Insulin and oral diabetic agents

Question 1

type 1 diabetes pathophysiology

Answer 1

beta cell destruction

insulin deficient

Question 2

type 2 diabetes pathophysiology

Answer 2

insulin resistant

beta cell dysfunction

Question 3

treatment for type 1 diabetes

Answer 3

insulin

Question 4

treatment for type 2 diabetes

Answer 4

antihyperglycaemic agents including insulin at later stages

Question 5

what does metformin do overview

Answer 5

improves insulin resistance in skeletal muscle and liver through cAMP mechanism

Question 6

what 3 organs does metformin act on

Answer 6

gut
liver
skeletal muscle

Question 7

what does metformin do to the gut

Answer 7

prevents absorption of glucose

Question 8

what does metformin do to the liver

Answer 8

inhibits glycogenolysis and inhibits gluconeogenesis

Question 9

what does metformin do to skeletal muscle

Answer 9

enhances skeletal muscle glucose uptake

Question 10

effect of metformin

Answer 10

HbA1c reduction 1%

Question 11

what percentage of HbA1c is a marker of diabetes

Answer 11

> 6.5%

Question 12

benefits of metformin (3)

Answer 12

weight neutral
no risk of hypoglycaemia
improves cardiovascular mortality

Question 13

3 side effects of metformin

Answer 13

GI
Lactic acidosis
vitamin B12 deficiency

Question 14

what is metformin taken with meals

Answer 14

GI side effects

Question 15

what is sulphonylureas

Answer 15

insulin secretogogue (stimulates the release of insulin from beta cells)

Question 16

2 types of sulphonylureas

Answer 16

Gliclazide

Glimepiride

Question 17

side effects of sulphonylureas

Answer 17

weight gain

hypoglycemia

Question 18

what do thiazolidinediones do

Answer 18

modulate the transcription of insulin sensitising genes

Question 19

e.g of a thiazolidinedione

Answer 19

Glitazones

Question 20

benefits of Glitazones

Answer 20

reduce HbA1c by 1%
no hypo risk
beta cell preservation?

Question 21

side effect of Glitazones (3)

Answer 21

weight gain
oedema
bone fracture

Question 22

What is the incretin effect

Answer 22

the increase in insulin release when glucose is given orally vs intravenously

Question 23

2 incretin hormones

Answer 23

GLP-1

GIP

Question 24

what is GLP-1

Answer 24

glucagon like peptide

Question 25

what degrades GLP-1 and GIP rapidly

Answer 25

DPP-4 enzyme

Question 26

where is GLP-1 released from

Answer 26

Intestinal L cells

Question 27

what do incretins do in beta cells

Answer 27

stimulate beta cells to produce insulin in a glucose dependant manor

Question 28

what does a glucose dependant manor mean

Answer 28

only stimulate the secretion of insulin if blood glucose is high

Question 29

what do incretins do on alpha cells

Answer 29

decrease glucagon release

Question 30

what organs do incretins act on

Answer 30

stomach hypothalamus pancreas

Question 31

what is the incretin effects on the brain

Answer 31

reduces appetite | promotes satiety

Question 32

incretins effect on the stomach

Answer 32

reduce gastric emptying

Question 33

purpose of GLP-1 analogues

Answer 33

because GLP-1 gets degraded so quickly by DPP-4

Question 34

e.g of GLP-1 analogue

Answer 34

liraglutide

Question 35

positives of Liraglutide (any GLP-1 analogue)

Answer 35

Reduce HbA1-c reduce weight improves cardiovascular motility

Question 36

side effects of GLP-1 analogues

Answer 36

GI | association of pancreatitis

Question 37

what do DPP-4 inhibitors do

Answer 37

block the degradation of GLP-1

Question 38

what do DPP-4 inhibitors end in

Answer 38

Gliptins

Question 39

advantages of Gliptins (DPP-4 inhibitors)

Answer 39

reduce HbA1-c by 0.8% weight neutral oral preparation

Question 40

side effects of Gliptins

Answer 40

mild GI acute pancreatitis? Increase respiratory infections

Question 41

apart from diabetes what can cause blood glucose in the urine

Answer 41

familial renal glucosuria

Question 42

what are the receptors in the kidneys that are Na/ glucose transporters

Answer 42

SGLT1 | SGLT2

Question 43

which receptor of the kidneys absorbs glucose

Answer 43

SGLT2

Question 44

SGLT2 inhibitors end in

Answer 44

Gliflozin

Question 45

benefits of SGLT2 inhibitors

Answer 45

no hypo risk promotes weight loss reduce cardiovascular risk

Question 46

side effects of SGLT2 inhibitors

Answer 46

increased genitourinary infections

Question 47

2 species of insulin

Answer 47

human | animal

Question 48

2 types of animal insulin

Answer 48

pork | beef

Question 49

types of insulin (4)

Answer 49

short acting intermediate acting Biphasic Analogues

Question 50

Facts about short acting insulin (4)

Answer 50

30 min onset 1-3 hours peak duration up to 8 hours e.g Humulin S

Question 51

facts about long acting insulin

Answer 51

1.5 hours onset peak 4-12 hours up to 18 hrs duration Humulin I

Question 52

premixed insulin=

Answer 52

combination of short and intermediate acting insulin

Question 53

another word for premixed insulin

Answer 53

biphasic

Question 54

normal blood glucose range=

Answer 54

4-7mmol/l

Question 55

what happens normally after BG absorption

Answer 55

insulin pulsed into hepatic portal vein from storage in the pancreas

Question 56

in combined insulin what is the long acting for

Answer 56

to maintain levels of insulin throughout the day

Question 57

in combined insulin what is the short acting for

Answer 57

for meals (peaks of glucose)

Question 58

insulin side effects (3)

Answer 58

hypoglycaemia allergic reactions injection site problems