Diabetes Flashcards
Types of DM:
Type 1: destruction of the pancreatic beta cells, leading to absolute insulin deficiency. This is usually due to autoimmune destruction of the pancreatic beta cells.
Type-2: hyperglycemia, insulin resistance, and relative impairment in insulin secretion.
Function of Insulin on Liver:
Increases the storage of Glc via insertion of GLUT-2 transporter into cells, decrease protein catabolism.
Function of Insulin on Skeletal cells:
stimulates glycogen and protein synthesis via insertion of GLUT-4 transporter.
Function of Insulin on Adipose tissues:
Facilitate TG storage (via + lipoprotein lipase) and reducing lipolysis.
Insulin is synthesized as:
proinsulin (86 amino-acid single chain polypeptide)
Ultra short (rapid acting insulin)
Lispro (Humalog)
Aspart (Novorapid)
Glulisine (Apidra)
Short acting (6-10hr)
Regular insulin (Humalin)
Intermediate acting insulin (10-12hr)
NPH (neutral protamine hagedorn insulin): a combination of regular insulin and protamine (basic protein) leading to delayed effects
Long acting insulin (>24hr)
Glargine (Lantus, Toujeo)
Determir (Levemir)
Ultra long acting >40hr insulin:
Dugledec (Tresiba)
MOA of SGLT-2 inhibitors:
inhibit renal glucose absorption in the proximal tubules thus increasing Glc secretion, They increase urine volume.
-Associated with risk of UTI.
Drugs belonging to SGLT-2 inhibitors include:
-Ozin.
There was a tribe in the SGLT part of Africa known as the Ozin tribe, the tribe suffered from a rare condition where they urinate sugar all the time, The tribe consisted from 3 men who dominated Africa (at that time: these men and their wives performed operation (mainly foot amputations) although these women had osteoprosis they did the surgeries efficiently. The Ozin tribe: 1.CaNA (CanaglifOZIN (Invokana) 2.DapaForx (DapaglifOZIN (Forxiga) 3.EmpaJar (Epmaglifozin (JArdiance)
MOA of Thiazolidinediones:
binding and activating to PPAR-gamma which regulates gene transcription involved in glucose utilization.
Increase insulin sensitivity and uptake of Glc to muscles and adipose tissues.
Drugs belonging to Thiazolidinediones:
-ZONE
when you gain weight the chances of you getting a PIOrose are minimal which may lead to broken hearts, MIs and bladder cancer.
PioRose is a rare type of flowers given to people who take care of their LFT and take it bravely with renal issues.
PioRose has two main origins: Actos and Avanda countries.
Mechanism of action of Biguanides:
- Decrease hepatic gluconeogensis and hepatic Glc production via AMP-stimulated protein kinase.
- Stimulation of glycolysis and uptake of Gl.
- Reduce plasma Glucagon levels
Mechanism of action of Sulfonylurea (idE) & Meglitinide (RepaNate):
Insulin secretagogues (meaning promotes insulin release)
via closure of K+2 channels and increasing influx of Ca+2 leading to insulin release.
Agents belonging to Sulfonylurea:
-ide There was a girl named IDE who suffered from weight gaining and multiple personalities, these personalities developed due to the trauma of K+2 closure and release of insulin. Person.1: Glipmaryl (GLimpride (Amaryl) Person.2: GlyDao (Glyburide (Daonil) Person.3: GLimpride
Agents belonging to Meglitinide (RepaNate):
Fast acting insulin secretagogues
Weight gain
Repaglinide (Novonorm)
Nateglinide
Glucagon-like peptide (GLP)-1 is a ………………………. that stimulates ………………… secretion, …………………………, and ……………………… growth.
Glucagon-like peptide (GLP)-1 is a gut hormone that stimulates insulin secretion, gene expression, and β-cell growth.
MOA of GLP-1 agonist (aka Incretin mimetics):
it interacts with a G protein–coupled receptor on the β-cells, which causes accumulation of cAMP leading to increased intracellular Ca+2 levels.
It is present in Pancreatic α-cells & L-cells of the intestinal mucosa.
the hormone is metabolized rapidly by DPP IV
Agents belonging to GLP-1 agonists include: -tide
-tide
3 best scents include:
Li-saxa-vic perfume
Exenatide
Benefits: weigh Loss and Feeling of satiety.
Risk of Pancreatitis and thyroid cancer
DDP-1 inhibitors:
-liptin.
Tea flavor developed tremendously over the years, one should try at least the amazing benefits that comes with the newer generation of Tea coming from China, these benefits include; increase HF hospitalizations URI (upper respiratory tract infections).
Flavors include:
Linta: purple tea with daisy on top (Linaglptin (Trajenta)
Sitvia: Pink with glitter (SItagliptin (Januvia)
Saxfor: blue with stars (Saxagliptin (Enforza)
α-Glucosidase Inhibitors:
inhibit intestinal Glc absorption
Acarbose, Miglitol
Pramlintide
AMylin analog which activates amylin receptors.
AMylin
a hormone cosecreted by the β-cell with insulin. Amylin has been shown to suppress prandial glucagon production and slow gastric emptying.
Epmaglifozin (JArdiance) belongs to
SGLT-2 inhibitors
weigh Loss is associated with:
Bigaunides, GLP-1 agonists
Linaglptin (Trajenta) belongs to:
DDP-1 inhibitors
Liraglutide (Victoza) belongs to:
GLP-1 agonists
Risk of Pancreatitis and thyroid cancer are associated with:
GLP-1 agonists
Example of Incretin mimetics:
DDP-1 inhibitors (i.e.Linagliptin, Saxagliptin (forxiga), Sitagliptin (Januvia)
GLP-1 agonist: Liraglutide (Victoza)
Heart Failure hospitalization is linked to:
DDP-1 inhibitors
insulin secretagogues
Sulfonylurea & Meglitinide
Pioglitazone (Actos) + Roseglitazone
Thiazoladindione
Associated with risk of UTI
SGLT-2 inhibitors
