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Block 8 Ellen > Insulin and oral diabetic agents > Flashcards

Insulin and oral diabetic agents Flashcards

1
Q

type 1 diabetes pathophysiology

A

beta cell destruction

insulin deficient

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2
Q

type 2 diabetes pathophysiology

A

insulin resistant

beta cell dysfunction

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3
Q

treatment for type 1 diabetes

A

insulin

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4
Q

treatment for type 2 diabetes

A

antihyperglycaemic agents including insulin at later stages

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5
Q

what does metformin do overview

A

improves insulin resistance in skeletal muscle and liver through cAMP mechanism

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6
Q

what 3 organs does metformin act on

A

gut
liver
skeletal muscle

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7
Q

what does metformin do to the gut

A

prevents absorption of glucose

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8
Q

what does metformin do to the liver

A

inhibits glycogenolysis and inhibits gluconeogenesis

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9
Q

what does metformin do to skeletal muscle

A

enhances skeletal muscle glucose uptake

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10
Q

effect of metformin

A

HbA1c reduction 1%

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11
Q

what percentage of HbA1c is a marker of diabetes

A

> 6.5%

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12
Q

benefits of metformin (3)

A

weight neutral
no risk of hypoglycaemia
improves cardiovascular mortality

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13
Q

3 side effects of metformin

A

GI
Lactic acidosis
vitamin B12 deficiency

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14
Q

what is metformin taken with meals

A

GI side effects

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15
Q

what is sulphonylureas

A

insulin secretogogue (stimulates the release of insulin from beta cells)

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16
Q

2 types of sulphonylureas

A

Gliclazide

Glimepiride

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17
Q

side effects of sulphonylureas

A

weight gain

hypoglycemia

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18
Q

what do thiazolidinediones do

A

modulate the transcription of insulin sensitising genes

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19
Q

e.g of a thiazolidinedione

A

Glitazones

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20
Q

benefits of Glitazones

A

reduce HbA1c by 1%
no hypo risk
beta cell preservation?

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21
Q

side effect of Glitazones (3)

A

weight gain
oedema
bone fracture

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22
Q

What is the incretin effect

A

the increase in insulin release when glucose is given orally vs intravenously

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23
Q

2 incretin hormones

A

GLP-1

GIP

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24
Q

what is GLP-1

A

glucagon like peptide

25
Q

what degrades GLP-1 and GIP rapidly

A

DPP-4 enzyme

26
Q

where is GLP-1 released from

A

Intestinal L cells

27
Q

what do incretins do in beta cells

A

stimulate beta cells to produce insulin in a glucose dependant manor

28
Q

what does a glucose dependant manor mean

A

only stimulate the secretion of insulin if blood glucose is high

29
Q

what do incretins do on alpha cells

A

decrease glucagon release

30
Q

what organs do incretins act on

A

stomach
hypothalamus
pancreas

31
Q

what is the incretin effects on the brain

A

reduces appetite

promotes satiety

32
Q

incretins effect on the stomach

A

reduce gastric emptying

33
Q

purpose of GLP-1 analogues

A

because GLP-1 gets degraded so quickly by DPP-4

34
Q

e.g of GLP-1 analogue

A

liraglutide

35
Q

positives of Liraglutide (any GLP-1 analogue)

A

Reduce HbA1-c
reduce weight
improves cardiovascular motility

36
Q

side effects of GLP-1 analogues

A

GI

association of pancreatitis

37
Q

what do DPP-4 inhibitors do

A

block the degradation of GLP-1

38
Q

what do DPP-4 inhibitors end in

A

Gliptins

39
Q

advantages of Gliptins (DPP-4 inhibitors)

A

reduce HbA1-c by 0.8%
weight neutral
oral preparation

40
Q

side effects of Gliptins

A

mild GI
acute pancreatitis?
Increase respiratory infections

41
Q

apart from diabetes what can cause blood glucose in the urine

A

familial renal glucosuria

42
Q

what are the receptors in the kidneys that are Na/ glucose transporters

A

SGLT1

SGLT2

43
Q

which receptor of the kidneys absorbs glucose

A

SGLT2

44
Q

SGLT2 inhibitors end in

A

Gliflozin

45
Q

benefits of SGLT2 inhibitors

A

no hypo risk
promotes weight loss
reduce cardiovascular risk

46
Q

side effects of SGLT2 inhibitors

A

increased genitourinary infections

47
Q

2 species of insulin

A

human

animal

48
Q

2 types of animal insulin

A

pork

beef

49
Q

types of insulin (4)

A

short acting
intermediate acting
Biphasic
Analogues

50
Q

Facts about short acting insulin (4)

A

30 min onset
1-3 hours peak
duration up to 8 hours
e.g Humulin S

51
Q

facts about long acting insulin

A

1.5 hours onset
peak 4-12 hours
up to 18 hrs duration
Humulin I

52
Q

premixed insulin=

A

combination of short and intermediate acting insulin

53
Q

another word for premixed insulin

A

biphasic

54
Q

normal blood glucose range=

A

4-7mmol/l

55
Q

what happens normally after BG absorption

A

insulin pulsed into hepatic portal vein from storage in the pancreas

56
Q

in combined insulin what is the long acting for

A

to maintain levels of insulin throughout the day

57
Q

in combined insulin what is the short acting for

A

for meals (peaks of glucose)

58
Q

insulin side effects (3)

A

hypoglycaemia
allergic reactions
injection site problems

Block 8 Ellen (14 decks)

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