout the day
in combined insulin what is the short acting for
for meals (peaks of glucose)
insulin side effects (3)
hypoglycaemia
allergic reactions
injection site problems
