Insulin

Question 1

What is the role of insulin?

Answer 1

Stimulates uptake of glucose into liver, muscles and adipose tissue

Decreases hepatic glucose output – inhibit gluconeogenesis

Inhibit glycogenolysis

Promotes uptake of fats

Question 2

What types of insulin are available?

Answer 2

Combine insulin

Animal

98% are on human insulin = genetically identical, made in factories

Question 3

How does altering the structure of insulin effect its pharmacokinetics?

Answer 3

If you alter the structure of insulin = change its rate of metabolism

Swapping a proline for aspartine in the beta chain = very rapidly absorbed insulin = novorapid

Question 4

Discuss insulin pump therapy

Answer 4

For T1 DM

Delivering a constant stream of rapid acting insulin

Have a meal – it will then delivery insulin

Question 5

Describe rapid acting insulin

Answer 5

Action 5-15 min

Inject before eating

Lasts 6 hrs

Novorapid

Question 6

Describe short acting insulin

Answer 6

Action 30-60 min

Inject 15-30 min before eating

Lasts 10 hrs

Actrapid, humulin S

Question 7

Describe Intermediate acting insulin

Answer 7

Action 2-4 hrs

Lasts 20 hrs

Covers between meals and over night

Insulatard

Question 8

Describe long and very long acting insulin

Answer 8

Action 2-6 hrs

Long lasts 24 hrs

Very long lasts 50+ hrs

Question 9

What is the gold standard treatment for DM

Answer 9

Gene therapy

Take cells – turn them into beta cells

Question 10

Outline the adverse effects of insulin

Answer 10

Hypoglycaemia

Hyperglycaemia

Lipodystrophy – lipohypertrophy or Lipoatrophy

Painful injections

Insulin allergies

Question 11

How does T1 and t2 DM differ?

Answer 11

1 = destruction of beta cells

2 = most overweight, insulin resistant or beta cell failure

Question 12

How do we treat T2 DM?

Answer 12

Lifestyle = low sugar/fat/calorie, exercise

Non-insulin therapies = bariatric surgery

Drug = metformin, sulphonylureas, alpha glucosidase inhibitor, glitazones

Question 13

What are the NICE targets regarding T2 DM

Answer 13

HbA1c = 6.5-7.5%

Question 14

Discuss metformin

Answer 14

Reduces hepatic gluconeogenesis

Limits weight gain

Decreased insulin resistance

Decreased CVS events

Side effects = GI symptoms
Limits weight gain

Question 15

Discuss sulphonylureas

Answer 15

Stim beta cell to release insulin

Gliclazide

Side effects = weight gain, hypo

Question 16

Describe alpha glucosidase inhibitors

Answer 16

Inhibits breakdown of carbohydrates to glucose by blocking action α Glucosidase

Acarbose

Side effects = GI symptoms

Rarely used now

Question 17

Discuss glitazones

Answer 17

Increased insulin sensitivity in muscle/adipose

Decreased hepatic glucose output

Pioglitazone

Side effects = weight gain, effect bone metabolism, fluid retention, HF, bladder cancer

Rarely used

Question 18

Describe glucagon like peptide 1 therapies (GLP-1)

Answer 18

Increase insulin secretion from the beta cells

Decreases production of Glucagon from alpha cells

Decreased food intake through increased satiety

Side effects = GI symptoms, reflux

Question 19

Describe dapagliflozin

Answer 19

Block the renal tubule from reabsorbing glucose

Risk of lower UTI, thrush

Osmotic diuresis