Treatment of diabetes Flashcards
what are the symptoms of diabetes
always tired frequent urination sudden weight loss non healing wounds always hungry sexual problems blurry vision vaginal infections numb/ tingly hands and feet always thirsty
what factors can contribute to type 2 diabetes
too much food with too much animal fat
not enough exercise
genes for hunger/ insulin release/ damage to islet cells etc
associated with high blood pressure and cholesterol
how can type 2 diabetes progress
beta cell failure surpasses a critical threshold of 90%
what blood glucose level will cause glucose in the urine
> 10 mM
what are rapid acting soluble insulins
lispro or aspart
(designer insulins) prevent dimer formation so higher bioavailability
name some longer acting insulins
neutral protamine hagedorn insulin
isophane insulin
name some longer acting insulins
insulin zinc formulations
Insulins are precipitated in suspensions which slowly dissolve
what is insulin glargine
longer acting designer insulin which forms aggregates that slowly dissolve
what type of insulin is given in hyperglycaemic emergencies
soluble insulin by IV
what proportion of DM2 patients use insulin
a third
what is flexible insulin therapy
used for patients with a strong understanding of glucose metabolism that gives patients more control of what they eat but takes time to learn how to do it
patients can change how much insulin they use according to what they are eating
what type of insulin would type 2 diabetics use
long acting (glargine) or intermediate (NPH)
what is basal bolus insulin
patient takes multiple injections of insulin throughout the day
what is metformin
can potentiate residual insulin by increasing insulin sensitivity
reduces gluconeogenesis in the liver
opposes the actions of glucagon
increases glucose uptake in muscle
delays carbohydrate absorption in the gut
increases fatty acid oxidation thereby reducing atherosclerosis
can suppress apetitie and so encourage weight loss
can be combined with drugs that stimulate insulin release
how does metformin work
alters energy metabolism
acts on the mitochondria to change ratio of AMP to ATP
this inhibits glucagon signalling
AMPK increases transcription of genes involved in glucose and fatty acid metabolism
takes time to work
what are sulphonylureas
older class of orally active hypoglycaemic drugs for DM2
increase insulin release from beta cells
requires functioning beta cells to work
can be combined with metformin and glitazones
name some sulphonylureas
tolbutamide
chlorpropramide
glibenclamnide
glipizide
what are the side effects of sulphonyl ureas
weight gain due to stimulated appetite
can interact with other drugs to produce severe hypoglycaemia
what is repaglinide and nateglinide
drugs that act in the same way as sulphonyl ureas but do not cause as much weight gain
what is the MOA of sulphonylureas
high affinity receptors are present in beta cell membranes
blocks ATP sensitive K+ channels in Beta cells
causes beta cell depolarization which leads to insulin secretion
what are thiazolidinediones (glitazones)
increases insulin sensitivity and lowers blood glucose in type 2 diabetics
reduces amount of exogenous insulin needed
increases glucose uptake into muscles in response to insulin
reduces blood glucose and FFA conc
promotes gene transcription of genes that are important for insulin signaling
what are the side effects of thiazolidinediones
weight gain and fluid retention
linked to bladder cancer, heart failure, osteoporotic fractures (withdrawn in some countries)
what is pioglitazone
a thiazolidinedione
what is the MOA of pioglitazone
PPAR-y ligands promote transcription of genes important in insulin signaling
used in addition to other oral hypoglycaemics
