Managing Diabetes/Diabetic Drugs Flashcards
What is the first line drug in T2 diabetes?
Metoformin
What is the MoA of metoformin?
Decreases hepatic glucose production
Increases insulin sensitivity
What diabetic drugs are weight neutral/loss?
What diabetic drugs cause weight gain?
Weight loss/neutral
- metformin
- SGLT2 inhibitors
- Incretin drugs (in part. GLP-1 receptor agonist)
Weight gain
- TZDs (pioglitazone)
- SUs
What drug class is associated with hypoglycaemia?
SUs
Both incretin drugs and SUs are insulin secretagogues, why do incretin drugs not carry the same risk of hypoglycaemia?
Incretin drugs use the amplifying pathway so are glucose dependant
SUs bind to the SUR1 of the ATP dependant K+ channels - glucose independent
What side effect is associated with DPP4 inhibitors?
Pancreatitis
How do DPP4 inhibitors work?
They inhibit DPP4 which breakdown GIP and GLP-1 (incretins) so with more of them in blood - amplified insulin secretion
Describe the incretin effect.
Where are the incretins released?
How is this affected in T2 diabetes?
Oral consumption of glucose leads to a greater increase of insulin due to incretins produced in the gut that amplify insulin secretion as they bind to their receptors on the pancreatic beta cell
GLP-1 - ileum
GIP - duodenum
(I before L, I released first in intestine)
In T2 diabetes this effect is greatly reduced
Match the following drug suffixes/prefixes/ drug names to their drug class
- flozin
- gliptin
- tide
- gliptin
- gli-…-ide
Empagliflozin semaglutide Alogliptin gliclazide Pioglitazone
- flozin (Empagliflozin) - SGLT2 inhibitors (think floz = flow = increase sugar in urine)
- gliptin (Alogliptin) = DPP4 inhibitors (P = dPP4)
- tide (semaglutide) = GLP-1 receptor agonist
- gli-…-ide (gliclazide) = SUs (glide into coma into coma = hypoglycaemia = worrying side effect)
Pioglitazone = TZD (zone = movement of fat from visceral to subcutaneous = move zone)
What drug is contradicted in older patients but allowed in young obese female in particular?
Pioglitazone
How many times a day should metformin be taken?
BD
What is the very common side effect of metformin?
Why is it contradicted in kidney disease?
GI upset
Can cause MALA (metformin assoc. lactic acidosis)
- important to test for eGFR and U&Es as a result
How do thiazolidinediones (TZDs) work?
(link to increase weight side effect)
Name the TZD used in the UK?
Bind and activate PRAR-gamma -> increase subcutaneous fat mass -> decreases visceral fat -> increase adiponectin -> increase insulin sensitivity
pioglitazone
What are the two classes of incretin drugs?
DPP4 inhibitors
GLP-1 receptor agonists
What drug is given via 1x weekly injection as opposed to tablets?
Semaglutide
How do SGLT2 inhibitors work?
Partially block SGLT2 in kidneys -> increase in blood sugar urine secretion -> decrease in blood glucose and kcals
Side effects of SGLT2 inhibitors?
Thrush
Polyuria and thirst
Fournier Gangrene - v rare but buzzword I feel
What drugs are protective for the heart post coronary syndrome?
- GLP-1Ra
- SLGT2i
What oral drug requires blood glucose monitoring?
SUs due to risk of hypo
What should all >50 T2 diabetic patients be started on for CV protection?
Statin
If there is proteinuria present on dipstick what does this mean?
Impaired renal function -> changes what drug might decide to use
What is the most important factor in diet when encouraging a patient to lose weight?
What specific components of the diet should be reduced/increased?
Maintenance to the diet
Increase fibre
Decrease fat
What categories of people should be assessed for their diabetic risk when in clinic using computer scoring methods?
- individuals >40
- ethnic minority groups 25-39
- individuals with conditions that raise risk of T2
T1 diabetics can undergo carbohydrate counting to adapt their insulin treatment to best suit them.
What are the 3 steps involved?
What is the name of the education programme which teaches how to do this?
- Identify carbohydrates (CHO)
- How much CHO is in each meal?
- What is my insulin:CHO ratio and apply this
DAFNE = dose adjustment for normal eating
Why are low GI diets no longer recommend for T1 diabetics?
There positive effect is so easily impacted by many variables e.g. how the food is cooked, what it is served alongside etc.
How are the following monogenic diabetic conditions managed?
- Neonatal
- MODY caused by defect in glucokinase
- MODY caused by defect in HNF-1alpha (transcription factor)
Neonatal - high dose SUs
MODY caused by glucokinase - no treatment at all
MODY caused by HNF-1alpha - low dose SUs
How do T1DM use insulin on a daily basis?
Long acting insulin - to maintain basal levels
Short acting insulin - taken 15 mins prior to each meal
How often should glucose levels be checked on IV insulin?
Once trasnferred from IV insulin back to SC, how many times should blood glucose be checked in the first 24hrs?
Hourly
4x
How is a patient transferred from IV insulin back to SC?
SC must be given at a suitable mealtime and IV is stopped an hour after this
When should SUs be taken?
20 mins before meal due to risk of hypo
What is the MoA of SUs?
Close K+/ATP channels on beta cells -> continual depolarisation
