Diabetes C5

Question 1

should insulin be orescribed brand specific

Answer 1

yes

Question 2

MOA DPP-4 inhibitors

Answer 2

Incretin enhancer
Blocks the enzyme responsible for incretin degradation

Incretins are responsible for stimulating the lowering of blood glucose. By inhibiting their degradation we encourage lowering of blood glucose levels

BNF:
Inhibits dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion.

Question 3

define diabetic ketoacidosis

Answer 3

ketoacidosis: this is when the body has a lack of insulin so cant move sugar into cells resulting in the breakdown of fat into ketones.

Question 4

MOA sulphonylurea (eg gliclazide)

Answer 4

Augments the secretion of insulin

Binds to the sulfonylurea receptor and blocls ATP sensitive potassium channels = dec in potassium efflux = depolarisation
Opens the voltage dependant calcium channels leading to exocytosis of insulin containing secretory granules

Question 5

MOA SGLT2 inhibitor (eg dapagloflozin, empagloflozin)

Answer 5

Inhibits sodium-glucose transporter located in proximal tubule of nephron. Means more glucose is excreted in urine

Question 6

side effects of SGLT2 inhibs

Answer 6

Back pain, cystitis (increased sugar in urine increase risk of cyctitis and thrush), urinary disorders

Question 7

MOA GLP1 mimetic (eg semaglutide - ozempic)

Answer 7

Promotes glycemic control via several different mechanisms

Analogue of the GLP1 hormine – stimulates iselet cells to increase synthesis of insulin. It also works by reducing glucagon secretion.

Question 8

how may GLP1 mimetics be misued

Answer 8

Misuse in weight loss– reduces appetite an food cravings however side effects still present

Question 9

insulin role

Answer 9

Insulin is normally secreted by the beta cells in the pancreas as a response to high levels of glucose in the blood

Bind to insulin receptors to regulate glucose transporters = increase in glucose absorption from blood

Inhibition of gluconeogenesis in liver

Binds to insulin receptor, consisting of two extracellular alpha units and two transmembrane beta units. Insulin binds to alpha unit. Stimulated tyrosine kinase activity at the beta subunit. Receptor phosphorylation activates proteins = downstream signalling. This regulates the activity of the glucose transporter and protein kinase C – involved in metabolism. This results in GLUCOSE uptake

Question 10

why is it impornat to rotate the injection site for insulin

Answer 10

Rotate the injection site of insulin. If not the consequence is lipohypertrophy – build up of fat under the skin. This can slow the absorption of insulin.