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Flashcards in Pancreatic Hormones Deck (44):
1

Cell Types with the corresponding secretory products

Alpha cells (20%) Glucagon, Proglucagon
Beta cells (75%) Insulin, Proinsulin, Amylin, C- peptide
Delta cells (3-5%) Somatostatin
G cell (1%) Gastrin
F cell (1%) Pancreatic peptide

2

Type I DM
- Type IA
- Type IB

Type I DM: Insulin Dependent Diabetes Mellitus
Type IA: Immune mediated DM
Type IB: Idiopathic

3

Diagnosis of DM :
- Symptomatic

- Asymptomatic

A. Symptomatic
- RBS (Random Blood Sugar)
- RBS >200mg ( 11.1 mmol/L)
B. Asymptomatic
- FBS (Fasting Blood Sugar)
- FBS >126mg/dL or >7mmol/L on atleast 2 separate occasions
- OGTT (Oral Glucose Tolerance Test)
- Using a 75g Glucose challenge 2 hrs. post prandial blood sugar
- >200mg on atleast 2 occasions
- HbA1c (Glucosylated Hb)
- Index of blood sugar control for atleast 3 months
>6.5% for atleast 2 occasions

4

Pathology of Type I DM

Pathology of Type II DM

Type I: Destruction of B cells leading to absolute Insulin deficiency

Type II: Inadequate insulin secretion from B cells
Insulin resistance

5

(2) Insulin release patterns

1. Pulsatile in small amounts every 10 minutes
- BASAL INSULIN RELEASE
2. Large oscillations every 80-150 minutes
- w/ food intake and affected by food intake
- PRANDIAL INSULIN RELEASE

6

Type III DM

Type IV DM

Type III DM: Pancreatitis/ Pacreatectomy/ Non- pancreatitic

Type IV DM: Gestational DM
- Insulin resistance in the placental hormones during LAST TRIMESTER

7

M.O.D.Y

Maturity Onset Diabetes of the Young
- Mutation in the Glucokinase gene
in young and non obese patient

8

INSULINOPATHIES

Heterozygous inheritance of a defective gene
Release of insulin but do not bind to the receptor

9

Process by the golgi apparatus where it is hydrolyzed into insulin

PROINSULIN

10

A residual connecting segments called ________ by removal of 4 AMINO ACIDS

C peptide

11

Insulin receptors

ARBS
Alpha subunits - recognition
Beta subunits - Spans the membrane

12

Glucose Transporters 1

GLUT 1 (RBC/ Brain)
- Basal uptake of Glucose transport across the BBB

13

GLUT 2

(Ligu na kid)
- Liver/ GUT/ Kidney
Regulation of insulin release
Glucose homeostasis

14

GLUT 3

(PaKaBa)
- Placenta/ Kidney/ Brain
Uptake into neurons and other tissues

15

GLUT 4

(M---AD)
- Muscle/ Adipose tissues
Insulin mediated uptake of Glucose

16

GLUT 5

Absorption of Fructose
(Gusto ng Kid)
- GUT/ Kidney

17

Rapid Acting Insulin
- Decreases the late postmeal hypoglycemia

Insulin Lispro(Humulog)/ Aspart (Novolog)
OA: 5- 15 mins/ 10-20 mins
peak: 1 hr
DOA: 3-5 hrs

18

Short Acting Insulin

Regular Insulin
OA: 30 mins
peak: 2-3 hrs
DOA: 5-8 hrs
- (+) DKA

19

Intermediate Insulin

NPH (Isophane)
OA: 60-120 mins
LENTE INSULIN (30% Amorphous & 70% crystalline)

20

Long acting Insulin

- Glargine
- Detemir
OA: 1-1.5 hrs
peak: soluble peakless
DOA: 4-5 up to 11-24 hrs

21

Given before breakfast

MIXED (SA & IA)
30% SA
70% IA

22

Given before lunch and dinner

Regular Insulin
before meal: Regular
w/ meal : Lispro

23

Given at bedtime

IA
- Controls the NOCTURNAL HEPATIC GLUCOSE
- Improves the glucose tolerance
ass. w/ wt. loss > daytime

24

Insulin secretagogues

Sulfonylureas
Meglitinides

25

Sulfonylureas

1st gen (Inc. a/e Dec. potency)
2nd gen (vice versa)

26

Disulfiram like effect

Chlorpropamide (32 hrs half life)
- Diabenese

27

Used in mild moderate renal insufficiency

Gluguidone

28

Shortest half life

GLIPizide (Glucotrol XR)
Max DD: 20mg

29

Controls the post prandial glucose excursions
- No direct effect on insulin exocytocis

Repaglinide (Benzysuccinic acid derivative)

30

Rare a/e of Meglitinides

SJS/ TEN

31

MOA of Insulin secretagogues

Opens Ca channel
Closes the K channel

32

MOA of BIGuanides

Glucose --> Lactate
Stimulates Gluconeogenesis & Glycolysis
Dec. Glucagon levels

33

A/E of BIGuanides

B12 abs decrease
Diarrhea
GI ntolerance

34

MOA of Thiazolidinediones

Increase insulin resistance

35

Location of TZDS

Liver/ Fats/ Muscles

36

Drug Interaction between Sulfonyureas & a glucosidase inhibitors

Additive effect

37

C/I of a glucosidase inhibitors

IBS (Chrons Disease)

38

Amylin analog

PRAMLINTIDE
- SQ

39

MOA of Amylin analog

Modulates the post prandial glucose lvls
Suppress the glucagon release

40

GIP (Glu- dependent INSULINOTROPIC peptide)

GLP1 (Glucagon like peptide- 1)

GIP: K cells

GLP1: L cells

41

DPP4 Inhibitor

Sitagliptin (Januvia)

42

SGLT2

MOA:

Dapagli- FOZIN (1st drug developed)

MOA: Inh. the glucose absorption in Renal Proximal Tuule

43

MOA of Glucagon

Increase CAMP/ Gluconeogenesis/ Ketogenesis
Glycogenolysis

44

Use of Glucagon

Type I DM
B Blocker overdose
X- Ray visulaization of the bowel: relaxes the smooth muscle