Diabetes

Question 1

List classes of oral anti diabetic drugs

Answer 1

Biguanides, insulin secretagogues, thiazolidinediones (tzds), alpha glucosidase inhibitors, bile acid binding resins, amylin analogs, glifozins.

Question 2

MOA and examples of biguanides

Answer 2

Decrease liver production of glucose.
Example: metformin

Question 3

MOA and example of insulin secretagogues

Answer 3

Block inward rectifying K channel. Leads to depolarization and opening of voltage gated calcium channel. Calcium influx leads to insulin containing vesicle fusing to membrane.
Example: sulfonureas and meglitinide.

Question 4

Differences between 1st and 2nd gen sulfonureas and meglitinide.

Answer 4

1st gen requires higher dose. 2nd gen lower dose with less side effect.
Meglitinide to be taken with meals, shorter half-life, more freq dosing.

Question 5

MOA and example of tzds

Answer 5

Tzds increase insulin signal transduction to insulin receptors that have desensitized to elevated glucose.
Example: avandia and actos

Question 6

Risks associated with tzds

Answer 6

Increased risks of MI

Question 7

MOA and example of alpha glucosidase inhibitors

Answer 7

Block digestion of complex carbs. Block sucrase which converts disaccharides to monosaccharides.
Example: Acarbose

Question 8

MOA and example of incretin based therapies

Answer 8

GLP-1 agonist increases insulin secretion and blocks glucagon release.
Example: trulicity
DPP-4 Antagonist: DPP-4 enzyme inactivated GLP-1. Inhibition of DPP-4 prolongs GLP-1 activity.
Example: Januvia

Question 9

MOA and example of Amylin Analog

Answer 9

Decreases glucagon release.
Amylin is released from beta cells
Example: symlin

Question 10

Exocrine function of pancreas

Answer 10

Pancreatic enzymes breakdown fats and proteins

Question 11

Endocrine function of pancreas

Answer 11

Pancreatic islet cells: alpha cells and beta cells

Question 12

Function of islet alpha cells

Answer 12

Glucagon release, stimulated by decreased glucose levels

Question 13

Function of islet beta cells

Answer 13

Release insulin and c peptide and amylin in response to elevated glucose.

Question 14

What is unique about c peptide

Answer 14

C peptide holds A chain and B chain of insulin together. It can be used as a marker for endogenous insulin release.

Question 15

List four main types of diabetes

Answer 15

Type I- insulin dependent
Type II- non-insulin dependent
Type III- other causes of high glucose related to transient release in pancreatic hormone release (pancreatitis/pancreatic cancer, drug tx)
Type IV- gestational

Question 16

Main s/s of diabetes

Answer 16

Polydipsia, polyuria, polyphagia

Question 17

Polyol pathway

Answer 17

Take glucose into cell but stores it in the form of sorbitol (sugar alcohol). Sorbitol doesn’t leave cell, it will increase osmotic pressure. This causes water to enter cell until it bursts.

Question 18

Where is the sorbitol pathway most evident (where it can be seen more commonly)

Answer 18

Eye lens, nerves, RBCs

Question 19

List the high affinity GLUT transporters

Answer 19

GLUT 1 Brain and RBC. RBC only utilize glucose as energy. Brain prefers glucose but can use fatty acid oxidation.

Question 20

List low affinity GLUT transporter

Answer 20

GLUT 2: pancreas, liver, kidney and gut. Only active with high levels of glucose.

Question 21

Primary GLUT transporter in cells

Answer 21

GLUT 4

Question 22

Endocrine effects of insulin

Answer 22

Decrease glycogenolysis, decrease amino acids and fatty acid metabolism into ketoacids, enhances glucose storage into glycogen.

Question 23

Insulin receptor

Answer 23

Tyrosine kinase receptor, needs two insulin molecules to activate. Self dimerize. When activated cause GLUT 4 to locate at cell membrane.

Question 24

Inhibition of insulin secretion

Answer 24

1. Insulin operates via negative feedback
2. Leptin: secreted when stomach full inhibits insulin secretion
3. SNS: epi acts like glucagon
4. Chronically high glucose: initially higher insulin but chronically will desensitize insulin receptors
5. Drug therapy: phenytoin

Question 25

Rapid acting insulins:

Answer 25

Lispro, aspart, glulisine

Question 26

Shirt acting (regular) insulins

Answer 26

Novolin, humulin

Question 27

Intermediate acting insulins:

Answer 27

Neutral protamine Hagedorn

Question 28

Long acting insulins

Answer 28

glargine, detemir, degludec

Question 29

Insulin dosage

Answer 29

1 unit of Rapid acting insulin will displace 12-15 grams of carbs.

1 unit of Rapid acting insulin will lower glucose by 50 mg/dL

Question 30

Glucose during times of illness

Answer 30

Glucose will be highest if sick and NPO, elevated if sick and eating and lower when normal and healthy.

Question 31

Hypoglycemia s/s

Answer 31

Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating.

Question 32

Hypoglycemia treatment

Answer 32

Glucagon injection: 1 mg Q20mins
Simple sugars: 3-4 glucose tabs, 1/2 soda.

Question 33

Side effect of glifozins

Answer 33

Increased glucosuria which can feed bacteria in bedridden/incontinent patients. Leading to skin breakdown/infections