Term
| What are the different types of diabetes? |
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Definition
Type 1 - insulin dependent - juvenile onset
Type 2 - Non insulin dependent - mature onset |
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Term
| What is the function of insulin? |
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Definition
| activates the uptake and utilisation of glucose thus decreasing blood glucose levels |
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Term
| Name the ultra rapid and very short acting insulin preparation |
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Definition
Lispro
Regular/ crystalline zinc
- Lysine and proline residue are switched
Rapid onset and short acting allows it to be taken immediately before a meal
–Active within 5-10 mins.
–Peak action at 30-90 mins.
–Effect lasts 2-4 hrs. |
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Term
| Which Insulin preparations are given via IV |
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Definition
Lispro
Regular/ crystalline zinc - given in emergency cases |
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Term
Patient comes in with:
Polyuria, Polydipsia
Nausea, Fatigue
Fruity breath
Fatigue & Dehydration
What is the Diagnosis & how do you treat? |
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Definition
Diabetic ketoacidosis
IV crystaline zinc/ regularr |
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Term
| Name the intermediate onset & intermediate action insulin preparations |
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Definition
Isophane insulin suspension (NPH insulin)/ NPH - Neutral Protamine Hegedorn
Lente |
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Term
| What is the preferred intermediate onset & action insulin preparation to mix with regular/ crystalline zinc & why? |
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Definition
| NPH, as lente can slow down the onset of action of regular/ crystalline zinc insulin |
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Term
Name the Slow onset & long acting insulin preparations
When is it taken? |
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Definition
Ultra lente
Glargine
Usually once a day dose |
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Term
Which insulin preparation is the only one with no peaks?
What is an advantage of this? |
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Definition
Glargine
used to supply a constant background level, given once a day due to its ultra long duration of action
NO HYPOGLYCEMIA |
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Term
| What increases insulin release? |
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Definition
B agonist
M agonist
Glucose
Sulfonylureas |
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Term
| What decreases insulin release? |
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Definition
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Term
| How is Glargine chemically different to insulin? |
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Definition
On the Alpha chain Asparagine is replaced with Glycine
On the Beta chain 2 extra Asparagines are added to the end of the chain |
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Term
| What are the potential toxicities of insulin? |
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Definition
Hypoglycemia (except Glargine)
Allergy
Lipodystrophy - atrophy of fatty tissue at site of injection |
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Term
| What drug is contra indicated in diabetic patients & why? |
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Definition
| Propanolol - as it masks the symptoms of hypoglycemia |
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Term
Patient comes in with lethargy, tachycardia, sweeting, palpatations, nausea & hunger
What is the diagnosis?
How is it treated? |
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Definition
Hypoglycemia ADR of insulin preps
give IV dextrose & glucagon |
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Term
| What is given for the treatment of type 2 diabeties ONLY? |
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Definition
| Oral hypoglycaemic agents ie. sulfonylureas, metformin etc. |
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Term
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Definition
Blocks the ATP sensitive K+ channels - causing increase in Ca2+ influx - Causing insulin release
1st generation - Acetohexamide, Tolbutamide, Chlorpropamide
2nd generation - Glipizide, Glyburide & Glimepiride |
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Term
| What is the ADR's associated with sulfonylureas? |
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Definition
Disulfiram reaction (1st generation only)
Hypoglycemia
Hypersensativity (possible cross allergy with sulfonamides)
Drug interactions - causing increased hypoglycemia |
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Term
| What patients should not take Sulfonylureas? |
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Definition
1. Pts with liver disease
2. Obese patients ( as it increases lipogenesis)
3. Patients on propanolol |
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Term
| What are the drug interactions associated with sulfonylureas? |
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Definition
It is highly protein bound
1. displaced by - phenylbutazone, clofibrate & sulfonamides
2. Inhibit metabolism - warfarin, phenytoin, acute alcohol intake
3. prolong pharmacodynamic action - propanolol, lithium, theophylline
4. Induce metabolism - phenobarbitone, rifampicin |
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Term
| What is special about Glimepiride? |
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Definition
Promotes peripheral disposal of glucose by enhancing translocation of GLUT4 to the plasma membrane
** lower risk of hyperinsulinemia & hypoglycemia |
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Term
Biguanides
MOA
Drug?
ADR? |
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Definition
Decrease hepatic gluconeogenesis (NO HYPOGLYCEMIA!!!)
Metformin
Lactic acidosis (seen in patients who are chronic alcoholics & hepatic impairment)
Vit B12 deficiency |
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Term
| When is metformin contraindicated? |
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Definition
Patients with severe CV, renal, liver disorders
Alcoholics (increased risk of lactic acidosis) |
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Term
Thiazolidinediones aka Glitazones
Drugs
MOA |
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Definition
Pioglitazone, Rosiglitazone
Binds to PPAR's (peroxisome proliferator-activating receptor) - enhance insulin sensitivity in the peripheral tissues & decrease insulin resistance in the periphery) |
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Term
Alpha- Glucosidase inhibitors
Drugs?
MOA?
ADR? |
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Definition
Acarbose & Miglitol
Competitive inhibitors of alpha - glucosidase in brush birders in small intestine**
GI discomfort, bloating, welching, diarrhea etc |
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Term
| If a patient experiences hypoglycemia while being treated with Acarbose or miglitol what is given & why? |
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Definition
| IV dextrose - you can not give sugar/ candy, this will not be effective as these drugs delay the absorption of glucose. |
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Term
Meglitinides
Drugs?
MOA?
Use? |
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Definition
Repaglinide, Netaglinide
stimulates release of insulin from pancreatic Beta cells
Adjunctive use in type 2 diabetes - admin just before meals due to short t 1/2 |
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Term
Glucagon- Like peptide -1 (GLP-1)
analog?
MOA? |
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Definition
Exenatide
GLP-1 receptor full agonist used in combination with other agents in type 2 diabetes |
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