Diabetes

Question 1

Name 3 main target organs of insulin

Answer 1

1. Liver
2. Muscle
3. Fat

Question 2

Describe 2 reactions which insulin increases in the liver

Answer 2

1. Glycolysis increased generation of ATP by oxidation of glucose
2. Glycogen synthesis (increase in the storage form of glucose)

Question 3

Describe 2 reactions which insulin decreases in the liver

Answer 3

1. Gluconeogenesis from pyruvate or lactate

2. Glycogenolysis (break down of glycogen)

Question 4

What is the overall effect of insulin on the liver?

Answer 4

Increased storage of glycogen in the liver

Question 5

Describe 3 reactions which insulin increases in skeletal muscle

Answer 5

1. Glut4 translocation
2. Glycogen synthesis
3. Glycolysis

Question 6

Name 2 anabolic effects of insulin on skeletal muscle

Answer 6

1. Increased amino acid uptake

2. Increased protein synthesis

Question 7

Describe 2 reactions which insulin increases on adipose tissues

Answer 7

1. Glut4 membrane translocation

2. Glycerol concentration

Question 8

Describe the overall metabolic effect of insulin on the body

Answer 8

Fuel storage in the form of glycogen for situations where there is no food present

Question 9

Name 2 types of Diabetes Mellitus

Answer 9

1. Type 1 (insulin-dependent)

2. Type 2 (non-insulin dependent)

Question 10

Describe Type 1 diabetes

Answer 10

• β cells in pancreas destroyed
• No insulin produced
• Early age onset
• Moderate genetic predisposition

Question 11

Describe Type 2 diabetes

Answer 11

• Insulin stops working at target tissues
• 35+ years old onset
• Very strong genetic predisposition
• Frequently obese

Question 12

How is insulin manufactured for therapy of Type 1 diabetes

Answer 12

Recombinant human protein in bacteria

Question 13

Name 3 ways insulin can be administered

Answer 13

1. Subcutaneously (most common)
2. Intravenously
3. Intramuscularly

Question 14

Why is insulin not administered orally?

Answer 14

Insulin is degraded by GIT

Question 15

What is the principle of insulin preparations?

Answer 15

Alter rate of absorption by increasing particle size e.g. crystallisation or complexing with zinc

Question 16

What is a short acting insulin preparation?

Answer 16

Novorapid

Question 17

Name a modified insulin preparation

Answer 17

Insulin Glargine (Lantus)

Question 18

Describe Lantus

Answer 18

• Long acting insulin analogue
• Provides constant basal insulin supply
• Prolonged absorption from site of injection
• Reduces risk of night-time hypoglycaemia

Question 19

Name 3 side effects of insulin therapy

Answer 19

1. Hypoglycaemia
2. Coma
3. Brain damage

Question 20

How is hypoglycaemia with insulin therapy reversed?

Answer 20

Sweet drinks or IV glucagon if person is unconscious

Question 21

Name 4 factors which contribute to causation of Type 2 diabetes

Answer 21

1. Genetic predisposition
2. Obesity
3. Glucocorticoids
4. HIV protease inhibitors

Question 22

Describe insulin resistance

Answer 22

• Failure of insulin to trigger its effects at target tissues
• High blood glucose levels and high insulin levels
• Can exhaust pancreas and lead to decreased insulin production

Question 23

What is the pharmacological strategy in the treatment of Type 2 diabetes?

Answer 23

Improve sensitivity of target tissues to insulin with drugs and other factors

Question 24

Describe 4 components of the therapy of Type 2 diabetes

Answer 24

1. Reduce weight by exercise and diet
2. Lower blood pressure
3. Reduce cholesterol by reducing fat intake
4. Oral hypoglycaemic agents

Question 25

Name 6 types of drugs used for Type 2 diabetes

Answer 25

1. Biguanides 2. Sulfonylureas 3. Thiazolidinediones 4. Incretin drugs 5. SGLT2 inhibitors 6. Insulin

Question 26

Name an example of a biguanides drug

Answer 26

Metforin

Question 27

Describe the mechanism of action of metformin

Answer 27

Lower blood glucose levels by increasing uptake into striated muscle and inhibiting gluconeogenesis in the liver and intestinal glucose absorption

Question 28

Name 4 side effects of metformin

Answer 28

1. Nausea 2. Anorexia 3. Diarrhoea 4. Lactic acidosis

Question 29

Name 3 contra indications of metformin

Answer 29

1. Renal disease 2. Heart failure 3. Pregnancy

Question 30

Name an example of a sulfonylureas drug

Answer 30

Gliclazide

Question 31

Describe the mechanism of action of sulfonylureas drugs

Answer 31

- Bind to K ATP receptor on β cells to mimic ATP by blocking channel - Trigger membrane depolarisation and calcium ions to enter the cell - Release of insulin by exocytosis

Question 32

Name 1 drawback of sulfonylureas drugs

Answer 32

They only work if the β cells in the pancreas are still functional

Question 33

Name an example of a thiazolidindione drug

Answer 33

Rosiglitazone

Question 34

Describe the mechanism of action of thiazolidindiones

Answer 34

- Lower blood glucose and increase insulin sensitivity - Decrease gluconeogenesis in the liver - Increase glucose uptake in muscle

Question 35

Name 2 types of incretin drugs

Answer 35

1. Incretin analogues | 2. Incretin enhancers

Question 36

Name an example of an incretin analogue

Answer 36

Byetta

Question 37

Name an example of an incretin enhancer

Answer 37

Sitagliptin

Question 38

What is the overall mechanism of action for incretin drugs?

Answer 38

Bind to GLP-1 receptors on pancreatic β cells to increase insulin release

Question 39

Name an example of an SGLT2 inhibitor

Answer 39

Dapagliflozin

Question 40

What is the mechanism of action of dapagliflozin?

Answer 40

Reversibly inhibit SGLT2 in the kidney PCT decreasing glucose reabsorption and increasing urinary glucose excretion

Question 41

What is the main challenge with dental problems and diabetes?

Answer 41

Dental treatment may interrupt normal daily routine e.g. diet / injections

Question 42

Describe the relationship between diabetes and periodontal disease

Answer 42

- Poorly controlled T1DM patients with nephropathy most at risk - Caused by poor white blood cell chemotaxis or vascular damage to gums

Question 43

Describe the relationship between diabetes and increased risk of caries

Answer 43

- Decreased salivary function | - Resolved when patients have low carb diet

Question 44

Describe the relationship between diabetes and xerostomia

Answer 44

- Reduced salivary function - Increase in salivary gland size to compensate - Could lead to infection e.g. candidiasis