Topic 18 Diabetics

Question 1

The Endocrine Pancreas produces what ?

Answer 1

Produces insulin (signalling a “fed” state), glucagon (signalling a “hungry” state), gastrin, somatostatin, and many others

Question 2

Beta cells secrete

The Endocrine Pancreas

Answer 2

insulin which causes BldGlucose to DECREASE (after all, you’re in the fed state and need to stash that energy)

Question 3

Alpha cells secrete

The Endocrine Pancreas

Answer 3

glucagon which causes BldGlucose to INCREASE

Question 4

Delta cells secrete

The Endocrine Pancreas

Answer 4

somatostatin which regulates a LOT of things (and gets very, very complicated!)

Question 5

What goes awry with pancreatitis?

Answer 5

The Exocrine Pancreas

•Releases bicarb and digestive zymogens to break down fats and proteins

Question 6

Diabetes insipidus- Critter doesn’t produce or kidneys

Answer 6

don’t respond to Vasopressin (Antidiuretic Hormone/ADH)

Question 7

Type 1 DM is an absolute what?

Answer 7

Broadly, Type 1 DM is an absolute insulin deficiency and Type 2 DM is a relative deficiency of insulin

Question 8

All DM is characterized as what?

Answer 8

as an absolute or relative deficiency of insulin

Question 9

Type 1 DM:

Answer 9

“Insulin-Dependent DM (IDDM)”

Question 10

Type 2 DM:

Answer 10

“Non-Insulin-Dependent DM (NIDDM)”

Question 11

Classic symptoms of hyperglycemia (4)

Answer 11

• Polyphagia
• Polydipsia
• Polyuria
• weightloss

Question 12

Women may develop extreme insulin

resistance – what kind of diabetes is this???

Answer 12

DM TYPE 4
Women may develop extreme insulin
resistance during their third trimesters of pregnancy (same time they might be prone to blowing out mitral valves, eh?) as a result of hormonal changes
•Controlled with insulin: uncontrolled Type 4 DM can lead to extremely large babies, dystocia, and neonatal hypoglycemia

Question 13

Insulin is a small polypeptide consisting

of two chains connected by what?

Answer 13

a disulfide bond

Question 14

31 amino acid peptide used to differentiate Type 1 DM from Type 2 DM

Answer 14

C-Protein

Question 15

Insulin is produced by ____ in the _____ in response (generally) to glucose (the archetypical ______)

Answer 15

β-cells in the pancreas

glucose (the archetypical “fed state”)

Question 16

Insulin exhibits _____ on these target tissues

Answer 16

anabolic effects

Question 17

What increasingly being used by perfusionists for hyperkalemia therapy ?

Answer 17

Insulin

often in conjunction with glucose to
“drive” potassium intracellularly

Question 18

Regular insulin

Answer 18

Humulin R, Novolin R

Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)

Question 19

Insulin aspart

Answer 19

Novolog

Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)

Question 20

Insulin glulisine

Answer 20

Apidra

Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)

Question 21

Insulin lispro

Answer 21

Humalog

Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)

Question 22

Neutral Protamine Hagedorn (NPH) insulin

Answer 22

Humulin N, Novolin N

Intermediate onset/intermediate acting Insulin
Only given SQ

Question 23

Insulin glargine

Answer 23

Lantus

Long acting insulins
Do NOT mix with other types of insulin
Give only SQ

Question 24

Insulin detemir

Answer 24

Levemir

Long acting insulins
Do NOT mix with other types of insulin
Give only SQ

Question 25

Long-term BG measurement is via what?

Answer 25

Glycated (glycosylated) Hb (HbA1c)

Question 26

Pramlintide

Answer 26

Symlin Injectable Antihyperglycemics An “Amylin” analogue

Question 27

Amylin

Answer 27

is a polypeptide released by the pancreas in conjunction with insulin works with insulin to moderate physiologic glucose levels by slowing gastric emptying and digestion

Question 28

Exenatide

Answer 28

(Byetta) : SHORT ACTING Incretin Mimetics

Question 29

Liraglutide

Answer 29

(Victoza) : LONG ACTING Incretin Mimetics

Question 30

Incretins are hormones released by what and that stimulate the pancreas to release what?

