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MD4001 endocrine > Treatment of diabetes > Flashcards

Treatment of diabetes Flashcards

1
Q

what are the symptoms of diabetes

A 
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
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2
Q

what factors can contribute to type 2 diabetes

A

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

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3
Q

how can type 2 diabetes progress

A

beta cell failure surpasses a critical threshold of 90%

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4
Q

what blood glucose level will cause glucose in the urine

A

> 10 mM

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5
Q

what are rapid acting soluble insulins

A

lispro or aspart

(designer insulins) prevent dimer formation so higher bioavailability

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6
Q

name some longer acting insulins

A

neutral protamine hagedorn insulin

isophane insulin

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7
Q

name some longer acting insulins

A

insulin zinc formulations

Insulins are precipitated in suspensions which slowly dissolve

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8
Q

what is insulin glargine

A

longer acting designer insulin which forms aggregates that slowly dissolve

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9
Q

what type of insulin is given in hyperglycaemic emergencies

A

soluble insulin by IV

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10
Q

what proportion of DM2 patients use insulin

A

a third

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11
Q

what is flexible insulin therapy

A

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

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12
Q

what type of insulin would type 2 diabetics use

A

long acting (glargine) or intermediate (NPH)

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13
Q

what is basal bolus insulin

A

patient takes multiple injections of insulin throughout the day

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14
Q

what is metformin

A

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

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15
Q

how does metformin work

A

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

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16
Q

what are sulphonylureas

A

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

17
Q

name some sulphonylureas

A

tolbutamide
chlorpropramide
glibenclamnide
glipizide

18
Q

what are the side effects of sulphonyl ureas

A

weight gain due to stimulated appetite

can interact with other drugs to produce severe hypoglycaemia

19
Q

what is repaglinide and nateglinide

A

drugs that act in the same way as sulphonyl ureas but do not cause as much weight gain

20
Q

what is the MOA of sulphonylureas

A

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

21
Q

what are thiazolidinediones (glitazones)

A

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

22
Q

what are the side effects of thiazolidinediones

A

weight gain and fluid retention

linked to bladder cancer, heart failure, osteoporotic fractures (withdrawn in some countries)

23
Q

what is pioglitazone

A

a thiazolidinedione

24
Q

what is the MOA of pioglitazone

A

PPAR-y ligands promote transcription of genes important in insulin signaling

used in addition to other oral hypoglycaemics

25
Q

what is alpha glucosidase inhibitor

A

inhibits intestinal alpha glucosidase

delays carbohydrate absorption in the small intestine which reduces the postprandial spike in glucose

used for DM2 in combination with other hypoglycaemics

26
Q

what are the side effects of alpha glucosidase inhibitors

A

flatulence and diarrhea

27
Q

what are incretins

A

natural gut peptide hormones
including GLP1 and GIP which are secreted after meals

incretins stimulate insulin secretion, delay gastric emptying, inhibits glucagon secretion and increases satiety

degraded by an enzyme called dipeptidyl peptidase 4

28
Q

what is Acarbose

A

an alpha glucosidase inhibitor

29
Q

what are exenatide and liraglutide

A

incretin mimetics (analogues of exendin -4/ GLP1)

30
Q

what are the features of exenatide

A

given twice daily but can cause nausea

incretin mimetic

31
Q

what is exenatide LAR

A

long acting release which is administered weekly and gives less nausea
incretin mimetic

32
Q

what is liraglutide

A

an incretin memetic which has an additional fatty side chain which confers albumin binding and slows renal clearance

33
Q

what are the features of incretin mimetics

A

lowers blood glucose after a meal by increasing insulin secretion and suppressing glucagon secretion
used for DM2 in addition to oral agents
promotes weight loss
given subcutaneously

34
Q

what are the side effects of incretin mimetics

A

hypoglycaemia

a range of GI effects

35
Q

what are incretins

A

GIP and GLP which are released by the intestine and promote release of insulin

36
Q

what are DPP4 inhibitors

A

enhances endogenous incretin effects by blocking DPP4
lowers blood glucose by increasing first phase of insulin response after meals
used in DM2

37
Q

what is sitagliptin

A

DPP4 inhibitor

well tolerated and weight neutral

38
Q

what is vildagliptin

A

a DPP4 inhibitor

not available in the US due to side effects

39
Q

what is the DPP 4 enzyme

A

inactivates GLP1 which stimulates insulin release

MD4001 endocrine (15 decks)

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