Diabetes

Question 1

type 1 diabetes

Answer 1

autoimmune destruction of insulin producing pancreatic beta cells. insulin therapy required

Question 2

incretin hormones

Answer 2

synthesized by L cells, primarily in ileum and colon. produced in response to incoming nutrients. stimulate insulin secretion.

Question 3

glucagon-like hormone 1 (GLP-1) actions

Answer 3

enhances glucose dependent insulin secretion. slows gastric emptying. suppresses glucagon secretion. promotes satiety. receptors in the islet cells, CNS, elsewhere. metabolized rapidly by DPP-4 (2-3 minute half life)

Question 4

metformin

Answer 4

activates AMP-kinase and inhibits mitochondrial isoform of glycerophosphate dehydrogenase. Reduces hepatic glucose production. biguanides.

Question 5

glibenclamide, glipizide, gliclazide, glimepiride

Answer 5

closes Katp channels on B cell plasma membranes. increases insulin secretion. sulfonylureas.

Question 6

repaglinide, nateglinide

Answer 6

closes Katp channels on B cell plasma membranes. increases insulin secretion. meglitinides.

Question 7

pioglitazone, rosiglitazone

Answer 7

activates the nuclear transcription factor PPAR. increases peripheral insulin sensitivity. thiazolidinediones

Question 8

acarbose, miglitol

Answer 8

inhibits intestinal alpha glucosidase. intestinal carbohydrate and consequently glucose absorption slowed. alpha glucosidase inhibitors

Question 9

exenatide, liraglutide, albiglutide, dulaglutide

Answer 9

activates GLP-1 receptors. increases insulin secretion and satiety. decreases glucagon secretion. slows gastric emptying. GLP-1 receptor agonists

Question 10

sitagliptin, alogliptin, saxagliptin, linagliptin

Answer 10

inhibits DPP-4 activity. increases active GLP-1 and GIP concentration, increases insulin secretion, decreases glucagon secretion. DPP-4 inhibitors

Question 11

Canagliflozin, dapagliflozin, empagliflozin

Answer 11

reduces glucose resorption in the kidney; alpha cell agonist. urinary glucose excretion increases, glucagon secretion increases. SGLT2 inhibition.

Question 12

colesevelam

Answer 12

binds bile acids/cholesterol. decreases hepatic glucose production. bile acid sequestrant.

Question 13

hypoglycemia

Answer 13

most common with treatment with sulfonylurea drugs and insulin. more common in type 1 diabetes.

Question 14

glucagon emergency kit

Answer 14

given only if unconscious or unable to swallow. patient never gives to self. turn on side. type 1 should always have prescription for this. type 2 with previous severe low blood sugar should have this.

Question 15

amylin

Answer 15

released with insulin in response to eating. from beta cells. deficient in type 1, variable in type 2. slows gastric emptying, suppresses postprandial glucagon secretion, may reduce appetite

Question 16

pramlintide

Answer 16

amylin analog. inject before each meal. reduces post-prandial glucose levels. significant risk of hypoglycemia.

Question 17

indications for insulin therapy in type 2 diabetes

Answer 17

significant hyperglycemia at presentation. hyperglycemia on max doses of oral agents. surgery. pregnancy. decompensation. serious renal or hepatic disease.

Question 18

rapid acting insulin analogs

Answer 18

lispro insulin, aspart insulin, glulisine insuin

Question 19

intermediate acting insulin analogs

Answer 19

detemir insulin. neutral protamine lispro and neutral protamine aspart

Question 20

insulin detemir

Answer 20

dose dependent duration of action. delayed release from subQ injection site due to self-association and binding to albumin. should not be diulted or mixed with any other insulin preparations

Question 21

long acting insulin analogs

Answer 21

glargine insulin

Question 22

ultra long acting basal insulin analog

Answer 22

degludec insulin

Question 23

advantages/disadvantages of premixed insulins

Answer 23

A: Convenient, potentially longer shelf life, fewer dosing errors, simple.

D: loss of flexibility in matching to carb intake or physical activity. harder to treat short term glucose levels. lack of clinical outcome data. hypoglycemia risk.

rarely used in type 1 diabetes

Question 24

inhaled insulin

Answer 24

oral inhalation, rapid acting. doses 4-8 unit increments. requires pulmonary function tests. contraindicated with chronic lung disease (asthma or COPD). may cause decreased FEV. long term risks unknown, possible increase of lung cancer

Question 25

split mix insulin therapy advantages/disadvantages

Answer 25

A: easy to use, covers insulin requirements through most of day, lower cost with NPH and regular insulin

D: not very physiological. greater likelihood of nocturnal hypoglycemia. greater chance of fasting hyperglycemia

Question 26

adverse reactions to insulin

Answer 26

hypoglycemia, weight gain, local or systemic allergic reactions, lipohypertrophy, lipoatrophy (rare)

Question 27

weight gain

Answer 27

insulin therapy reverses catabolic effects of diavetes. risk of hypoglycemia often caues patients to increase caloric intake and avoid exercise. decreased weight gain risk with more physiologic insulin administration