B / 18 : Pancreatic hormones and parenterally applied anti diabetic drugs

Question 1

Therapeutic aims of anti-hyperglycaemic therapy

Answer 1

• HbA1c (glycated Hb) < 7%
• Preprandial glucose < 7.2 mmol/L
• Postprandial glucose < 11.1 mmol/L

Question 2

Main sites of insulin degradation?

Answer 2

• Liver
• Kidney
• Muscle

Question 3

Insulin antidiabetic drugs (5)

Answer 3

• Lispro insulin
• Aspart insulin
• Regular insulin
• Isophane (NPH) insulin
• Glargine insulin

Question 4

Lispro insulin, aspart insulin
- MOA
- Effect
- Indication
- Extra
- ROA

Answer 4

• Insulin analog
• AA sequence is modified to accelerate entry into circulation
• For continuous subcutaneous insulin infusion devices
• Rapid acting
• Subcutaneous

Question 5

Why are lispro and aspart insulin good for continuous subcutaneous usage?

Answer 5

Good control of post-prandial glucose spikes

Question 6

Regular insulin
- MOA
- Effect
- Indication
- SE
- Extra
- ROA

Answer 6

• Human insulin : up-regulates GLUT4
• Decreases blood glucose level by increasing glucose intake into skeletal muscle and adipose tissue
• For diabetic ketoacidosis, gestational diabetes, hyperkalemia
• Hypoglycemia, edema, hipokalemia, allergic skin symptoms
• Short acting
• IV

Question 7

What are other things that insulin stimulates?

Answer 7

• Glycolysis
• Protein synthesis
• Glycogen synthesis

Question 8

What does insulin inhibit? (5)

Answer 8

• Proteolysis
• Lipolysis
• Ketogenesis
• Gluconeogenesis
• Glycogenolysis

Question 9

Isophane (NPH)-insulin
- MOA
- Indication
- Extra

Answer 9

• Human insulin
• Combined with rapid and short acting insulin analogs
• Intermediate acting insulin

Question 10

Glargine insulin
- MOA
- Effect
- Extra

Answer 10

• Insulin analog
• Provide basal insulin level in maintenance
• Ultra-long acting

Question 11

What is a non-insulin subcutaneous antidiabetic agent?

Answer 11

Liraglutide

Question 12

Liraglutide
- MOA
- Effect
- Indication
- SE
- ROA

Answer 12

• GLP-1 analog (glucagon-like peptide)
• Stimulate insulin synthesis & secretion, inhibit glucagon release + delay gastric emptying + beta cell proliferation
• Treatment of obesity with diabetes
• Acute pancreatitis, heartburn, nausea
• Subcutaneous injection (1/ day)