Management of Diabetes Flashcards
What the mechanism of action of Sulphonylureas
Binds to sulfonylurea receptors (SUR-1) on functioning pancreatic beta-cells.
Binding closes the linked ATP-sensitive potassium channels
Decreased potassium influx depolarization of the beta-cell membrane.
Voltage-dependent calcium channels open and result in an influx of calcium
Translocation and exocytosis of secretory granules of insulin to the cell surface
How often do you take glimepiride
once daily
What is metformins action
Metformin works by improving insulin action which then lowers blood glucose because the insulin works more effectively
What drug is first line treatment for diabetes
Metformin
What two GLP analogues have cardiovascular benefit
Liraglutide and semaglutide
What are the Dis-advantages of Pioglitazone
Increase risk of bladder cancer - Caution in those of increased risk bladder cancer (Age, industry etc) Fluid retention - CCF Weight gain Fractures in females
What is a THIAZOLIDINEDIONE
Pioglitazone
What is the dose of glimepiride
1-6mg
What is the mechanism of action of Pioglitazone
Selectively stimulates thenuclear receptorperoxisome proliferator-activated receptor gamma (PPAR-gamma) and to a lesser extentPPAR - alpha
Modulates the transcription of theinsulin-sensitive genes involved in the control of glucose andlipid metabolismin themuscle,adipose tissue, and theliver.
Reduces insulin resistancein the liver and peripheral tissues;
increases the expense of insulin-dependent glucose;
Decreases withdrawal of glucose from the liver;
Reduces quantity of glucose, insulin andglycated haemoglobinin the bloodstream.
Are Sulphonylurea’s used as first line treatment?
No - Metformin is
How long does it take for the effect of metformin to start
Effect is quick but usually optimal after 2-3 weeks
What are Dis-advantages of gliflozins
Expensive SE: - UTI, fungal infections, osmotic symptoms Risk of digital amputation Glucoseuria – Gluocse in urine Risk of DKA CI in pregnancy and breastfeeding. Cannot use in renal impairment
Whats the mechanism of action for DPP IV inhibitors
They delay the breakdown of incretins by DPP-4 and thereby increase active incretin levels
What are advantages of Sulphonylureas
Used with metformin Rapid improvement in control Rapid improvement if symptomatic Rapid titration Cheap - Gliclazide 160mg bd £3.30 X1.4 - Glimepiride 6mg od £1.72 x0.7 Generally well tolerated
What are Dis-advantages of GLP analogues
Injection
Expensive
Contra Indicated in pregnancy and breastfeeding.
Nausea, vomiting
Where are Sulphonylureas metabolised
liver
Whats the mechanism of action of GLP-1 Analogues
work similar to bodies normal GLP BUT:
resistant to enzymatic degradation
greatly prolonged biological half-life
How are GLP-1 analogues taken
Most are subcutaneous
What are incretins and what do they do
Incretinsare a group of metabolic hormones that stimulate a decrease in blood glucose levels and are released after eating.
They augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism.
What are the DPP IV-inhibitors
Saxagliptin,
Sitagliptin,
Vildagliptin
Alogliptin
What are the Sulphonylurea
Gliclazide
Glimepiride
Glipizide
What are side effects of GLP-1 analogues
People can get nausea but others can get early satiety (helpful with people who eat lots of shite)
What are dis-advantages of Sulphonylureas
Risk of hypoglycaemia Weight gain Caution in renal and hepatic disease CI in pregnancy and breastfeeding. SE include - Hypersensitivity and photosensitivity reactions - Blood disorders
What does Pioglitazone do
It increases insulin sensitivity and decreases liver production of glucose
