Oral DM Medication & Insulin

Question 1

There are ____ main classes of insulin based on their absorption, what are they?

Answer 1

6

1. Ultrafast acting
2. Rapid acting
3. Short acting
4. Intermediate acting
5. Long acting
6. Very long acting

Question 2

What is the mechanism of action of insulin?

Answer 2

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

Question 3

When should ultrafast/rapid acting insulin be used relating to eating times?

What is the duration of such insulins?

Answer 3

Injected just before eating (5-15 minutes for onset)

Suration: 4-6 hours

Question 4

When should short acting insulin be used relating to eating times?

What is the duration of such insulins?

Answer 4

At least 15-30 minutes before eating

Need to inject several times a day

Duration: 8-10 hours

Question 5

When should intermediate acting insulin be used relating to eating times?

What is the duration of such insulins?

Answer 5

For injection between meals/afternoon/overnight to maintain a baseline level of insulin

Duration: 12-20 hours

Question 6

When should long and very long acting insulin be used relating to eating times?

What is the duration of such insulins?

Answer 6

These insulins keep a flat background profile

Duration: up to 24 hours

Question 7

Give some ADRs of insulin therapy

Answer 7

Hypoglycaemia

Hyperglycaemia

Painful injections

Allergies (to prep.)

NICE guidance: https://www.nice.org.uk/advice/ktt20/resources/safer-insulin-prescribing-pdf-58758006482629

Question 8

How do we treat Type 2 diabetes?

Answer 8

Lifestyle + non-insulin therapies

Question 9

What are the key challeneges for patients with T2 DM?

Answer 9

Risk (or perceived risk) of hypoglycaemia

Weight gain (from drugs used to managed DM)

= Poor adherence

Question 10

What is the general target HbA1c for TII diabetic patients?

Answer 10

6.5 - 7.5 %

Question 11

Name a drug from the biguanide class of antidiabetic agents

Answer 11

Metformin

Question 12

What is metformin’s mechanism of action?

Answer 12

Increased peripheral insulin sensitivity

Increased glucose uptake into and use by skeletal muscle

Decreased hepatic gluconeogenesis

Decreased intestinal glucose absorpttion

Question 13

What are the main side effects of metformin?

Answer 13

GI symptoms- nausea, diarrhoea, vommiting

Question 14

Name a drug from the sulponylurea class of antidiabetic agents

Answer 14

Glipizide

Question 15

Name a drug from the alpha-glucosidae inhibitor class of antidiabetic agents

Answer 15

Acarbose

Question 16

Name a drug from the glitazone class of antidiabetic agents

Answer 16

Pioglitazone

Question 17

Name two drugs from the incretin (metabolic hormone) class of antidiabetic agents

Answer 17

Exenatide (GLP-1 analogue)

Saxagliptin (DDP-4 inhibitor)

Question 18

How does glipizide work to reduce blood glucose levels?

Answer 18

Blocks K+ channels on beta cells of the pancreas to stimulate insulin release

Question 19

How does acarbose act to reduce blood glucose levels?

Answer 19

Inhibits alpha-glucosidase

Preventing the breakdown of carbohydrates to glucose

Question 20

What are the predictable side effects of acarbose?

Answer 20

Flatulence, loose stools and diarrhoea

Question 21

What is the mechanism of action of Pioglitazone in reducing blood glucose levels?

Answer 21

Activates PPARs to increase insulin sensitivity in muscle and adipose tissue

Reduces hepatic glucose output

Question 22

How do glucagon- like peptide 1 therapies reduce blood glucose concentrations?

Answer 22

increases insulin secretion from beta cells

Reduces production of glucagon from alpha cells

[Increased satiety reducing food intake]

Question 23

How do DDP-4 inhibitors (e.g. Sitagliptin) reduce blood glucose concentraions?

Answer 23

Inhibit DPP-4 activity which increases active GLP-1 concentrations