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Flashcards in CPT S4 - Diabetes Deck (25)
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1
Q

Give some types of diabetes

A
Type I - 
>insulin deficiency
>autoimmune or non-autoimmune
Type II - 
>insulin deficiency & insulin resistance
Genetic defects of beta cell
Genetic defects of insulin action
Drug-induced diabetes
Associated with other hormone disorders
2
Q

What treatments are available for type two diabetes?

A
Insulin sensitisers
Beta cell stimulators
Appetite suppressants
Weight loss agents
Urinary glucose eliminators
Insulin
3
Q

What diet and lifestyle advice can be given for diabetes?

A
Encourage complex carbohydrates
Limit alcohol
Limit salt
Stop smoking
Exercise
Reduce overall energy intake if overweight
4
Q

Name some types of non-insulin diabetes drugs

A
Biguanides
Sulphonylureas
Meglitinides
Thiazolidinediones
Alpha-glucosidase inhibitors
Glucagon-like peptide 1 (GLP1) analogues
Dipeptyl-peptidase 4 (DPP4) inhibitors
Sodium glucose cotransporter 2 inhibitors
5
Q

Give the actions and mechanism of action of biguanides?

A

Only one in use is metformin
Reduces insulin resistance by increasing insulin receptor sensitivity
Inhibits hepatic gluconeogenesis
Decreased glucose absorption from gut
Stimulates glucose uptake in muscle and adipose
Weight neutral
No action on islet cells

6
Q

Give some contraindications for metformin

A

Do NOT give in cardiac, respiratory, renal or hepatic failure due to increased risk of lactic acidosis

7
Q

Give some ADRs of metformin

A

High incidence of GI symptoms

May have slight weight gain

8
Q

Describe the pharmacokinetic activity of metformin

A

4 hour half life
Not metabolised
Renal elimination

9
Q

Give some examples of sulphonylureas

A

Gliclazide
Glimeprazide
Glipizide

10
Q

What is the mechanism of action of sulphonylureas?

A

Stimulates beta cells, so requires some residual function

Specific receptor on beta cell

11
Q

Give some ADRs for sulphonylureas

A

Hypoglycaemia, especially in the elderly, with missed meals or with excess alcohol
Weight gain
However, CAN be given in renal failure

12
Q

Describe meglitinides

A

Eg repaglinide & nateglinide
Site of action is a K ATPase channel on beta cells
Distinct from sulphonylureas as different receptors, but similar pharmacological action
Shorter half life
More rapid action than sulphonylureas
Taken immediately before meals

13
Q

Give the actions and mechanisms of actions of thiazolidinediones

A

Insulin sensitisers
Stimulate nuclear peroxisome proliferator activated receptor gamma
So regulate adipose, muscle and liver gene expression
Increased glucose utilisation
Decreased glucose production
Suppresses gluconeogenesis in liver

14
Q

What are some problems with thiazolidinediones, aka glitazones

A
Pioglitazone only available agent
Weight gain and oedema
Contraindicated in heart failure
Fractures in post menopausal women
Bladder cancers
Rarely used now
15
Q

Describe DPP4 inhibitors

A

Aka gliptins
Increases postprandial active GLP1 concentrations
Side effects include GI symptoms and ?pancreatitis
Low hypoglycaemic risk
Weight neutral
Modest HbA1c reduction

16
Q

Describe α glucosidase inhibitors

A

Inhibits α glucosidase activity in gut
Overall carbohydrate absorption unchanged
Delays glucose load into blood
Excreted unchanged in faeces

17
Q

What are some problems with αglucosidase inhibitors?

A

Flatulence and diarrhoea
Elevated ALT
Rarely used in UK

18
Q

Describe SGLUT2 inhibitors

A

Basically increase the glucose excreted in the urine
So many problems eg polydipsia, polyuria, thrush, UITs
No long term studies as new agents

19
Q

Give some roles of insulin

A

Stimulates uptake of glucose into liver, muscle and adipose
Inhibits gluconeogenesis
Inhibits glycogenolysis
Promotes uptake of fats

20
Q

What are the main insulin categories?

A
Short acting
Rapid acting
Intermediate acting
Long acting
Very long acting
21
Q

Describe short acting insulin

A
Starts to work in 30-60 minutes
Inject 15-30 minutes before eating
Peaks at 2-3 hours
Duration 8-10 hours
Needs to be injected several times per day to cover meals
22
Q

Describe rapid acting insulin

A

Starts working in 5-15 minutes
Inject just before eating
Peaks 30-90 minutes
Duration 4-6 hours

23
Q

Describe intermediate acting insulin

A

Onset 2-4 hours
Peaks 4-8 hours
Duration 12-20 hours

24
Q

Describe long and very long acting insulin

A

Onset 2-6 hours

Duration up to 24h in long and can be over 50 in very long

25
Q

Give some ADRs for insulin

A

Hypoglycaemia
Lipodystrophy
Painful injections
Allergy