Insulin & Oral Antidiabetics

Question 1

Is insulin a pancreatic catabolic hormone that promotes nutrient use?

Answer 1

No- anabolic and promotes storage

Question 2

What three things increase pancreas beta cells release of insulin?

Answer 2

1. Vagal innervation
2. GI hormones
3. Glucose, A.A.

Question 3

What are insulins effects on liver?

Answer 3

increase glycogen and trig. synthesis,

inhibits glyogenolysis, glycogenesis and ketogenesis

Question 4

What are insulins effects on muscle?

Answer 4

increase glucose and amino acid uptake. Increase glycogen and protein synthesis.

Question 5

What is insulins effect on adipose tissue?

Answer 5

increase triglyceride storage and inhibits lipolysis

Question 6

What if anabolic reactions can’t take place?

Answer 6

anabolic/catabolic balance is disturbed and catabolic prevail

Question 7

The metabolic changes that occur in DM are similar to those that occur during what?

Answer 7

fasting [if you have nothing to eat, you use and eventually deplete your stored nutrients.]

Question 8

What is the etiology of diabetes mellitus?

Answer 8

decrease insulin production or increase in insulin resistance

Question 9

Review epidemiology of diabetes

Answer 9

8% incidence, 20 million people in 2011, $245 billion

Question 10

What percentage are insulin dependent diabetes cases? what are they due to? detection? what age?

Answer 10

1. 5-10%
2. autoimmune destruction of beta cells
3. very low undetectable insulin
4. diagnose before 30

Question 11

What percentage is not insulin dependent? due to what? insulin levels? insulin response? onset age?

Answer 11

1. 90%
2. decreased responsiveness
3. subnormal
4. blunted
   5 usually over 40 and overweight

Question 12

What is gestational diabetes due to?

Answer 12

steroid induced insulin resistance- 7% of pregnancies –mostly 3rd trimester

Question 13

What drugs induce DM?

Answer 13

glucocorticoids or growth hormones

Question 14

What are the 4 therapeutic approaches to Type 1 DM?

Answer 14

1. insulin
2. insulin and pramlintide
3. diet
4. exercise

Question 15

What are the 4 therapeutic approaches to Type 2 DM?

Answer 15

1. diet
2. Exercise
3. anti-diabetic drugs individually or in combo
4. insulin

Question 16

What are the 3 things we do for gestational diabetes?

Answer 16

1. diet and exercise
2. insulin. only FDA approved
3. Some oral anti-diabetic drugs (sulfonylureas and biguanides)

Question 17

What are the major complications of diabetes?

Answer 17

end-stage renal disease, heart disease, stroke, hypertension, blindness, peripheral neuropathy

Question 18

What do sulfonylureas meglitides and nateglinide attack>

Answer 18

ATP sensitive K channels in the beta cells

Question 19

What do biguanides do?

Answer 19

reduce hepative gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase, antagonize the actions of glucagon

Question 20

What do thiazolidinediones act on?

Answer 20

PPARy in muscle, adipose, and liver

Question 21

Incretins or inhibitors of incretin degradation effect what cells?

Answer 21

alpha and beta cells in pancreas

Question 22

amylin analogs affect what cells?

Answer 22

alpha cells and CNS

Question 23

What receptor do we try to affect in the kidney?

Answer 23

inhibitors of sodium glucose co-transporter

Question 24

What does insulin form in concentrated solutions?

Answer 24

dimers and hexamers, but they are absorbed slowly when injected

Question 25

What are the main differences from types of administered insulin?

Answer 25

rate of absorption, onset, and duration of action

Question 26

how can we change rate of absorption?

Answer 26

mutation of amino acid residues, addition of components such as protamine, buffers in insulin

Question 27

What are lispro, aspart, glulisine?

Answer 27

rapid acting insulin

Question 28

What is regular crystalline insulin?

Answer 28

short acting

Question 29

What is NPH??

Answer 29

intermediate acting (slower than regular) insulin

Question 30

What are glargine and detemir?

Answer 30

long acting insulins

Question 31

Continuouse insulin infusions usually use what type of insulin?

Answer 31

regular or rapid acting [ lispro, aspart, glulisine]

Question 32

The effectiveness of insulin therapy can be enhanced with what?

Answer 32

amylins

Question 33

The insulin secretagogues effect what receptor?

Answer 33

decrease K efflux in beta cells(lowered with increased ATP)

Question 34

Do meglitinides or sulfonylureases have higher affinity for K channels?

Answer 34

meglitinides

Question 35

What inhibits mitochondrial glycerophosphate dehydrogenase?

Answer 35

biguanides- actions take place in the liver leading to reduction of gluconeogenesis and thus hepatic glucose output

Question 36

Does biguanides cause hypoglycemia and weight gain?

Answer 36

No, neither

Question 37

What are the agonists for PPARy?

Answer 37

Thiazolidinediones- increase insulin sensitivity in target tissures

Question 38

What do incretins do in pancreatic beta cells? alpha cells?

Answer 38

up insulin

down glucagon
[together decrease postprandial glucose]

Question 39

What does amylin do?

Answer 39

inhibit glucagon secretion and has CNS-mediated anorectic effect

Question 40

What is the only combination approved for type 1 diabetes?

Answer 40

insulin and pramlintide