Diabetes: week 1

Question 1

what happens during glycogenesis

Answer 1

glucose turning into glycogen (by insulin)

Question 2

what kind of acid base issue does ketogenesis cause?

Answer 2

metabolic acidosis

Question 3

which hormone stimulates glycogen breakdown into glucose

Answer 3

glucagon

Question 4

what are the 4 hormones that increase blood glucose

Answer 4

• epinephrine
• cortisol
• growth hormone
• glucagon

Question 5

what hormones decrease blood glucose (2)

Answer 5

• GLP-1
• insulin

Question 6

what is the main difference between type 1 and type 2 DM

Answer 6

• type one is when the pancreas fails to produce insulin due to loss of beta cells
• type 2 is when the tissue cells become resistant to insulin (this can be due to decreased sensitivity of target cells or decreased glucose production in the liver)

Question 7

what is the primary goal of treatment for DM

Answer 7

manage symptoms of hyperglycemia

Question 8

what are the 5 symptoms of acute hyperglycemia

Answer 8

• polyuria
• poydipsia
• weight gain
• lethargy
• blurred vision

Question 9

what are the 7 major complications of chronic hyperglycemia

Answer 9

• eye disease
• renal failure
• diabetic foot (ulcers)
• stroke
• heart damage
• nerve disease
• arteriosclerosis

Question 10

how does chronic diabetes affect the eye

Answer 10

high blood glucose and high blood pressure can damage eye blood vessels, causing retinopathy, cataracts, and glaucoma

Question 11

how does chronic hyperglycemia affect the kidneys

Answer 11

high blood pressure damages small blood vessels and excess blood glucose overworks the kidneys, causing nephropathy

Question 12

which issue with the heart is common which high blood pressure and insulin resistance

Answer 12

coronary heart disease

Question 13

what is coronary heart disease?

Answer 13

Coronary heart disease is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries

Question 14

what does insulin do to amino acids and proteins

Answer 14

holds on to amino acids and increases protein synthesis

Question 15

where does insulin act on when the body consumes amino acids and proteins

Answer 15

the muscle

Question 16

how does insulin act on lipids

Answer 16

increases triglyceride synthesis
decreases the release of FFA and glycerol
decreases oxidation of FFA to ketoacids

Question 17

what are the 3 major adverse effects of insulin

Answer 17

• hypoglycemia
• hypokalaemia
• lipodystrophy (injection practices)

Question 18

which type of insulin can be administered intravenously

Answer 18

Regular Insulin

Question 19

what factors would determine which type of insulin you use? ```

Answer 19

the onset, peak and duration

Question 20

which type(s) of insulin have short duration and are rapid acting

Answer 20

• insulin lispro
• insulin Aspart

Question 21

which type(s) of insulin is short duration and short acting

Answer 21

regular insulin

Question 22

which insulin will have intermediate duration

Answer 22

NPH

Question 23

which type(s) of insulin will have long duration

Answer 23

insulin glargine (Lantus), and insulin detimir

Question 24

which insulin(s) have ultra long duration

Answer 24

insulin Dregludec

Question 25

what is humilin 50/50

Answer 25

combination insulin

Question 26

what are the bolus insulins

Answer 26

insulin lispro, insulin aspart, insulin glulisine and regular insulin

Question 27

what are the basal insulins

Answer 27

NPH insulin, insulin glargine and insulin detemir

Question 28

what are the 5 main categories/types of insulin's

Answer 28

- short duration, rapid acting - short duration, short acting - intermediate duration - long duration - ultra long duration

Question 29

what are the 2 insulin sensitisers

Answer 29

- metformin (biguinide) - Rosiglitazone (TZDs)

Question 30

what are the 2 incretin agents

Answer 30

- GLP-1 receptor agonists (Liraglutide) - DPP-4 inhibitors (Sitagliptin)

Question 31

what are the 2 insulin secretagogues

Answer 31

- sulfonylureas (gliclazide) - meglitinides(repaglinide)

Question 32

what are the 2 glucose wasters

Answer 32

- SGLT 2 inhibitors - alpha glucosidase inhibitors

Question 33

how does metformin work to lower blood glucose and improve glucose tolerance

Answer 33

- it inhibits glucose production in the liver - it sensitises insulin receptors in target tissues

Question 34

can the insulin sensitizers be used to treat T1DM?

Answer 34

no, there needs to be insulin present

Question 35

which type of drug is Liaglutide

Answer 35

a GLP-1 receptor agonist

Question 36

what does GLP-1 do

Answer 36

it regulates hormones after eating to cause: - increase in insulin - decrease in glucagon - slows gastric emptying - decrease in appetite

Question 37

which anti-hyperglycemic medications are also considered non-insulin injectables

Answer 37

The incretin agents (GLP-1 receptor agents and DPP-4 inhibitors)

Question 38

what do DPP-4 inhibitors do

Answer 38

- basically inhibits DPP-4 which allows GLP-1 to do its thing

Question 39

which drug may cause hypoglycemia if taken with DPP-4 inhibitors

Answer 39

sulfonylurea

Question 40

what type of drug is Sitagliptin

Answer 40

DPP-4 inhibitor

Question 41

what are meglitinides and what do they do

Answer 41

they stimulate the release of insulin from the pancreas (same category as gliclazide/sulfonylureas but shorter acting)

Question 42

what do alpha glucosidase inhibitors do (MOA)

Answer 42

delays the absorption of dietary carbs, reducing the spike in blood glucose after a meal

Question 43

what is alpha glucosidase and what does it do

Answer 43

- alpha glucosidase is an enzyme located in the intestine that normally breaks down carbs for absorption (alpha glucosidase inhibitors inhibits this enzyme which slows the digestion of carbohydrates)

Question 44

how do you treat hypoglycemias in a patient who is taking alpha glucosidase inhibitors

Answer 44

don't give sucrose, give glucose tabs (becasue sucrose needs to be broken down and the whole point of the drug is that it doesnt break down glucose)

Question 45

what is the MOA for SLGT2 inhibitors

Answer 45

they basically inhibit SGLT-2 in the kidney, reducing reabsorption of glucose - they also increase urinary glucose excretion

Question 46

Combination insulin usually consists of which 2 types of insulin?

Answer 46

30% regular insulin and 70% NPH insulin

Question 47

what is the main benefit for sliding scale insulin

Answer 47

you can titrate to address blood sugar at that moment, prescribers will set units and rates so you just do it

Question 48

what are the three adverse effects of insulin

Answer 48

hypoglycemias hypokalemia lipoduistrophy

Question 49

which short duration rapid acting insulin should be given just after meals

Answer 49

insulin aspart

Question 50

what is the peak onset for insulin lispro

Answer 50

30 mins to 2.5 hours

Question 51

what is the peak of insulin aspart

Answer 51

1-3 hours

Question 52

what is the peak of NPH insulin

Answer 52

6-14 hours

Question 53

what is the peak of R insulin

Answer 53

1-5 hours

Question 54

what is the cloudy insulin

Answer 54

NPH

Question 55

out of biguanides and TZDs, which acts more on increasing insulin sensitivity (primarily)

Answer 55

TZDs are primarily going to work on insulin sensitivity, as well as inhibit glucose production in the liver

Question 56

whats the difference between glycogenesis and glucogenolysis

Answer 56

glycogenesis is glucose to glycogen, and glycogenolysis is vice versa

Question 57

whats the difference between meglitinides and sulfonurea?

Answer 57

meglitinides are shorter acting