Pharmacology of Diabetes

Question 1

What are the treatments for T1DM?

Answer 1

insulin injection, islet transplants

gene therapy

Question 2

When is insulin used?

Answer 2

T1DM life saving

gestational

Question 3

What is the risk with insulin injections?

Answer 3

patients may give themselves too much

Question 4

What is the v.short acting insulin?

Answer 4

lispro

Question 5

What is the short acting insulin?

Answer 5

regular

Question 6

What in the intermediate acting insulins?

Answer 6

NPH and lente

Question 7

What is the long acting insulin?

Answer 7

ultra lente

Question 8

What is the ultra long acting insulin?

Answer 8

glargine

Question 9

What is significant about lispro?

Answer 9

lysine B28
proline B29
must be used in combination with long acting

Question 10

What is significant about glargine?

Answer 10

glycine A 21
2 arginine on the end of B
single bedtime dose

Question 11

Why is transplant and stem cells not appropriate therapy?

Answer 11

needs 3 donors per person and costs a lot

body would probably attack new beta cells

Question 12

What are the treatments for T2DM?

Answer 12

Incretins
Sulfonylureas
Glitazones
Biguanides
a-glucosidase inhibitors
DIET and EXERCISE

Question 13

How does metformin work?

Answer 13

insulin sensitiser
biguanide
activates AMPK
inhibits glucose production and increases uptake by liver

Question 14

What is good about metformin?

Answer 14

reduces the risk of MIs and increases survival
it doesnt cause hypo
antihyperinsulinemic

Question 15

What is the problem with metformin?

Answer 15

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

Question 16

How do sulfonylureas work?

Answer 16

stimulate insulin secretion from pancreatic islets

regulate K-ATP channels by binding to SUR proteins

Question 17

What are the problems with sulfonylureas?

Answer 17

relatively expensive
danger of hypoglycemia
weight gain

Question 18

How do glitazones work?

Answer 18

bind PPAR y transcription factor and regulate genes involved in lipid and carbohydrate metabolism
induce glucose uptake in fat, liver and muscle cells

Question 19

What are the problems with glitazones?

Answer 19

very expensive
some weight gain
gives some patients edema
often used with SURs so hypoglycaemia is a risk

Question 20

What are the problems with glitazones?

Answer 20

very expensive
some weight gain
gives some patients edema
often used with SURs so hypoglycaemia is a risk

Question 21

What is a-carbarose?

Answer 21

fungal metabolite that slows carbohydrate digestion and thus absorption

Question 22

What are the problems of a-carbarose?

Answer 22

minor benefits for some major GI side effects

only used if patient has real difficulty reducing calorie intake

Question 23

How do incretins work?

Answer 23

slow gastric emptying which decreases hunger
increases insulin secretion
protects the pancreas

Question 24

What is the problem with incretins?

Answer 24

must be injected

short half life at present

Question 25

What is a new therapy coming out?

Answer 25

SGLT2 inhibitors

Question 26

What is the effect of SGLT2 inhibitors?

Answer 26

lowers blood glucose as less is reabsorbed in the urine and gut
independent of insulin and low risk of hypoglycaemia

Question 27

What is the issue with some SGLT2 inhibitors?

Answer 27

some minor UTIs