Diabetes drugs
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Diabetes Drugs. Important because. Diabetes is a common problem throughout whole medical career. 10% Patients+ in hospital are Diabetics. All the drugs can Interact, lack of Insulin = death. Intermediates…. Treatment…. What are the 3 categories of treatment that we need to think about?

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Diabetes Drugs

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Diabetes drugs

Diabetes Drugs


Important because

Important because

  • Diabetes is a common problem throughout whole medical career. 10% Patients+ in hospital are Diabetics.

  • All the drugs can Interact, lack of Insulin = death.

  • Intermediates…


Treatment

Treatment…

  • What are the 3 categories of treatment that we need to think about?

  • Conservative, Medical and Surgical

  • In Diabetes, Conservative is especially important:

    • T1DM – Carbohydrate counting and Diet planning

    • T2DM – Weight loss and reduced fat intake

      • Obesity is the Main cause of Insulin Resistance. If you loose weight, your insulin sensitivity improves.


Learning pharmacology

Learning Pharmacology

  • Plenty of different pieces of info about one drug that can be tested.

  • Good to use a table – easy to revise from

  • Mneumonics

  • Anyone from South Africa?


Drug table

Drug Table…


Insulin

Insulin

  • Who needs Insulin?

  • Anyone with T1DM, or T2 which is uncontrolled by diet

  • What are the main types

  • Rapid acting, Short acting, Intermediate acting, Long Acting

  • Whats the Mechanism of action?

  • Acts on Tyrosine Kinase receptors.

  • Causes Glut4 receptors in cells to move to surface

  • Glut4 allows Glucose to move into cells

  • Which Cells Release Insulin Naturally?

  •  cells – Islets of Langerhans.


Insulin regimes

Insulin Regimes

  • Pre-mixed Insulin – contains what?

    Rapid acting and long acting. Can be 1x/2x/3x per day. Both types in one injection

  • 1/2X daily regime – contains what?

    Long/Intermediate acting. Covers all day, need to be wary of skipping meals etc…

  • Basal Bolus regime contains what?

  • Rapid acting Inject 3x per day before meals and Long acting 1/2x per day for base cover. (5x injections per week

  • How is Insulin Administered?

    Subcutaneous injection: either with ‘pens’ or pumps


Safety

SAFETY

What are 2 important complications that can occur without Insulin?

-DKA.

-Hyperglycaemia causing raised HBA1C leading to long term complications…. (nephropathy/retinopathy/neuropathy etc …)

If DKA occurs, what else needs to be given to patient and why?

Potassium – Insulin drives K into cells, and so hypokalaemia can occur.

What are 3 ECG signs that might indicate Hypokalaemia?

  • T wave flattening/Inversion

  • PR Interval prolongation

  • ST depression

  • Prominent U waves


Type 2 diabetes

Type 2 Diabetes

(Insulin)

Biguanides

Thiazoladinediones

Sulphonureas

Alpha Glucosidase inhibitors

Post Prandial Glucose regulators

Metformin

Pioglitazone

Gliclazide

Alpha Glucosidase blocker

Repaglinide


Biguanides

Biguanides

  • Example?

    Metformin

  • Mechanism:

  • Glucose uptake in muscle

  • Gluconeogenesis

  • Glucose absorption

  • INSULIN RESISTANCE


When to administer

When to administer:

  • An insulin sensitiser: It only works if there is endogenous insulin.

  • Can help patients to loose weight: helps to reduce appetite

  • What other condition can metformin be used to treat?

  • PCOS

  • Side Effects

  • GI upset – common. Lactic Acidosis rarely.


Thazolidinediones

THAZOLIDINEDIONES

  • Example?

  • Pioglitazone

  • Can combine with Metformin/Sulphonyurea

  • Mechanism?

  • Transcription of Insulin sensitive genes:

  • Glucose uptake & utilisation

  • Lipogenesis

  • An insulin sensitiser: It only works if there is endogenous insulin.


Side effects thiazoladinediones

Side Effects - Thiazoladinediones

  • Weight gain

  • Cardiac failure/Odema

  • Anaemia

  • Liver damage

  • Hypoglycaemia

  • Osteoporotic fractures


Sulphonyurea

SULPHONYUREA

  • Eg

  • Glicazide

  • Mechanism

  • Binds and blocks K+ on  cells.

  • - Insulin is secreted from  cells


Side effects sulphonyurea

Side Effects- sulphonyurea

  • Hypoglycaemia

  • Loss of normalInsulin control

  • Weight gain

  • Who is it contra-indicated for?

  • Elderly people and those with renal insufficiency


Alpha glucosidase inhibitors

ALPHA GLUCOSIDASE INHIBITORS

  • Mechanism

  • Inhibits A.G receptors which absorbs sugar in gut

  • What effect will this have on blood glucose?

  • Reduces spike of glucose after meals


Side effects a g inhibitors

Side effects – A.G inhibitors

  • If more sugar than normal is passing through GI system – what is a likely side effect

  • GI disturbance and flatulence

  • How might this affect the patients attitude to the drug?

  • Poor compliance – Raised HBA1C etc…


Post prandial glucose regulators

POST PRANDIAL GLUCOSE REGULATORS

  • Mechanism:

  • -Binds and blocks K+ on  cells.

  • - Insulin is secreted from  cells

  • This is the same Mechanism as which other drug we have seen today?

  • Sulphonyureas

  • (Has a different binding site to Sulphonyureas)


Post prandial glucose regulators1

POST PRANDIAL GLUCOSE REGULATORS

  • These are well tolerated and patients normally have good compliance

  • Hypos can occur


In practise

In practise….


Final questions

Final Questions:

  • Which 2 drugs are insulin Sensitisers?

  • Biguanides (metformin) and Thiazoladinediones (Gliclazides)

  • Which is the best Drug to reduce your HBA1C?

  • Metformin

  • Which drugs are contra-indicated in patients with heart Failure?

  • Thiazadoledinediones

  • What is a side effect of Alpha Glucosidase inhibitors?

  • GI upset and Flatulence.


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