Diabetes

Question 1

Pancreatic enzymes and the receptors

Answer 1

• alpha- Glucagon- releases glucose stores of glycogen
• Beta- Insulin- Causes influx of glucose and K from blood to tissue
• Gamma- Pancreatic polypeptide- regulates pancreatic secretion, liver glycogen storage and GI secretions
• Delta- Somatostatin- Inhibits release of both insulin and glucagon
• Epsilon- Ghrelin- increases hunger drive

Question 2

Insulin receptors

Answer 2

• Insulin receptors are tyrosine Kinases

Question 3

Diabetes

Answer 3

• Clinical signs- glucosuria, hyperglycaemia, polyuria, polydipsia

Question 4

Rapid acting

Answer 4

• Insulin Aspart/Lispro
• Very soluble
• Injected around meals

Question 5

Intermediate

Answer 5

• Insulin Isophane
• Insulin combined with protamine
• Makes it less soluble and more slowly absorbed
• Given with fast acting for a biphasic response

Question 6

Long acting

Answer 6

• Glargine
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Question 7

Biguanide (Metformin)

Answer 7

• Metformin reduces basal hyperinsulinemia, and in combination with insulin, reduces insulin requirement
• Metformin reduces hepatic glucose production.
• Metformin facilitates peripheral glucose uptake and utilization, in part by increasing insulin action
• Uptake from circulation is increased and absorption from food is decreased
• Additional mechanisms attributed to the gut include an increase in release of glucagon-like peptide 1 (GLP-1) and a decrease of bile acid resorption
• Metformin can improve the lipid profile in hyperlipidaemic individual

Question 8

Metformin side effects

Answer 8

• Headache
• N&V- take with food
• Lactic acidosis
• Reduced B12 absorption

Question 9

SGLT2 inhibitor

Answer 9

• Inhibition of SGLT2 by dapagliflozin reduces reabsorption of glucose from the glomerular filtrate in the proximal renal tubule with a concomitant reduction in sodium reabsorption leading to urinary excretion of glucose and osmotic diuresis

Question 10

Sulphonylureas

Answer 10

• Gliclazide reduces blood glucose levels by stimulating insulin secretion from the β - cells of the islets of Langerhans
• Causes hypoglycaemia and weight gain

Question 11

Pioglitazone

Answer 11

• Improved insulin sensitivity. Pioglitazone appears to act via activation of specific nuclear receptors (peroxisome proliferator activated receptor gamma) leading to increased insulin sensitivity of liver, fat and skeletal muscle cells in animals. Treatment with pioglitazone has been shown to reduce hepatic glucose output and to increase peripheral glucose disposal in the case of insulin resistance.
• Causes bladder Ca, worsens HF, GI disturbanes, liver impairment and weight gain

Question 12

GLP-1

Answer 12

• GLP-1 is a physiological hormone that has multiple actions in glucose and appetite regulation, and in the cardiovascular system. The glucose and appetite effects are specifically mediated via GLP-1 receptors in the pancreas and the brain
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Question 13

Diabetic complications

Answer 13

• Hypo/hyper
• DKA
• Nephropathy
• Neuropathy
• Retinopathy
• Poor wound healing (foot infections)
• Gastroperesis
• ED