Treatment for Diabetes

Question 1

What is the role of insulin?

Answer 1

Stimulates uptake of glucose into liver, muscle and adipose tissue

Inhibits gluconeogenesis

Inhibits glycogenolysis

Promotes uptake of fats

Question 2

What types of insulin are available?

Answer 2

Animal (porcine and bovine)

Recombinant DNA technology - human

• Short acting, rapid acting, intermediate acting, long acting, very long acting

Question 3

What are the 6 main insulin categories?

Answer 3

Ultrafast acting, rapid acting, short acting, intermediate acting, long acting, very long acting

Note that when absorbed, they all act in the same way. Difference is just in time taken to absorb.

Question 4

What are examples of rapid acting insulins?

Answer 4

Humalog, novorapid

Question 5

How are rapid acting insulins used?

Answer 5

Inject just before eating - rapid onset action 5 to 15 mins, peaks at 60 mins

Duration 4-6 hours

Question 6

What are some examples of short acting insulins?

Answer 6

Humulin S, actrapid

Question 7

How are short acting insulins used?

Answer 7

Injected 15 to 30 minutes before eating several times daily to cover meals

Starts to work 30-60 mins, peaks at 2-3 hours

Duration 8-10 hours

Question 8

What are examples of long and very long acting insulin?

Answer 8

Glargine, detemir, degludec

Question 9

Describe the onset and duration of long and very long acting insulin

Answer 9

Slow onset of 2-6 hours
Duration up to 24 hours
Very long up to 50+ hours (degludec)

This decreases risk of hypos

Question 10

What are some adverse effects of insulin?

Answer 10

Hypoglycaemia, hyperglycaemia, lipodystrophy, painful injections, insulin allergies

Question 11

How is type 2 diabetes treated?

Answer 11

Lifestyle, biguanides (metformin), sulphonylureas

Question 12

What is the target HbA1c for all with type 2 diabetes?

Answer 12

6.5-7.5%

Question 13

What are the mechanisms of action of metformin?

Answer 13

Inhibition of gluconeogenesis and decreasing insulin resistance

Question 14

What are the adverse effects of metformin?

Answer 14

Gi irritation, lactic acidosis (rare)

Question 15

What do sulfonylureas do?

Answer 15

Increase insulin release from beta cells of pancreas by binding to receptors and blocking K+/ATP channel - leads to Ca influx and release of insulin

Question 16

What are some side effects of sulfonylureas?

Answer 16

Weight gain and hypoglycaemia

Question 17

What is a basal bolus insulin regimen?

Answer 17

A basal-bolus routine involves taking a longer acting form of insulin to keep blood glucose levels stable through periods of fasting and separate injections of shorter acting insulin to prevent rises in blood glucose levels resulting from meals