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43 Cards in this Set

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Define diabetes mellitus
Diabetes mellitus is a multisystem disease,
characterised by hyperglycemia,
caused by absolute or relative lack of insulin production or action.
Name the different types of diabetes
Diabetes mellitus types 1 & 2
gestational diabetes
diabetes insipidus
Common signs and symptoms of diabetes?
Acute signs:
glycosuria
ketones on breath
weight loss
polyuria
polydipsia
fatigue/lethargy
What is polydipsia?
Abnormally intense thirst
What is polyuria?
Production of large volumes of dilute, pale urine
What is the criteria for diagnosis of diabetes mellitus?
Fasting plasma glucose = > 7mmol/L. (WHO)
NB Random glucose tests are unreliable.
What is an HbA1c test and what does it represent?
reflects glycosylated haemoglobin levels over prev 3mths
What is the action of insulin?
Insulin is a potent hypoglycemic hormone, produced by Beta cells.
Target= muscle cells, WBCs and connective tissue
Action= reduces circulating glucose by enhancing membrane transport of glucose into certain cells
What is the action of glucagon?
Glucagon is a potent hyperglycemic hormone, produced by Alpha cells.
Target= liver
Action= release glucose into bloodstream
Three cardinal signs of diabetes mellitus?
1. polyuria (copious wee)
2. polyphagia (intense hunger)
3. polydypsia (intense thirst)
What is the range of blood glucose levels that drug therapy aims at in DM?
DM blood glucose ranges:
4-7 mmol/L fasting
<9 mmol/L after meals
What is HbA1c?
A test of glycosylated haemoglobin.
HbA1c should be 6.5-7.5%
What is the current prevalence of diabetes in the UK?
Current UK diabetes prevalence is 5%.
How does excess blood sugar lead to diabetic complications?
Excess blood glucose reacts with proteins in body tissue to form advanced glycation end-products (AGE)s. These cause inflammation in the vasculature which causes heart disease and organ damage.
Outline the process of insulin secetion by a Beta cell.
Increase in blood glucose.
Glucose enters B-cell via Glut2 channel. Glucose is metabolised in cell, producing ATP. ATP blocks K+/ATP channels and depolarises membrane. This causes Ca2+ channels in membrane to open, allowing influx of Ca2+. This signal induces insulin granules to be secreted from B-cell.
Standard Tx for T1D?
T1D treated by:
- insulin (short or medium acting)
- injections (thigh, abdomen, upper arms)
Tx for type 2 diabetes?
Tx algorithm for T2D=
1) diet only
2) diet + tabs
3) diet + tabs + insulin
Categories of oral antidiabetic agents?
Oral antidiabetic agents:
1. Biguanides
2. Sulphonylureas
3. Intestinal Alpha-glucosidase inhibitors
4. Thiazolidinediones (TZDs)
5. Insulin secretion stimulators
Example of a biguanide
biguanide=metformin
example of a sulphonylurea
sulphonylureas
1st generation=Tolbutamide
2nd generation=Gliclazide, Glibenclamide
Give two examples of the thiazolidinediones
Thiazolidinediones=
Pioglitazone
Roziglitazone
Name one intestinal alpha-glucosidase inhibitor
Acarbose is an intestinal alpha-glucosidase inhibitor
When are Repaglinide and Nateglinide indicated?
Repaglinide and Nateglinide are indicated:
-
Which antidiabetic agents are insulin secretagogues?
Insulin secretagogues
= sulphonylureas
= thiazolidinediones
What is the action of a thiozolildinedione? Give an example of the drug.
Thozolidinedione drugs
=Rosiglitazone or Pioglitazone

promotes expression of genes influencing insulin signalling in liver, fat cells and muscle
Name three sulphonylurea drugs.
State their action.
Give advantages and disadvantages of this class.
Sulphonylureas
= Tolbutamide, Gliclazide, Glibenclamide

Action: insulin secretagogues. Bind to the K+/ATP channels in Beta cell membrane, causing depolarisation and opening of the Ca2+ channels leading to influx of calcium and secretion of insulin.

Advantages:
- usually well-tolerated
- can be combined
- useful in early T2D when Beta-cells still functioning

Disadvantages:
- hypoglycemia
- stimulates appetite
- drug interactions (NSAIDs, warfarin, alcohol increase effect)
- GI disturbance
State the indications and contraindications for Metformin.
Metformin

Indications=first line antidiabetic drug, no hypoglycemia, no weight gain, can be combined

Contraindications=liver or renal impairment, heart failure, hypoxic pulmonary disease (lactic acidosis)
If a patient cannot tolerate metformin or other drugs and their diabetes cannot be controlled by diet, what drug may be used?
Acarbose - an intestinal Alpha-glucosidase inhibitor.
Acarbose blocks carbohydrate absorption in the gut.
Side effects of Thiazolidinediones?
Thiazolidinedione side effects?
=weight gain
=fluid retention
=higher LDL and HDL
=liver toxicity
Side effects of Sulphonylureas?
Sulphonylureas side effects?
=hypoglycemia
=weight gain
=GI disturbance
=drug interactions (NSAIDs, imazole antifungals, warfarin increase hypoglycemic effect)
Side effects of intestinal Alpha-glucosidase inhibitors?
Intestinal Alpha-glucosidase inhibitors side effects:
=flatulence
=loose stools
=abdominal pain
Side effects of Metformin
Metformin side effects:
=initial GI disurbance
=loss of taste
=vitamin B12 deficiency
=lactic acidosis (can be fatal)
Side effects of Meglitinides?
Meglitinides side effects:
=
State the NICE guidelines for treatment of T2D.
NICE T2D algorithm:
Diet (always included)
Diet + Metformin (or Sulphonylurea)
Diet + Metformin + Sulphonylureas (or Repalglinide/Nateglinide or Thiazolidinediones)
D + M + S + Insulin/TZD
Then...increase insulin dose
What HbA1c level means that diet control is not working?
HbA1c of >6.5% with diet control means that diet control not working
If a patient is on Metformin and Sulphonylurea, at what HbA1c should their medication be altered?
If a patient is on Metformin and a Sulphonylurea and their HbA1c rises above 7.5%, then Insulin or TZD should be added.
Which antidiabetic drug is a black triangle drug? Why?
Rosiglitazone is a Black Triangle drug.
Adverse reactions in patients with CV disease have been noted.
What are the initial symptoms of hypoglycemia?
sweating
headache
nervousness
tremor
hunger
What should you go in the event of a pt having a hypoglycemic attack in clinic?
-stop procedure
-give glucose
-monitor pt's condition
-call ambulance??
How might Tx differ between T1 and T2D?
T1D = always insulin
T2D = depends on stage and severity of diabetes
What are the types of insulin used?
Various sources
Various durations
Name the drug categories for Tx of T2D
T2D:
-Biguanides
-Sulphonylureas
-Thiazolidinediones
-Meglitinides
-Intestinal Alpha-glucosidase inhibitors
-Enantide
List the actions of the drugs for Tx of T2D?
1-Insulin Secretagogues
2-Stimulate expression of genes for insulin signalling
3-Stimulate uptake and utilisation of glucose by muscles
4-Block carbohydrate absorption by the gut