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Diabetes Drugs

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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  1. Diabetes Drugs

  2. 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…

  3. 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.

  4. 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?

  5. Drug Table…

  6. 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.

  7. 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

  8. 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

  9. Type 2 Diabetes (Insulin) Biguanides Thiazoladinediones Sulphonureas Alpha Glucosidase inhibitors Post Prandial Glucose regulators Metformin Pioglitazone Gliclazide Alpha Glucosidase blocker Repaglinide

  10. Biguanides • Example? Metformin • Mechanism: • Glucose uptake in muscle • Gluconeogenesis • Glucose absorption • INSULIN RESISTANCE

  11. 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.

  12. 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.

  13. Side Effects - Thiazoladinediones • Weight gain • Cardiac failure/Odema • Anaemia • Liver damage • Hypoglycaemia • Osteoporotic fractures

  14. SULPHONYUREA • Eg • Glicazide • Mechanism • Binds and blocks K+ on  cells. • - Insulin is secreted from  cells

  15. Side Effects- sulphonyurea • Hypoglycaemia • Loss of normalInsulin control • Weight gain • Who is it contra-indicated for? • Elderly people and those with renal insufficiency

  16. 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

  17. 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…

  18. 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)

  19. POST PRANDIAL GLUCOSE REGULATORS • These are well tolerated and patients normally have good compliance • Hypos can occur

  20. In practise….

  21. 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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