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Flashcards in Session 5 - Insulin Deck (24)
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1

What are the roles of insulin?

Stimulates uptake of glucose into the liver, muscle and adipose tissue.
Decreases hepatic glucose output via inhibition of gluconeogenesis.
Inhibits glycogenolysis.
Promotes uptake of fats.

2

What are the 6 main insulin categories?

Ultra fast acting
Rapid acting
Short acting
Intermediate acting
Long acting
Very long acting

3

Give an example of ultra fast acting insulin.

Insulin aspart

4

Give examples of rapid acting insulin.

Novorapid
Humalog
Apidra

5

Give examples of short acting insulin.

Actrapid
Humulin S
Hypurin Bovine
Porcine Neutral

6

Give an example of an intermediate acting insulin.

Insulatard

7

Give examples of long and very long acting insulins.

Glargine
Detemir
Degludec

8

What is insulin pump therapy?

Device used to give continuous subcutaneous insulin therapy for the treatment of type 1 diabetes mellitus. Some come with a sensor to measure the tissue glucose levels.

9

What are the possible adverse effects of insulin?

Hypoglycaemia
Hyperglycaemia
Lipodystrophy - lipohypertrophy or lipoatrophy
Painful injections
Insulin allergies

10

What causes blood glucose levels to rise outside the normal ranges?

Inability to produce insulin due to beta cel failure AND/OR insulin production is adequate but insulin resistance prevents the insulin from working effectively.

11

How is type 2 diabetes treated?

LIFESTYLE (e.g. low calorie diet)

Plus non-insulin therapies such as:
- metformin
- sulphonylureas
- thiazolidinediones
- alpha-glucosidase inhibitors
- glucagon-like peptide 1
- bariatric surgery

12

What are two important factors that affect adherence to therapy?

Risk (or perceived risk) of hypoglycaemia
Weight gain (or fear of weight gain)

13

What is the general target range for HbA1c?

6.5 - 7.5%

14

What is the mechanism of action of metformin?

Decreases insulin resistance leading to increased glucose uptake by tissues.
Decreases hepatic gluconeogenesis.
Limits weight gain.
Decreases CVS events.

15

What are the side effects of metformin?

GI symptoms
Lactic acidosis (but rare)

16

What is the mechanism of action of sulphonylureas?

Stimulates beta cells to release insulin.

17

What are the side effects of sulphonylureas?

Weight gain
Hypoglycaemia

18

Give examples of sulphonylureas.

Gliclazide
Glimepiride

19

What is the mechanism of action of alpha glucosidase inhibitors?

Inhibits the breakdown of carbohydrates to glucose by inhibiting the action of the enzyme alpha-glucosidase.

20

What are the side effects of alpha glucosidase inhibitors?

Flatulence
Loose stools
Diarrhoea

21

Give examples of glucagon like peptide 1 (GLP 1) therapies.

Exenatide
Liraglutide
Lixisenatide

22

What are the physiological effects of GLP 1 therapies?

Increased insulin secretion
Decreased glucagon secretion
Increased insulin biosynthesis
Decreased gluconeogenesis
Decreased gastric emptying
Decreased food intake through increased satiety

23

What are the adverse side effects caused by GLP-1 therapies?

GI symptoms - nauseas, loos stools, diarrhoea
Gastro-oesophageal reflux
Hypoglycaemia
Painful to inject

24

What is the mechanism of action of Dapagliflozin?

Dapagliflozin selectively inhibits SGLT2 in the renal proximal tubule.