Answer 30

-by the GI tract post-prandially -the pancreas to release insulin, slow gastric emptying, decrease glucagon release, and encourage β-cell growth

Question 31

Incretins side affects | [Exenatide and liraglutide]

Answer 31

Side effects are mainly GI

Question 32

Incretins both are given how? | [Exenatide and liraglutide]

Answer 32

Both are proteins that are given SQ prior | to eating

Question 33

Oral Insulin adjuncts (5)

Answer 33

* Insulin Secretagogues * Insulin Sensitizers * α-Glucosidase Inhibitors * Dipeptidyl Peptidase-IV Inhibitors * Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors)

Question 34

Oral Insulin adjuncts often used as port of what?

Answer 34

Often used as part of “progressive combination therapy” for Type 2 DM

Question 35

Glyburide

Answer 35

Diabeta, Micronase Sulfonylureas, Insulin Secretagogues

Question 36

Insulin Secretagogues do what?

Answer 36

*Increase β-cells production of insulin (so critter must still have functioning pancreas), lower hepatic glucose production, and increase peripheral insulin sensitivity

Question 37

Glimepiride

Answer 37

Amaryl Sulfonylureas, Insulin Secretagogues

Question 38

Glipizide

Answer 38

Glucotrol Sulfonylureas, Insulin Secretagogues

Question 39

Nateglinide

Answer 39

Starlix Glinides, Insulin Secretagogues

Question 40

Repaglinide

Answer 40

Prandin Glinides, Insulin Secretagogues

Question 41

Insulin Sensitizers do what?

Answer 41

*Increase peripheral cellular sensitivity to insulin without increasing insulin secretion Two types: Biguanides and Thiazolidinediones

Question 42

Metformin

Answer 42

Glucophage Biguanides, Insulin Sensitizers

Question 43

Pioglitazone

Answer 43

Actos Thiazolidinediones, Insulin Sensitizers

Question 44

Rosiglitazone

Answer 44

Avandia Thiazolidinediones, Insulin Sensitizers

Question 45

Biguanides prevents what?

Answer 45

Prevents hepatic gluconeogenesis (huh?) | ***This is very important because hepatic glucose production is the main source of excessive glucose in Type-2 DM!

Question 46

Thiazolidinediones do what?

Answer 46

Increase intracellular receptors in skeletal muscle, liver, and adipose tissue to become more sensitive to endogenous insulin.

Question 47

α-Glucosidase Inhibitors (2)

Answer 47

Acarbose (Precose) | Miglitol (Glyset)

Question 48

α-Glucosidase Inhibitors work by inhibiting what? which delays what?

Answer 48

Work by reversibly inhibiting an enzyme in the small intestines that helps digest polysaccharides into simple sugars. *This delays complex sugar digestion which “spreads out” the post-prandial blood glucose spike.

Question 49

α-Glucosidase Inhibitors cause hypoglycemia??

Answer 49

Don’t cause hypoglycemia by themselves, but will contribute significantly in combination RX

Question 50

Saxagliptin

Answer 50

Onglyza Dipeptidyl Peptidase-IV Inhibitors

Question 51

Sitagliptin

Answer 51

Januvia Dipeptidyl Peptidase-IV Inhibitors

Question 52

Miglitol

Answer 52

(Glyset) α-Glucosidase Inhibitors

Question 53

Acarbose

Answer 53

(Precose) α-Glucosidase Inhibitors

Question 54

Sodium Glucose Co-Transporter Inhibitor | SGLT Inhibitor

Answer 54

Canagliflozin (Inkovana) Only one is currently approved for use in the U.S.

Question 55

Inkovana

Answer 55

Canagliflozin | Sodium Glucose Co-Transporter Inhibitor SGLT Inhibitor

Question 56

Dapagliflozin what is it and what is unique about it?

Answer 56

(Farxiga) Sodium Glucose Co-Transporter Inhibitor (SGLT Inhibitor) was almost approved for use in the U.S. (and is still used extensively in Europe) but it was found to have one small side-effect (besides nasty intractable urinary tract yeast infections