S5) Diabetes Flashcards
Describe four different functions of insulin in the body
- Stimulates uptake of glucose into liver, muscle and adipose tissue
- Inhibits gluconeogenesis
- Inhibits glycogenolysis
- Promotes fat uptake
What are the six main insulin categories?
- Ultrafast acting
- Rapid acting
- Short acting
- Intermediate acting
- Long acting
- Very long acting
How is insulin absorbed and administered?
Absorption into blood stream via subcutaneous injection
Provide an example of an ultra fast acting insulin
Aspart (FiAsp)
Provide two examples of rapid acting insulins
- Humalog
- Novorapid
Describe the following for rapid acting insulins:
- Onset
- Administer
- Peak
- Duration
- Onset: rapid (5-15 minutes)
- Administer: inject just before eating
- Peak: ~60 minutes
- Duration: 4-6 hours
Provide two examples of short acting insulins
- Actrapid
- Humulin S
Describe the following for short acting insulins:
- Onset
- Administer
- Peak
- Duration
- Onset: 30-60 minutes
- Administer: inject at least 15-30 minutes before eating several times daily to cover meals
- Peak: 2-3 hours
- Duration: 8-10 hours
Provide an example of intermediate acting insulins
Humulin I
Describe the following for intermediate acting insulins:
- Onset
- Peak
- Duration
- Onset: 2-4 hours (slower)
- Peak: 4-8 hours
- Duration: 12-20 hours
Provide three examples of long and very long acting insulins
- Glargine
- Detemir
- Degludec
Describe the following for long and very long acting insulins:
- Onset
- Duration
- Onset: 2-66 hours (slow)
- Duration: up to 24 hours (very long up to 50+ hours)
Identify five adverse effects of insulin
- Hypoglycaemia
- Hyperglycaemia
- Lipodystrophy (lipohypertrophy / lipoatrophy)
- Painful injections
- Insulin allergies
How does one treat Type II diabetes?
- Lifestyle +
- Non-insulin therapies e.g. α- Glucosidase inhibitors, SGLT2s +
- Non pharmacologic methods (bariatric surgery and very low calorie diets)
What are the key challenges for patients with Type 2 diabetes in terms of patient adherence and quality of life?
- Weight gain (or fear of weight gain)
- Risk of hypoglycaemia (or perceived risk)
What is the NICE target for Hbac1 for treating patients with Type II Diabetes?
In general target for all is HbA1c 6.5 to 7.5%
- HbA1c 6.5%: Diet and first 2 treatment steps
- HbA1c 7.5%: Beyond this or if at risk of severe hypoglycaemia
Describe the four effects of metformin on the body
- ↓ insulin resistance leading to increased glucose by tissues
- ↓ hepatic gluconeogenesis
- Limits weight gain
- ↓ CVS events
What are the side effects of metformin?
- GI symptoms (nausea, loose stools, diarrhoea)
- Vitamin B12 deficiency (uncommon)
- Lactic acidosis (rare)
Describe the two effects of sulphonylureas on the body
- Stimulate beta cell to release insulin
- ↓ Microvascular risk
What are the side effects of sulphonylureas?
- Weight gain
- Hypoglycaemia
Describe the effects of acarbose, an α glucosidase inhibitor, on the body
Acarbose Inhibits the breakdown of carbohydrates to glucose by blocking action of the enzyme α glucosidase
What are the side effects of acarbose?
Predictable:
- Flatulence
- Loose stools
- Diarrhoea
Describe the 3 effects of glitazones on the body
- ↑ insulin sensitivity in muscle and adipose tissue
- ↓ hepatic glucose output
- Bind to and activate 1/more peroxisome proliferator-activated receptors (PPARs)
Describe the side effects for the following glitazone drugs:
- Rosiglitazone
- Pioglitazone
- Rosiglitazone – CVS concerns
- Pioglitazone – weight gain, fluid retention, heart failure, effects on bone metabolism and bladder cancer
Describe the mechanism and use of glucagon like peptide 1 therapies
- Mechanism: alternative hormone system influencing glucose metabolism
- Use: high glucose in Type II diabetes due to insufficient release of insulin and over production of glucagon
Identify three drugs used in GLP 1 therapy
- Exenatide
- Liraglutide
- Lixisenatide
Describe the physiological effects of GLP 1 therapies on the pancreas
- Increase insulin secretion from the beta cells
- Decreases production of glucagon from alpha cells
Describe the physiological effects of GLP-1 therapies on the following organs/structures:
- Pancreas
- Liver
- Brain
- Stomach
- Muscle
What are the side effects of GLP 1 agonists?
- GI symptoms (nausea, loose stools, diarrhoea)
- Gastro oesophageal reflux
- Hypoglycaemia (low risk)
- Pancreatitis and pancreatic carcinoma (possible)
Identify a contra-indication for GLP 1 agonists
Avoid if eGFR < 30ml/min
Provide four examples of Gliptins (/ DPP-4 inhibitors)
- Sitagliptin
- Vildagliptin
- Saxagliptin
- Linagliptin
Describe the effects of gliptins on the body
Inhibits DPP-4 activity by increasing postprandial active GLP-1 concentrations
What are the side effects of gliptins?
- GI symptoms (nausea, loose stools, diarrhoea)
- Pancreatitis
- Hypoglycaemia (low risk)
- HbA1c reduction (modest)
When are glifozins used?
Glifozins can be used for patients with Type I and Type II diabetes as add on therapy
Provide three examples of glifozins
- Dapagliflozin
- Canagliflozin
- Empagliflozin
What are the side effects of glifozins?
- Lower urinary tract symptoms (increased risk)
- Polyuria
- Hypoglycaemia (low risk)
