Pharmacology of Diabetes Flashcards
What are the treatments for T1DM?
insulin injection, islet transplants
gene therapy
When is insulin used?
T1DM life saving
gestational
What is the risk with insulin injections?
patients may give themselves too much
What is the v.short acting insulin?
lispro
What is the short acting insulin?
regular
What in the intermediate acting insulins?
NPH and lente
What is the long acting insulin?
ultra lente
What is the ultra long acting insulin?
glargine
What is significant about lispro?
lysine B28
proline B29
must be used in combination with long acting
What is significant about glargine?
glycine A 21
2 arginine on the end of B
single bedtime dose
Why is transplant and stem cells not appropriate therapy?
needs 3 donors per person and costs a lot
body would probably attack new beta cells
What are the treatments for T2DM?
Incretins Sulfonylureas Glitazones Biguanides a-glucosidase inhibitors DIET and EXERCISE
How does metformin work?
insulin sensitiser
biguanide
activates AMPK
inhibits glucose production and increases uptake by liver
What is good about metformin?
reduces the risk of MIs and increases survival
it doesnt cause hypo
antihyperinsulinemic
What is the problem with metformin?
only works in about 50% cases
small amount of people causes lactic acidoses
not pleasant to take - intestinal problems
resistance occurs after a few years
combination therapy is common
How do sulfonylureas work?
stimulate insulin secretion from pancreatic islets
regulate K-ATP channels by binding to SUR proteins
What are the problems with sulfonylureas?
relatively expensive
danger of hypoglycemia
weight gain
How do glitazones work?
bind PPAR y transcription factor and regulate genes involved in lipid and carbohydrate metabolism
induce glucose uptake in fat, liver and muscle cells
What are the problems with glitazones?
very expensive
some weight gain
gives some patients edema
often used with SURs so hypoglycaemia is a risk
What are the problems with glitazones?
very expensive
some weight gain
gives some patients edema
often used with SURs so hypoglycaemia is a risk
What is a-carbarose?
fungal metabolite that slows carbohydrate digestion and thus absorption
What are the problems of a-carbarose?
minor benefits for some major GI side effects
only used if patient has real difficulty reducing calorie intake
How do incretins work?
slow gastric emptying which decreases hunger
increases insulin secretion
protects the pancreas
What is the problem with incretins?
must be injected
short half life at present
What is a new therapy coming out?
SGLT2 inhibitors
What is the effect of SGLT2 inhibitors?
lowers blood glucose as less is reabsorbed in the urine and gut
independent of insulin and low risk of hypoglycaemia
What is the issue with some SGLT2 inhibitors?
some minor UTIs
