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E: Regulatory Physiology & Pharmacology > Diabetes > Flashcards

Flashcards in Diabetes Deck (40):
1

Name the 3 important nomenclature?

Glucose: as a sugar

Glucagon: hormone acts to stimulate glucose production

Glycogen: polymer of glucose

2

Hormones producing during starvation/fasting?

Glucagon is a peptide hormone that is released from the pancreatic alpha-cells when blood glucose drops.

Stimulates glucose production and secretion from the liver and glucogen breakdown in muscle.

 

3

Hormones produced after food or nutrient intake?

Insulin is a peptide hormone that is released from the pancreatic beta-cells when blood glucose rises.

Induces glucose removal from blood and storage.

 

4

What is the normal blood glucose level?

5mM

5

What organ in the body needs a constant supply of glucose?

Brain

6

Type 1 Diabetes?

Characterised by the failure to synthesis or secrete insulin.

Autoimmune destruction of beta cells.

 

7

Type 2 diabetes cause?

Caused by target tissues becoming resistant to the effects of inuslin

 

8

What are the minor forms of diabetes?

MODY and gestational.

9

What is the major risk factor for type 2 diabetes?

Obesity

10

3 Treatments for type 1 diabetes?

Insulin injection

Islet transplants and stem cells.

Gene therapy

11

What is the difference in structure for the proinsulin and insulin?

Proinsulin contains C peptide chain as well as alpha and beta chain (With disulphride bonds between them).

Cleaved with PC2 and 3 to make insulin (Without the C peptide chain)

12

What are the clinical uses of insulin?

Life saving for type 1 diabetes.

Last option for type 2:  for type 2 diabetes the body still produces insulin but the target cells do not respond to this insulin. Therefore the beta cells try to compensate by producing more insulin. Eventually this destroys the beta cells and insulin is needed.

Gestatinal diabetes

13

Human insulin is produced how for clincal use?

Produced by recombinant technology 

Replaced bovine and porcine insulin preparations.

14

what is the danger of injecting insulin?

If you give too much: danger of hypoglucemia. 

 

15

Is it a set insulin preparation or is there many?

There are many insulin prepartions.

Formulated to differ in their peaks and durations.

Individualised treatment

16

Name the 5 types of insulin preparations?

  1. Ultra fast/ ultra short acting
  2. Short-acting
  3. Intermediate-acting
  4. Long-acting 
  5. Ultra long-acting.

Short acting ones are best straight after nutient intake.

17

How do they make insulin ultrafast and ultra-short acting?

example of a preparation?

The 20 and 21 amino acid (Lys and Pro respectively) are swapped over on the beta chain.

Affecting the stability of this insulin prepartion. Causing it to be short acting.

 

Insulin lispro

18

Insulin lispro?

Monomeric

Rapidly acting insulin

Must be used with long-acting preparations.

19

Insulin glargine is an example of what kind of insulin preparation?

How does it vary in structure to normal insulin?

Its an ultra long-acting insulin

21st amino acid on the alpha chain is Gly and the 31 and 32nd amino acids on the beta chain are now ARG.

 

20

How successful has transplant been?

Few successful transplants.

Most had to return to insulin.

Additionally high cost: 3 donors per patient (have to be dead)

Still on drugs: swap insulin for immunosuppressants. 

21

What are stem cells?

Basal cells.

Still havent decided their fate

Can be induced into any cell fate (including beta-cells in the pancreas)

22

How could stem cell therapy be used for the treatment of type 1?

Stem cells could be removed from the patient and treated in a culture to becomes beta-cells of the pancreas.

Injected back in.

Since the cells are the patients one: immunosuppressants are not required.

23

Current treatment for type 2 diabetes?

Exercise and diet control (reduce weight): first line of treatment.

Drugs:

Alpha-glucosidase inhibitors: stops the feeling of needing to eat.

Incretins: increase insulin production.

Sulfonylureas: Stimulates insulin production. Weight gain

Giltazones (TZDs): affects adipose function.

Biguanides: Insulin sensitiser.

24

Why is exercise the first treatment?

Prevents obesity.

Utilises the glucose

Activates AMP kinase

25

What does AMP do?

Binds to and allosterically activate AMPK.

Competes to the same site as ATP (used to inactivate AMPK).

AMPK inhibits energy consuming processes.

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26

Benefits of exercise?

Reduce type 2 diabetes.

Reduce obesity and therefore the risk of obesity related disease.

27

Why exercise is the first treatement and not drugs?

Exercise doesnt impact your life

Lots of drugs have to be taken and all at different times.

Drug interactions can occur (and side effects)

28

Metformin?

Biguanide class of compounds.

Insulin sensitiser (helps insulin to work)

Increases glucose uptake into liver while inhibiting glucose production.

Activate AMP kinase

29

Problems with metformin?

Only works in 50% of cases.

Side effect: can produce lactic acidosis.

Intestinal problems.

Resistance can occur

30

Sulphonylureas?

Insulin secretogogues.

Stimulate insulin secretion from pancreatic islets.

Regulate KATP channels.

31

Problems with Sulphonylureas (SURs)?

Expensive.

Danger of hypoglycemia

Weight gain

32

Glutazones (TZD)

Bind to PPARgamma

Regulate transcription of many genes involved in metabolism of lipids and carbohydrate.

Mainly expressed in adipose.

Reduce blood glucose.

 

33

Lipogenesis?

Storing excess glucose into fat.

34

TZD problems?

Hepatotoxicity.

Hypoglcemia risk.

Very expensive

35

Acarbose?

Fungal metabolite

Slow carbohydrate digestion

36

Problems with acarbose?

Minor benefits.

Gastrointestinal side effects.

 

37

Exendin-4

Peptide produced by the salivary glands of the gila monster.

Regulate blood glucose- increasing insulin secretion from the pancreas.

38

Incretins?

Gastrointestinal peptides released into the circulation.

Breakdown the food more efficiently. 

Act at specific receptors in the pancreatic beta-cells to increase insulin secretion (only when glucose is present)

 

39

Problem with incretins?

Half life is too short to be used clinically.

Degraded by DPP-IV.

 

40

SGLT2 inhibitors?

Inhibit the SGLT2 receptor: used for the reuptake of glucose in the kidney.

Independent of insulin: low risk of hypoglycemia