Therapeutics of DM

Question 1

List the goal of T2DM Tx and what is used for this

Answer 1

goal is to control BGL reducing peaks and avoiding troughs with use of human insulin or insulin analogues

Question 2

List the cause and symptoms of diabetic ketoacidosis

Answer 2

not enough insulin to bring glucose from bloodstream into cells, symptoms: rapid breathing, sweat breath, nausea, vomiting

Question 3

List the mechanisms of Ketoacidosis

Answer 3

Inadequate glucose available in cell tissue due to lack of insulin allowing transfer from bloodstream to cell tissue, glucose accumulates in bloodstream, body needs to find another source of energy and breaks down fat producing ketones as by product, these accumulate in bloodstream, body tries to excrete excess glucose and ketones through urine causing water loss -> dehydration and possible worsening of ketoacidosis

Question 4

List the causes and tx of hypoglycaemia

Answer 4

hypoglycaemia caused by: too much insulin, skipped meals, unplanned exercise, variations in meals
tx: fast acting carbs eg jelly beans, IV dose of blood sugar if needed eg unconscious

Question 5

Describe the tx of T2DM

Answer 5

first line: lifestyle modifications (trial for 3mnths) including: dietary, increased exercise, weight loss
first line pharmacotherapy: metformin
second line: SGLT2 inhib, DPP4 inhib, GLP1 receptor agonists, sulphonylureas, insulin

Question 6

Metformin
MOA:
CI:
SE:

Answer 6

MOA: decreases hepatic glucose production, increases insulin sensitivity in skeletal muscles
CI: liver/renal dx, alc abuse, mod-severe HF
SE: GI upset, vitamin B12 malabsorption

Question 7

GLP-1 receptor agonists
MOA:
SE:

Answer 7

MOA: glucagon like peptide 1 analogue, increases glucose dependent insulin secretion, decreases inappropriate glucagon secretion, delays gastric emptying, slows glucose absorption and suppresses appetite
SE: nausea, vomiting, GI upset

Question 8

DPP-4 inhibitors
MOA:
SE:

Answer 8

MOA: dipeptidyl peptidase 4 inhibition, increase natural secretion of insulin, decrease glucagon secretion
SE: hypoglycaemia, constipation

Question 9

SGLT2 inhibitors
MOA:
SE:

Answer 9

MOA: sodium glucose cotransporter 2 inhibitors, blood glucose released from blood stream in kidneys and discarded through bladder
SE: hypoglycaemia, genital infection, UTI

Question 10

Sulphonylureas
MOA:
SE:

Answer 10

MOA: increased secretion of insulin from pancreas
SE: hypoglycaemia, weight gain

Question 11

Insulin
SE:
reserved for when-

Answer 11

SE: hypoglycaemia, costly
reserved for use when glycaemic control not achieved after conventional tx protocol