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(LUSUMA) Clinical Pharmacology & Therapeutics > S5) Diabetes > Flashcards

S5) Diabetes Flashcards

1
Q

Describe four different functions of insulin in the body

A
  • Stimulates uptake of glucose into liver, muscle and adipose tissue
  • Inhibits gluconeogenesis
  • Inhibits glycogenolysis
  • Promotes fat uptake
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2
Q

What are the six main insulin categories?

A
  • Ultrafast acting
  • Rapid acting
  • Short acting
  • Intermediate acting
  • Long acting
  • Very long acting
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3
Q

How is insulin absorbed and administered?

A

Absorption into blood stream via subcutaneous injection

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4
Q

Provide an example of an ultra fast acting insulin

A

Aspart (FiAsp)

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5
Q

Provide two examples of rapid acting insulins

A
  • Humalog
  • Novorapid
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6
Q

Describe the following for rapid acting insulins:

  • Onset
  • Administer
  • Peak
  • Duration
A
  • Onset: rapid (5-15 minutes)
  • Administer: inject just before eating
  • Peak: ~60 minutes
  • Duration: 4-6 hours
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7
Q

Provide two examples of short acting insulins

A
  • Actrapid
  • Humulin S
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8
Q

Describe the following for short acting insulins:

  • Onset
  • Administer
  • Peak
  • Duration
A
  • 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
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9
Q

Provide an example of intermediate acting insulins

A

Humulin I

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10
Q

Describe the following for intermediate acting insulins:

  • Onset
  • Peak
  • Duration
A
  • Onset: 2-4 hours (slower)
  • Peak: 4-8 hours
  • Duration: 12-20 hours
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11
Q

Provide three examples of long and very long acting insulins

A
  • Glargine
  • Detemir
  • Degludec
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12
Q

Describe the following for long and very long acting insulins:

  • Onset
  • Duration
A
  • Onset: 2-66 hours (slow)
  • Duration: up to 24 hours (very long up to 50+ hours)
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13
Q

Identify five adverse effects of insulin

A
  • Hypoglycaemia
  • Hyperglycaemia
  • Lipodystrophy (lipohypertrophy / lipoatrophy)
  • Painful injections
  • Insulin allergies
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14
Q

How does one treat Type II diabetes?

A
  • Lifestyle +
  • Non-insulin therapies e.g. α- Glucosidase inhibitors, SGLT2s +
  • Non pharmacologic methods (bariatric surgery and very low calorie diets)
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15
Q

What are the key challenges for patients with Type 2 diabetes in terms of patient adherence and quality of life?

A
  • Weight gain (or fear of weight gain)
  • Risk of hypoglycaemia (or perceived risk)
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16
Q

What is the NICE target for Hbac1 for treating patients with Type II Diabetes?

A

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
17
Q

Describe the four effects of metformin on the body

A
  • ↓ insulin resistance leading to increased glucose by tissues
  • ↓ hepatic gluconeogenesis
  • Limits weight gain
  • ↓ CVS events
18
Q

What are the side effects of metformin?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Vitamin B12 deficiency (uncommon)
  • Lactic acidosis (rare)
19
Q

Describe the two effects of sulphonylureas on the body

A
  • Stimulate beta cell to release insulin
  • ↓ Microvascular risk
20
Q

What are the side effects of sulphonylureas?

A
  • Weight gain
  • Hypoglycaemia
21
Q

Describe the effects of acarbose, an α glucosidase inhibitor, on the body

A

Acarbose Inhibits the breakdown of carbohydrates to glucose by blocking action of the enzyme α glucosidase

22
Q

What are the side effects of acarbose?

A

Predictable:

  • Flatulence
  • Loose stools
  • Diarrhoea
23
Q

Describe the 3 effects of glitazones on the body

A
  • ↑ insulin sensitivity in muscle and adipose tissue
  • ↓ hepatic glucose output
  • Bind to and activate 1/more peroxisome proliferator-activated receptors (PPARs)
24
Q

Describe the side effects for the following glitazone drugs:

  • Rosiglitazone

- Pioglitazone

A
  • Rosiglitazone – CVS concerns
  • Pioglitazone – weight gain, fluid retention, heart failure, effects on bone metabolism and bladder cancer
25
Q

Describe the mechanism and use of glucagon like peptide 1 therapies

A
  • 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
26
Q

Identify three drugs used in GLP 1 therapy

A
  • Exenatide
  • Liraglutide
  • Lixisenatide
27
Q

Describe the physiological effects of GLP 1 therapies on the pancreas

A
  • Increase insulin secretion from the beta cells
  • Decreases production of glucagon from alpha cells
28
Q

Describe the physiological effects of GLP-1 therapies on the following organs/structures:

  • Pancreas
  • Liver
  • Brain
  • Stomach
  • Muscle
A
29
Q

What are the side effects of GLP 1 agonists?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Gastro oesophageal reflux
  • Hypoglycaemia (low risk)
  • Pancreatitis and pancreatic carcinoma (possible)
30
Q

Identify a contra-indication for GLP 1 agonists

A

Avoid if eGFR < 30ml/min

31
Q

Provide four examples of Gliptins (/ DPP-4 inhibitors)

A
  • Sitagliptin
  • Vildagliptin
  • Saxagliptin
  • Linagliptin
32
Q

Describe the effects of gliptins on the body

A

Inhibits DPP-4 activity by increasing postprandial active GLP-1 concentrations

33
Q

What are the side effects of gliptins?

A
  • GI symptoms (nausea, loose stools, diarrhoea)
  • Pancreatitis
  • Hypoglycaemia (low risk)
  • HbA1c reduction (modest)
34
Q

When are glifozins used?

A

Glifozins can be used for patients with Type I and Type II diabetes as add on therapy

35
Q

Provide three examples of glifozins

A
  • Dapagliflozin
  • Canagliflozin
  • Empagliflozin
36
Q

What are the side effects of glifozins?

A
  • Lower urinary tract symptoms (increased risk)
  • Polyuria
  • Hypoglycaemia (low risk)

(LUSUMA) Clinical Pharmacology & Therapeutics (29 decks)

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