1DIABETES AND LIPID LOWERING DRUGS

DIABETES

2DIABETES AND LIPID LOWERING DRUGS

DIABETES MECHANISM OF ACTION INDICATION ADVERSE EFFECTS

INSU

LIN

RAPIDAspart

To mimic prandial (mealtime) insulin. Aspart must be consumed right before meal or up to

15mins after meal whereas soluble insulin 15mins prior meal or immediately after.

Subcutaneously

In emergency e.g. DKA given IV subC in regular basis usually given

with LA

Headache Anxiety Tachycardia Confusion Vertigo Diaphoresis Lipodystrophy Hypersensitivity

SHORTSoluble insulin INTERMEDIATEIsophane insulin (NPH)

Delayed absorption from its conjugation with protamine, forming less soluble complex. SubC

All type of diabetes except DKA Use for basal control and usually

given with rapid or short acting insulin for mealtime control

STANDARD TREATMENT VS INTENSIVE TREATMENT

Standard treatment involves injection of insulin twice daily. In contrast intensive treatment involves more frequent injections.

ADA recommend target mean blood glucose levels of Hba1c of 7% or less or 154mg/dL

3DIABETES AND LIPID LOWERING DRUGS

LONGGlargine

Isoelectric point of insulin glargine is lower than that of human insulin, leading to precipitation at the injection site and extending its action.

Given subC Slower onset than NPH, and has

flat, prolonged hypoglycaemic effect with no peak

SULP

HONY

LURE

AS

GLICLAZIDE

Stimulate insulin release from β-cells by blocking the ATP sensitive K+ channel

Reduce hepatic glucose production Increase peripheral insulin sensitivityPharmacokinetics Extensively metabolised by CYP 450 enzymes in the

liver Excreted via liver and kidney To be used with caution in patients with renal or

hepatic insufficiency

Suitable for pt with DM2 that cannot be controlled with only diet

Hypoglycaemia Weight gain (as

insulin preferentially deposits calories in adipose tissue in Type 2 diabetics)

Hyperinsulinemia

BIGU

ANID

ES

METFORMIN

1. Reduction of hepatic glucose output (inhibits gluconeogenesis)

2. Slows intestinal absorption of sugars3. Improves peripheral glucose uptake and utilisation

(especially in muscle cells)4. Reduces hyperlipidemiaPharmacokinetics Not metabolised, cleared from the body by active

tubular secretion, excreted unchanged in the urine To be used with caution in patients with renal

insufficiency or those predisposed to metabolic acidosis

useful in overweight people with diabetes

Can suppress appetite and causes less weight gain than sulphonylureas

Largely gastrointestinal including anorexia, diarrhoea, nausea and abdominal discomfort

May cause lactic acidosis

TZDS

/GL

ITAZ

ONE

PIOGLITAZONE

Activate the transcription factor PPAR, which affects adipose cell differentiation and lipid metabolism

Metabolised in the liver by CYP 450 enzymes, metabolites are eliminated mainly in bile

Weight gain Fluid retention Heart failure Bladder cancer?

HYPOGLYCAEMIA Clinical Features

AUTONOMIC NEUROGLYCOPENIC1. Anxiety 2. Sweating3. Hunger 4. Tremor 5. Palpitations 6. Dizziness

1. Confusion 2. Vertigo 3. Drowsy 4. Visual trouble seizures 5. Coma

Initial Management

oral sugar or LA starch (toast)

if x swallow - 25-50ml 50% glucose IV (via larger vein with 0.9% saline flush to prevent phlebitis)

OR

glucagon 1mg IM if no IV access (SA so repeat after 20min

and follow with oral carbs)

4DIABETES AND LIPID LOWERING DRUGS

DIABETIC KETOACIDOSIS Clinical Features Ketonaemia ≥3 mmol/L or significant ketonuria (++ on urine dipstick) Blood glucose >11 mmol/L or known diabetes mellitus Bicarbonate (HCO3-) <15 mmol/L and/or venous pH < 7.3

Intial Management

LIPID DIS. MOA INDICATION CONTRAINDICATION ADVERSE EFFECTS INTERACTION

STAT

IN SIMVASTATIN

Inhibit enzyme HMG Co A reductase in cholesterol synthesis

Primary Hyperlipidaemia (Reduce LDL by 30% & Raise HDL by 20%)

2’ Hypercholesterolemia

during pregnancy and lactation

Headache, nausea, rashes

Sleep disturbances Rise in serum

transaminase Myositis &

Rhabdomyolysis

increased statin concentrations e.g ciclosporin, clarithromycin, calcium channel blockers, antifungals

commence 0.9% NaCl via infusion

pump + K+ replacement

IV insulin infusion (0.1u/kg/hr)

50u soluble insulin (SA) made up to 50ml with 0.9% NaCl solution

Fluid replacement

systolic <90mmHg - 500ml NaCl/10-15minsystolic >90mmHg - 1000ml/60mins

Potassium

>5.5 - NIL3.5 - 5.5 - 40mmol/L<3.5 - senior review