case pres diabetes insulin

Question 2

Parameters for the definition of Diabetes •Diabetes may be suspected :random whole blood venous samples >of __ •The fasted (8h) blood sample >___.•If 6.1-7.0 mM should do an _______

Answer 2

11.1 mM7mMoral glucose tolerance test

Question 3

Oral Glucose Tolerance Test undertaken if__• fasts overnight, •A fasting glucose sample taken•An oral glucose solution is given (75g in 300ml water)•Blood and urine samples are taken after __

Answer 3

diagnosis is uncertain2hourspatient should also rest during test

Question 4

Synthesis of Insulin - 1single chain precursor :preproinsulin. removal of its signal peptide during insertion –> ER generates ___

Answer 4

proinsulin

Question 5

Synthesis of Insulin - 2Proinsulin : 3 domains: an __-terminal B chain, a ___-terminal A chain connecting ‘C peptide’ Processing requires endopeptidases:

Answer 5

amino (β) carboxy (α) PC (prohormone convertase) enzymes - PC2 + PC3 activated in the acidified secretory granules

Question 6

Synthesis of Insulin - 3Within the ER, proinsulin acted on by specific ___which excise the C peptide, –> mature insulin. Insulin +free C peptide are packaged in the Golgi into_____

Answer 6

endopeptidases secretory granules which accumulate in the cytoplasm.Insulin forms hexamers with Zn -granule core surrounded by C-peptide

Question 7

Insulin molecules tend to form ___in solution due to H-bonding between the C-termini of B chains. Zinc ions, dimers –>___.

Answer 7

dimers hexamersMonomers + dimers readily diffuse into blood, whereas hexamers diffuse poorly.

Question 8

insulin injectionsIf the needle is injected into the muscle, the insulin is absorbed too fast.•Insulin is absorbed quickest when it is given in the ____.

Answer 8

abdomenno. of injections varies, can be 1 e.g. some young children or those in partial remission phase maintain metabolic control on intermediate or long-acting insulins alone

Question 9

RegimensTwo injections daily :mixture of short +_______ insulins (before breakfast and dinner)•Three injections daily : mixture of ____ + __ acting insulins before breakfast; short-acting alone before an afternoon snack /dinner; intermediate-acting insulin before bed

Answer 9

intermediate-actingshort and intermediate

Question 10

RegimensBasal-bolus :short-acting insulin __before main meals intermediate or long-acting insulin at bedtime

Answer 10

20–30 min can have rapid acting immediately before main meals

Question 11

Short acting soluble insulin is used in the following crisis situations: (3)

Answer 11

•diabetic ketoacidosis•control of diabetes during surgery•hyperglycemic episodes at home

Question 12

Intermediate-acting Insulins•Isophane NPH insulins•Crystalline zinc acetate insulin (IZS or lente insulins)•Isophanes extensively used in __, can mix with soluble /rapid-acting insulins in the same syringe without interaction

Answer 12

children•When soluble insulin is mixed with lente preparations it reacts with excess zinc, blunting its short-acting properties

Question 13

Long-acting Insulins•Ultralente® and Ultratard® insulins : duration of action > 24 h can be used in basal-bolus injection regimens.children?

Answer 13

action profile in children appears to be extremely variable and they may have to be injected twice daily to meet basal insulin requirementsinsulin glargine and detemir most widely used

Question 14

Pre-mixed insulins commonly used in pen injector devices__:___ in different ratios, e.g. 10:90, 15:85• may be useful when ___ is a problem

Answer 14

1. soluble:isophane2. compliance