Pharmacology diabetes 3 Flashcards
What are the isoforms of SGLT
SGLT1 and SGLT2
What do SGLT do in the body?
- help body absorb sugar
- 1 helps absorption in small intestines
- 2 helps absorption in proximal convoluted tubule of kidney
- inhibition of the SGLT2 will reduce renal threshold for glucose allowing excretion of more glucose so lowering plasma glucose levels
drug ending of SGLT2 inhibitors?
-gliflozin
When are SGLT2 contraindicated?
Patients with eGFR below 45mL/min
When are SGLT2 used?
- dual therapy with metformin
- good for weight loss
- also good in reducing risk of some adverse CV events
What are adverse effects of SGLT2?
- Polyuria
- more prone to UTI
- Ketoacidosis (can occur in type 2 which otherwise very unusual)
- Osteoporosis
- increased risk of amputation if have any lower limb complications e.g. ulcers
What drugs interact with SGLT2?
Drugs which are also hard on kidney:
- Diuretics
- ACE inhibitors
- NSAIDS
When is insulin used in type 2
- dual therapy along with metformin usually to reduce weight gain and lower CV risk
- also used in surgery and pregnancy (improve control and better outcomes)
- Renal disease (lots of oral agents contraindicated)
- allergy to oral agents
What form of insulin is used in type 2 diabetes?
- usually single daily dose of long intermediate acting insulin
- if need intensification than can take insulin along with food (bolus regime)
What other diabetes medications are contraindicated with insulin?
Sulfonylureas (too avoid hypoglycaemia as both very strong hypoglycaemic agents)
TZD (increased risk of heart failure)
When is Long-acting insulin analogue used over Human NPH insulin (First line)?
- lifestyle factors make more frequent injections inappropriate
- patient unable to inject there own insulin
- target HbA1c not reached
- significant hypoglycaemia is occurring with NPH insulin
What are the first, second and third line insulin forms?
First - Human NPH insulin
Second - Long acting insulin analogues
Third - Biphasic human insulin
What is the target of the thiazolidinediones?
Peroxisome Proliferator-activated receptors
- receptors found on adipose tissue, skeletal muscle and large intestines
What is the effect of thiazolidinediones on the cell?
substrate receptor complex binds to DNA promoting gene transcription of genes involved in insulin signalling, therefore increasing sensitivity of tissues to insulin
What is the overall effect of thiazolidinediones?
- reduces insulin resistance
- enhances uptake of glucose/fatty acids
- reducing blood glucose
