Oral DM Medication & Insulin Flashcards
There are ____ main classes of insulin based on their absorption, what are they?
6
- Ultrafast acting
- Rapid acting
- Short acting
- Intermediate acting
- Long acting
- Very long acting
What is the mechanism of action of insulin?
Binds tyrosine kinase receptors where it inititates 2 pathways:
- MAP kinase: cell growth and proliferation
- PI-3K pathway: transport of GLUT4 receptors to cell surface membrane, transport glucose into cells
When should ultrafast/rapid acting insulin be used relating to eating times?
What is the duration of such insulins?
Injected just before eating (5-15 minutes for onset)
Suration: 4-6 hours
When should short acting insulin be used relating to eating times?
What is the duration of such insulins?
At least 15-30 minutes before eating
Need to inject several times a day
Duration: 8-10 hours
When should intermediate acting insulin be used relating to eating times?
What is the duration of such insulins?
For injection between meals/afternoon/overnight to maintain a baseline level of insulin
Duration: 12-20 hours
When should long and very long acting insulin be used relating to eating times?
What is the duration of such insulins?
These insulins keep a flat background profile
Duration: up to 24 hours
Give some ADRs of insulin therapy
Hypoglycaemia
Hyperglycaemia
Painful injections
Allergies (to prep.)
NICE guidance: https://www.nice.org.uk/advice/ktt20/resources/safer-insulin-prescribing-pdf-58758006482629
How do we treat Type 2 diabetes?
Lifestyle + non-insulin therapies
What are the key challeneges for patients with T2 DM?
Risk (or perceived risk) of hypoglycaemia
Weight gain (from drugs used to managed DM)
= Poor adherence
What is the general target HbA1c for TII diabetic patients?
6.5 - 7.5 %
Name a drug from the biguanide class of antidiabetic agents
Metformin
What is metformin’s mechanism of action?
Increased peripheral insulin sensitivity
Increased glucose uptake into and use by skeletal muscle
Decreased hepatic gluconeogenesis
Decreased intestinal glucose absorpttion
What are the main side effects of metformin?
GI symptoms- nausea, diarrhoea, vommiting
Name a drug from the sulponylurea class of antidiabetic agents
Glipizide
Name a drug from the alpha-glucosidae inhibitor class of antidiabetic agents
Acarbose
Name a drug from the glitazone class of antidiabetic agents
Pioglitazone
Name two drugs from the incretin (metabolic hormone) class of antidiabetic agents
Exenatide (GLP-1 analogue)
Saxagliptin (DDP-4 inhibitor)
How does glipizide work to reduce blood glucose levels?
Blocks K+ channels on beta cells of the pancreas to stimulate insulin release
How does acarbose act to reduce blood glucose levels?
Inhibits alpha-glucosidase
Preventing the breakdown of carbohydrates to glucose
What are the predictable side effects of acarbose?
Flatulence, loose stools and diarrhoea
What is the mechanism of action of Pioglitazone in reducing blood glucose levels?
Activates PPARs to increase insulin sensitivity in muscle and adipose tissue
Reduces hepatic glucose output
How do glucagon- like peptide 1 therapies reduce blood glucose concentrations?
increases insulin secretion from beta cells
Reduces production of glucagon from alpha cells
[Increased satiety reducing food intake]
How do DDP-4 inhibitors (e.g. Sitagliptin) reduce blood glucose concentraions?
Inhibit DPP-4 activity which increases active GLP-1 concentrations
