Pharmacology & Exercise for Diabetes Flashcards
insulin therapy in Type 1 diabetes - 2 options
basal-bolus injection therapy or continuous subcutaneous insulin infusion
basal-bolus injection therapy
this is considered intensive therapy - bc requires at least 3-5 injections and is the co=losest to our bodies physiological response
bolus insulin at meal times and basal injection once or twice daily
- covers insulin requires fro meal
continuous subcutaneous insulin infusion
insulin pump therapy via catheter into subcutaneous tissue
- covers insulin need throughout the day and into the night- this is also considered intensive therapy
what is conventional therapy?
more commonly used in elderly and less educated patients and it is limited to 2 injections a day
why is basal insulin important?
bc our normal physiological response is never at zero - insulin has a base level - need to maintain this in therapy
why is bolus insulin important?
to cover the glucose bumps after meals
human basal injection
requires one injection/day in the morning
- it reaches basal insulin levels higher than required and has a slow release which will peak around lunch time, then reaches normal physiological peaks later in the day
analogue basal insulin
this is better formulated than the human basal insulin bc it maintains basal levels closer to normal physiological levels and avoids a peak in the middle of the day
human bolus
3 injections per day
- inject right before meal, and peak will be slightly delayed
analogue bolus
3 injection per day
- better pairing with blood glucose compared to human bolus
conventional therapy
not recommended or preferred treatment
- premixed insulin ( mis of long and short actin insulin with different ratios)
human vs analogue premixed insulin
human will partially cover break, lunch and dinner
analogue will cover quite well breakfast and dinner but skip lunch almost entirely ( risks of hypo and hyper)
types of bolus insulin
rapid acting (Lispo/humalog) and short acting (regular/ humulin)
types of basal insulin
intermediate acting ( NPH?humulin) long acting (Glargine/Lantus)
premixed
30 % reg / 70% NPH
considerations for conventional insulin therapy
strict meal plan, consistent meals day to day, PA may lead to hypoglycemia
intensive therapy considerations
more flexible with mea timing - MUST learn carb counting - dose may be adjusted for exercise -alwasys preferred over conventional -
why is intensive therapy better?
DCCT study showed that intensive sharply declined A1C, whereas conventional remained high (8.5%)
also reduced the risk of non-fatal MI, stoke and health from CVD (60% decrease- this is HUGE)
Metformin (glucophage) mechanism
first line medication for diabetes
- has 2 actions:
1. in liver- decrease gluconeogeneis
2. increase insulin sensitivity
other benefits of metformin
known safety, no hypoglycaemia, weight management, few side effects
what are side effects
mostly just GI , B12 and folate must be monitored annually!
contraindications for metaformin
renal insufficiency, liver or heart failure
Alpha-glucosidase inhibitors mechanism
in the intestine to delay intestine glucose absorption (must be taken with meals)
insulin secretagogues
will stimulate the secretion of insulin - short acting 4-7 hours or long lasting - once daily
side effects in insulin secretagogues
hypoglycemia
Incretins mimetics
- not pills, injectables
- stimulates insulin release and reduces glucagon secretion
- delays gastric emptying
mechanism of incretin mimetics (DPP-4 inhibitors)
normally when GLP-1 is released into circulation it gets degraded by DPP-4 enzyme through neg feedback. DPP-4 inhibitors block this and extend the life of GLP-1
mechanism of GLP-1 agonist (incretins memitics)
will enhance the action of GLP-1 on the receptor
- GLP-1 acts on the hypothalamus (regular satiety)
- stimulates insulin release, inhibit glucagon, slow gastric emptying and increase satiety = better weight control
Thia-zo-lidined-iones
increase insulin sensitivity in peripheral tissues and liver
SGLT2 inhibitors mechanims
block glucose transport on the proximal renal tubule so glucose cannot be reabsorbed back into the blood- gets excited - glycosuria = lower mood glucose and lower weight
side effects of SGLT2 inhibitors
dehydration ( lots of water loss and sodium loss) this is how SGLT2 also help control HPT
- risk of UTI, genital infections, hypotension, more risk of keto acidosis
some more advantages of SLGT2 inhibitors
raise HDL, lower BP and rare hypoglycemia
what are symptoms of hyperglycemia
polydipsia and polyuria and/or metabolic decompensation
what is the goal of treatment
normalize A1C levels
can insulin increase BW, why?
yes bc since we are injecting insulin into subcataneous tissue we need to inject greater levels than what is actually required endogenously–> this may lead to weight gain and risk of hypoglycemia
TZD lead to weight gain?
yes bc increase insulin sensitivity, intake glucose, lipid and proteins
why is it important to consider wight gain or loss in medications?
need to inform patient and need to monitor dietary patterns as further weight gain may be harmful
insulin secretagogues should avoid?
alcohol 9 bc mask the symptoms of hypoglycaemia)
pharmacotherapy for HPT in patients with diabetes considerations
- check potassium and creatinine at baseline within 1 to 2 weeks of initiation
- combination of agents that block RAAS should not be used
- more than 3 drugs may be needed to reach target values for patients with diabetes
which diabetic patients should receive statins?
- CVD
- ages greater than 40
- DM for more than 15 yrs
