Treatment of Diabetes Flashcards

1
Q

At what blood glucose level would you expect it to be detected in the urine?

A

> 10mM

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2
Q

Give some examples of insulin medications given in diabetes treatment and their formulations

A
  • rapid-acting soluble insulin: insulin (eg. insulin lispro): wutg amino acid modifications which prevents dimer/hexamer formation increasing bioavailability of active monomers
  • intermediate-acting (eg. isophane insulin): forms precipitate suspensions that slowly dissolve
  • longer-acting insulin (eg. insulin glargine): forms aggregates that slowly dissolve and has decreased solubility at neutral pH
  • longer-acting insulin with fatty acid (eg. insulin detemir): confers albumin binding, slowly dissociates to prolong activity
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3
Q

Describe fixed insulin regimens

A
  • amount of insulin taken at each meal will not vary from day to day
  • helps simplify understanding of blood glucose results but not much flexibility of how much carbs patient may choose to consume at a meal
  • means routine and consistency needed
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4
Q

Describe flexible insulin regimens

A
  • used for patients that really understand glucose metabolism and gives patients more control of what they eat and how they balance their blood glucose levels
  • patients choose how much insulin to inject at each meal and allows for doses to be varied in response to different carb quantities at meals
  • means patients must check their blood glucose readings, calculate how much carbs they are going to consume and adjust their dose accordingly
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5
Q

Describe the 1, 2, 3 insulin therapy

A
  • 1-3 injections a day taken in the morning and meals
  • suitable for T2D with basic understanding of glucose metabolism
  • rapid-acting/short-acting insulins mixed with intermediate insulins used
  • meal times and content are fixed
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6
Q

Describe the basal-bolus insulin therapy

A
  • > 3 injections a day (intensive) given throughout the day
  • suitable for T1D and some T2D with a high understanding of glucose metabolism
  • intermediate/long-acting with short-acting insulins
  • meal time and content more flexible
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7
Q

Describe the insulin pump therapy

A
  • semi-automated injections given when needed throughout the day
  • suitable for T1D with medium/high understanding of glucose metabolism
  • short-acting formulation used
  • meal times and content flexible
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8
Q

List some lifestyle modifications to prevent prediabetes

A
  • increasing exercise and having a healthy diet:
  • decreasing intake of processed carbs
  • ensure carbs come from fruits, veg, and whole grains
  • eat low-fat dairy and oily fish
  • limit trans/saturated fats
  • eat small frequent meals to prevent glucose spikes
  • increase fibre and eat complex carbs
  • decrease alcohol consumption
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9
Q

What are oral hypoglycaemic agents?

A
  • drugs used to alter glucose metabolism in type II diabetics
  • first-line drug is metformin
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10
Q

Describe the physiological action of metformin

A
  • reduces gluconeogenesis in liver
  • opposes action of glucagon
  • increases glucose uptake and utilisation in skeletal muscle
  • delays carb absorption in gut
  • increases fatty acid oxidation (reduces circulating LDL and VLDL which can help obesity and atherosclerosis development)
  • suppresses appetite
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11
Q

Describe the cellular action of metformin

A
  • enters the cell through transporter in membrane
  • acts on mitochondria to increase ratio of AMP to ATP
  • activates AMP-activated protein kinase (switches on metabolism)
  • inhibits glucagon signalling and gluconeogenic pathways
  • increases transcription of genes for glucose transport, fatty acid oxidation and inhibits fatty acid synthesis
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12
Q

What are the insulin secretagogues: sulphonylureas/meglitinides?

A
  • older class of hypoglycaemic drugs
  • eg. gliclazide and tolbutamide (sulphonylureas) repaglinide and nateglinide (metlitinides)
  • used in early stages of type II diabetes because it needs functional beta cells to work
  • can lead to weight gain as it can stimulate appetite
  • can be combined with other insulin drugs
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13
Q

Describe the cellular mechanism of action of sulphonylureas

A
  • high affinity receptor on B cell membrane
  • drug enters and blocks ATP-sensitive K+ channels
  • causes beta cell depolarisation leading to insulin secretion
  • only works in functional beta cells
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14
Q

What are examples of SGLT2 inhibitors and when are they indicated?

A
  • empagliflozin and canagliflozin
  • used in type II diabetes as monotherapy
  • used when exercise alone is not adequate and metformin is contraindicated or inappropriate
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15
Q

Describe the action of SGLT2 inhibitors

A
  • block SGLT2 transporters in proximal tubule of kidney

- would normally reabsorb glucose from the forming urine into the blood

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16
Q

What are incretins and their actions on the body?

A
  • GKP-1 secreted by L cells and GIP secreted by K cells in the gut
  • stimulate insulin biosynthesis/secretion, inhibit glucagon secretion in pancreas
  • delay gastric emptying
  • increase CO and brain satiety signals
  • indirectly increase insulin sensitivity in muscle and decrease gluconeogenesis in liver
17
Q

What enzyme is responsible for the breakdown of incretins?

A

dipeptidyl peptidase-4 (DPP-4)

18
Q

What are examples of incretin mimetics and their physiological action

A
  • exenatide
  • liraglutide (has additional fatty side chain which albumin can bind to, slows clearance)
  • increases insulin secretion and suppresses glucagon secretion
19
Q

Describe the mechanism of action of the gliptins and examples

A
  • blocks DPP-4 enhancing endogenous incretin effects
  • lowers blood glucose by increasing first phase of insulin response after meals
  • eg. sitagliptin and vildagliptin
20
Q

Describe the mechanism of action and example of glitazones

A
  • PPAR-gamma agonists (receptors in adipose tissue, muscle and liver)
  • increases insulin sensitivity, lowers blood glucose,
  • promotes esterification/storage of FFAs in adipose tissue (increases transcription of genes that promote this)
  • eg. pioglitazone
21
Q

What are the drawbacks of glitazones?

A

associated with bladder cancer, heart failure, and osteoporotic fractures

22
Q

Describe the mechanism of action of alpha-glucosidase inhibitors with an example

A
  • competitive inhibitor of intestinal alpha-glucosidase
  • delays carb absorption in small intestine reducing post-meal spike in glucose
  • allows cells time to absorb and process glucose
  • acarbose