Diabetes (Rahhal)

Question 1

What hormones do each of the following cells produce? Beta cells:______ Alpha cells:_____ Delta cells:_____

Answer 1

Beta cells: insulin Alpha cells: glucagon Delta cells: somatostatin

Question 2

How does insulin work in regards to the protein GLUT4?

Answer 2

the pancreas releases insulin where it travels to find its receptor on various tissues. When insulin binds to its receptor, a cascade of events occurs, one of which is the expression of the protein GLUT4. GLUT4 gets inserted into the cell membrane to allow for the passage of Glc into the cell.

Question 3

What are the 3 anabolic actions of insulin with regard to the following tissues? Adipose tissue:_______ Muscle:___________ Liver:_____________

Answer 3

Adipose tissue: increase glc uptake and lipogenesis, decrease lipolysis Muscle: increase glc uptake, glycogen synthesis and protein synthesis Liver: increase glc synthesis and lipogenesis, decrease gluconeogenesis

Question 4

type ___ diabetes is a defect first of insulin action and second secretion, whereas type ____ diabetes is purely a defect of insulin secretion.

Answer 4

II; I

Question 5

type I diabetes is mostlly caused by an autoimmune response in which antibodies are made to various types of cells or antigens in the pancreas - one of the most common antibodies in type I diabetes is against this enzyme

Answer 5

glutamic acid decarboxylase

Question 6

what is the most common environmental trigger that turns on type II diabetes?

Answer 6

obesity; thought to be due to the excess circulation of free fatty acids and inflammatory cytokines that impair the insulin receptor, causing resistance, and that are toxic to beta cells

Question 7

what is a hemoglobin A1c, and why is it measured as an average over several months?

Answer 7

it is a percentage that represents that amound of glucose that is attached to red blood cells. should be <5.7%

Question 8

diabetes leads to complications such as _______ disease, which is the leading cause of end stage renal disease, adult onset blindness, and nontraumatic lower extremity amputations

Answer 8

microvascular

Question 9

this disease is seen an ~20-30% of patients with DM, which presents initially with microalbuminemia that progresses to heavy albuneuria and proteinuria

Answer 9

diabetic kidney disease (nephropathy)

Question 10

what is the leading cause of death in diabetics?

Answer 10

cardiovascular disease

Question 11

Is diabetes good or bad?

Answer 11

BAD (you’re ready for the wards!)

Question 12

what non-pharmacological approaches are appropriate for a type I diabetic? Type II?

Answer 12

Type 1: control carb intake Type 2: lose weight and control carbs

Question 13

these diabetes managment drugs inhibit the enzymes that break down complex sugars, which then slows the absorption of glucose

Answer 13

alpha glucosidase inhibitors

Question 14

this alpha glucosidase inhibitor decreases the absorption of glucose, does not affect insulin secretion so do not cause hypoglycemia, and main side effect includes flatulence and diarrhrea

Answer 14

acarbose

Question 15

what are the 3 types of insulin “secretagogues”?

Answer 15

sulfonylureas/meglitinides, GLP-1 agonists, DPP-IV inhibitors

Question 16

this class of drugs binds to their own receptors on the ATP-sensitive K+ channels in the pancreatic islet cells which starts a chain reaction that ultimately leads to the influx of calcium into the cell, and glucose-independent secretion of insulin

Answer 16

sulfonylureas (ie, glipizide, glimepiride, glyburide) and meglitinides

Question 17

where is endogenous GLP-1 made, and how do GLP-1 agonists work?

Answer 17

GLP-1 is made endogenously in the L-cells of the small intestine. GLP-1 agonists work by binding the GLP-1 receptor on the islet cells to enhance the production of insulin. It is glucose-dependent, so the main benefit is they do not cause hypoglycemia. They do not work unless glucose is already present.

Question 18

What are the 2 main side effects of GLP-1 agonists (ie, exenatide, liraglutide)?

Answer 18

nausea, some cases of pancreatitis

Question 19

contraindications of this drug include patients with heart or renal failure, becuse of the excess amount of lactic acid that is produced

Answer 19

metformin

Question 20

Which class of insulin secretagogues would you want to give to help a patient jump start their weight loss?

Answer 20

GLP-1 agonists

Question 21

what is the main side effect of sufonylureas and meglitinides?

Answer 21

hypoglycemia

Question 22

main side effects of this class of drugs includes weight gain, fluid retention, and increased risk of CV disease/death

Answer 22

TZDs (ie, rosiglitazone)

don’t use in patients with edema or CHF

Question 23

what two classes of drugs work by improving insulin sensitivity?

Answer 23

biguanides (metformin) and TZD

Question 24

how do DPP-IV inhibitors work?

Answer 24

they help GLP-1 last longer by preventing its breakdown by the DPP-IV enzyme.

*same side effects as GLP-1 agonists - may cause pancreatitis in some individuals with a history and do NOT cause hypoglycemia because they are glucose-dependent drugs.

Question 25

this drug works on the liver only to decrease gluconeogenesis; side effects include diarrhea, nausea, bloating and abdominal pain

Answer 25

metformin

Question 26

This class of drugs works by promoting insulin sensitivity, increasing glucose uptake in the skeletal muscle and increasing fatty acid uptake in adipose tissue

Answer 26

TZDs (PPAR gamma agonists)

Question 27

class of drugs that prevents the reabsorption of glucose, increasing its excretion in the proximal tubule of the kidneys

Answer 27

SGLT-2 inhibitors (ie, canagliflozin)

Question 28

side effects of this class of drugs includes vulvovaginal candidiasis and UTIs

Answer 28

SGLT-2 inhibitors

Question 29

why do we use both long-acting and short-acting treatments to control secretion of insulin?

Answer 29

becuase this mimics the body's natural secretion of insulin. long-acting for basal maintenance of insulin levels (ie, to prevent gluconeogenesis from happening all the time) and short-acting to accommodate the burst of insulin needed to handle a bolus of food.

Question 30

what is the first line treatment of a type II diabetic, after diet and exercise?

Answer 30

metformin to improve insulin sensitivity, then can add other classes as needed. evetually type II diabetics will need insulin because the pancreas will get tired.

Question 31

what is the treatment for type I diabetes?

Answer 31

insulin only

Question 32

what is the maximum effect of all drugs (besides injectable insulin) on HbA1c?

Answer 32

at maximum dose, drugs reduce HbA1c by 1% each

Question 33

what is the goal of diabetes therapy for microvascular disease?

Answer 33

HbA1c \< 7%

Question 34

what is the best way to reduce a diabetic patient's macrovascular (ie cardiovascular) disease risk?

Answer 34

control blood pressure, reduce lipids, and smoking cessation