Module F

Question 1

List and describe the functions of the 4 hormones produced by the endocrine pancreas

Answer 1

• Insulin: produced by beta cells. Increases glucose uptake, storage, and utilization, lowering blood glucose
• Glucagon: produced by alpha cells. Inhibits insulin activity and promotes glycogenolysis and gluconeogenesis, increasing blood glucose.
• Pancreatic polypeptide: facilitates digestive processes, exact functions unclear
• Amylin: function is unknown

Question 2

Describe general features of the pathophysiology, onset, and signs/symptoms of type 1 diabetes

Answer 2

• rapid onset (over a few weeks)
• Ususally juvenile onset, but may be later
• severe insulin depletion
• increased circulating glucagon (insulin inhibits glucagon secretion)
• May cause ketoacidosis

Question 3

oral hypoglycemics generally ______ (are / are not) effective in management of type 1 NIDDM

Answer 3

are not!

Question 4

Insulin ______ (can / can not) be given orally

Answer 4

can not

it is a polypeptide and is hydorlyzed in the GIT

Question 5

1 unit (u) of insulin is defined as:

Answer 5

the amount required to mobilize 10g of dietary carbohydrates

Question 6

Outline 4 major physiologic effects of insulin

Answer 6

• Inhibits glycogenolyis and promotes glycogenesis in the liver and skeletal muscles
• Promotes glucose uptake in liver and skeletal muscles by up-regulating GLUT transporters
• Promotes utilization of glucose for ATP production in skeletal muscle
• Promotes lipogenesis from glucose in adipose tissue

Question 7

Compare circulating insulin, glucagon, glucose, and ketone levels in patients with unmanaged type 1 vs type 2 diabetes

Answer 7

• Type 1: Insulin = low, glucagon = high, glucose = high, ketones = high
• Type 2: Insulin = high, glucagon = low, glucose = high, ketones = low

Question 8

The 5 classes of insulin analogues are:

Answer 8

• rapid-acting
• short-acting
• intermediate-acting
• long-acting
• inhaled

Question 9

The class of insulin analogue used to control post-prandial blood glucose is ________

Answer 9

Rapid-acting

Question 10

Rapid-acting insulins (novolog, humalog), are often combined with a ________

Answer 10

long-acting insulin (Glargine/lantus)

Question 11

The only class of insulin suitable for IV injection during DKA is _______

Answer 11

short-acting

Question 12

short-acting insulin ______ (is / is not) suitable for post-prandial glucose control because:

Answer 12

is not, because the onset is too slow and duration too short so it causes post-prandial hyperglycemia followed by reflex hypoglycemia

Question 13

The cheapest form of insulin preparation is _________. The drawbacks of this formulation are:

Answer 13

intermediate acting. Drawbacks are no consistent absorption, and much interpatient variability in activity

Question 14

Long-acting insulin (glargine/lantus) may be released over a period of ______. It is used to control _____ (basal / post-prandial) insulin levels and is often combined with _____

Answer 14

24hrs. Basal insulin levels. A rapid acting insulin

Question 15

Describe the function and advantages of inhaled insulins

Answer 15

used in place of rapid or short-acting insulins. Advantage is that it doesn’t require SC injection and therefore may lead to better patient adherence.

Question 16

The two classes of insulin secretagogues are:

Answer 16

sulfonylureas and meglinitides

Question 17

The mechanism of action of sulfonylurea drugs is:

Answer 17

they increase pulsatile (not basal) insulin secretion and decrease glucagon production. They also increase insulin sensitivity somewhat in type 2 DM

Question 18

The major adverse effects of sulfonylurea drugs (glyburide, etc.) are:

Answer 18

• hypoglycemia with increased activity or skipped meals
• skin rashes, N/V, hematologic effects
• many drug interactions

Question 19

The drugs of choice in treating type 2 diabetes are:

Answer 19

metformin

Question 20

Describe the MOA and administration of meglinitide agents

Answer 20

they increase insulin secretion over a 3-4 hour period. They are taken orally pre-prandially

Question 21

The most commonly used oral hypoglycemic is:

Answer 21

metformin

Question 22

sulfonylureas _____ (may / may not) be co-administered with a meglinitide. Either insulin secretagogue _____ (may / may not) be combined with metformin

Answer 22

may not. May

Question 23

Describe the MOA of metformin

Answer 23

• primarily inhibits liver gluconeogensis
• Increases insulin sensitivity by promoting insulin-receptor binding and up-regulating GLUT-4 transporter production
• inhibits glucose absorption from the GIT

Question 24

The first-line therapy for all type 2 diabetes is:

Answer 24

diet and lifestyle changes

Question 25

Describe the two major clinical uses of vasopressin

Answer 25

• Used as an antidiuretic to treat states of extreme water excretion such as diabetes insipidus
• Used as a vasoconstrictor to manage hypotension due to V1 receptor binding in smooth muscle

Question 26

Contrast the effects of V1 and V2 receptor binding by vasopressin

Answer 26

• V1: found in vascular smooth muscle. Binding causes vasoconstriction and increased BP
• V2: found in renal collecting ducts. Cause aquaporin production on luminal surface of CD, increased water retention and concentration of urine. Leads to increased blood volume and increased BP