Type 2 Diabetes Drugs

Question 1

what does an insulin sensitiser mean?

Answer 1

deceases insulin resistance

Question 2

what T2 drugs are insulin sensitisers

Answer 2

thiazolidinediones

Question 3

what T2 drugs increase secretion of insulin?

Answer 3

SURs
incretin mimetics
glinides
DPP-4 inhibitors

Question 4

what T2 drugs do not involve insulin control?

Answer 4

alpha glucosidase

SGLT-2

Question 5

what do SGLT2 inhibitors do?

Answer 5

enhance glucose excretion by kidney

Question 6

what do alpha glucosidase drugs do?

Answer 6

slow glucose absorption from GI tract

Question 7

when is glucose phosphorylated to g6p?

Answer 7

just after it is diffused into the cell by GLUT-2

Question 8

how is the membrane depolarised for insulin secretion?

Answer 8

ATP from glycolysis closed KATP channels

Question 9

what is the structure of a KATP channel?

Answer 9

octomer containing 6 KIR6.2) receptors in the middle and 4 SUR1 receptors on the outside

Question 10

what do the SUR1 subunits in the KATP channel do?

Answer 10

regulate the channel’s activity

Question 11

is the KATP channel opened or closed when extracellular glucose is low?

Answer 11

opened

Question 12

what opens the KATP channel?

Answer 12

ADP binding to SUR1 subunits only

Question 13

what do SURs do?

Answer 13

bind to SUR1

close the channel = depolarisation and insulin release

Question 14

why do SURs require functioning beta cells in order to work?

Answer 14

cause pancreatic beta cell insulin secretion

Question 15

what kind of drug is gliclazide?

Answer 15

SUR

Question 16

what kind of drug is glibenclamide?

Answer 16

SUR

Question 17

how long does it take for an SUR to cause peak insulin release?

Answer 17

1-2hrs

Question 18

who is most likely to get hypoglycaemic from SURs?

Answer 18

elderly

reduced hepatic/renal function patients

Question 19

when would an SUR be first line?

Answer 19

if pt is intolerant of metformin

if they have weight loss

Question 20

why do you get weight gain with insulin secreting drugs?

Answer 20

insulin is anabolic
increase appetite
less urine loss of glucose

Question 21

what onset do glinides have?

Answer 21

glinides

Question 22

do glinides cause hypoglycaemia like SURs?

Answer 22

no

Question 23

what drugs can glinides be used with?

Answer 23

metformin

thiazolidinediones

Question 24

what are the 2 types of enteroendocrine cells and where are they located?

Answer 24

L cells- ileum

K cells- duodenum

Question 25

what stimulates release of GLP-1 and GIP?

Answer 25

ingestion of food

Question 26

what does GIP stand for?

Answer 26

glucose dependent insulinotropic peptide

Question 27

what to GLP-1 and G1P do?

Answer 27

BOTH enhance insulin release from beta cells to enhance glucose uptake GLP-1 ONLY decreases glucagon release from alpha cells

Question 28

main role of DPP-4 inhibitors?

Answer 28

restore incretin by terminating DPP-4 which inhibits GLP-1 and GIP

Question 29

how should DPP-4 inhibitors be used?

Answer 29

combo with SU or metformin

Question 30

if it says "gliptin" in the name, what drug class should it belong to?

Answer 30

DPP-4 inhibitors

Question 31

what drug mimics the action of GLP-1?

Answer 31

incretin analogues

Question 32

do incretin analgogues cause weight loss?

Answer 32

yes

Question 33

can incretin analogues cause hypos?

Answer 33

no

Question 34

what drug can stop postprandial glucose spikes?

Answer 34

alpha glucosidase inhibitors

Question 35

why can alpha glucosidase inhibitors stop postprandial glucose spikes?

Answer 35

stops the enzyme that breaks down starch and disaccharides into absorbable glucsoe

Question 36

side effect of alpha glucosidase inhibitors?

Answer 36

GI upset

Question 37

what kind of drug is metformin

Answer 37

biguanide

Question 38

how does metformin work?

Answer 38

reduces gluconeogenesis reduces carb absorption increases glucose uptake by skeletal muscle increases fatty acid oxidation

Question 39

can metformin cause hypos?

Answer 39

no

Question 40

side effects of metformin?

Answer 40

GI upset | lactic acidosis

Question 41

main action of TZDs?

Answer 41

PPAR (a transcription factor coding insulin signalling proteins) gamma agonists

Question 42

can TZDs cause hypos?

Answer 42

no

Question 43

can TZDs cause weight gain?

Answer 43

yes

Question 44

only TZD used in UK?

Answer 44

pioglitazone

Question 45

what other drugs can pioglitazone be used in combo with?

Answer 45

metformin | SUs

Question 46

what part of the kidney do SGLT2 inhibitors work?

Answer 46

proximal tubule of kidney

Question 47

what is the main aim of SGLT2 inhibitors?

Answer 47

cause glycosuria to get it out

Question 48

why is the closing of KATP channels called depolarisation?

Answer 48

the ATP is changing the membrane potential of the cell from negative to more positive

Question 49

what should you do if a patient's HbA1C is >2% over target? why?

Answer 49

give insulin as most oral agents only decrease HbA1C by 1-2%

Question 50

what BMI would make you think the T2D problem is insulin deficiency rather than insulin resistance?

Answer 50

<30

Question 51

which T2D drug causes increased incidence of bladder cancer?

Answer 51

TZDs

Question 52

maximum dose of metformin available?

Answer 52

1g tds (3g per day)

Question 53

another word for DPP4 agonists?

Answer 53

gliptin

Question 54

what is the no.1 drug to use in patients who still have a high HbA1C + are obese but are on metformin and SUR?

Answer 54

GLP-1

Question 55

no.1 drug to use in a patient with a BMI of 27 who isnt responding to metformin or SUR?

Answer 55

insulin

Question 56

when could you use DPP4 agonists instead of SURs?

Answer 56

don't have co-morbid renal disease

Question 57

essential information to give a patient hen they commence a SUR?

Answer 57

hypo symptoms

Question 58

if a patient is getting recurrent hypos from an SUR, do you decrease dose or change drug?

Answer 58

decrease dose

Question 59

target HbA1C values in pregnancy?

Answer 59

43mmol/mol