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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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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?
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
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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