Diabetes

Question 1

________ is the only drug used to treat type 1 diabetes.

Answer 1

Insulin

Question 2

T/F: Insulin is typically the first drug used to treat type II diabetes.

Answer 2

False

Patients sometimes end up needing insulin but not initially

Question 3

What is the goal of secretagogues?

Answer 3

Get beta cells to release more insulin

Question 4

What are the three classes of secretagogues?

Answer 4

1. Sulfonylureas
2. Meglitinides
3. Drugs working on GLP-1 receptors (incretins)

Question 5

What is the standard of care for treating type II diabetes?

Answer 5

Sulfonylureas and biguanides

Question 6

T/F: Suflonylureas are good for treating type I diabetes.

Answer 6

False

They will promote beta cell release of insulin but type I diabetics do not produce insulin in the first place

Question 7

The _______ decides what to do metabolically based on blood glucose levels.

Answer 7

liver

Question 8

The ________ decide whether to secrete insulin based on blood glucose information.

Answer 8

Beta cells

Question 9

How do beta cells respond to various levels of blood glucose?

Answer 9

Adjust ratio of ATP/ADP -> changes in K+ channel regulating insulin release

Question 10

What happens when someone is fasting?

Answer 10

ATP/ADP low -> K+ channel open -> hyperpolarized cell -> Ca+ channels closed -> no insulin secretion

Question 11

What happens after a meal?

Answer 11

ATP/ADP high -> K+ channel closed -> cell depolarized -> Ca+ channel open -> insulin secreted

Question 12

What is the duration of action for most sulfonylureas?

Answer 12

12-24 hours

Question 13

Where do sulfonylureas bind?

Answer 13

To a subunit of the K+ channel on beta cells - closes the K+ channel

Question 14

________ have a more rapid onset, and shorter duration of action than sulfonylureas.

Answer 14

Meglitinides

Question 15

_______ are used to generally beat down blood sugar levels. ________ are used specifically before meals.

Answer 15

Sulfonylureas; meglitinides

Question 16

What is the general mechanism of action for both sulfonylureas and meglitinides?

Answer 16

Work to promote insulin release by inhibiting K+ efflux from ATP/ADP regulated K+ channels

Question 17

________ act at the GLP-1 receptor on beta cells and stimulate insulin release.

Answer 17

Incretins

Question 18

What is generally the first line of treatment in type II diabetes?

Answer 18

Biguanides (metformin)

Question 19

T/F: Biguanides stimulate insulin secretion.

Answer 19

False

Question 20

What are the two main functions of biguanides?

Answer 20

1. Increase glucose uptake and utilization in skeletal muscle
2. Reduce hepatic glucose production

Question 21

T/F: Many patients lose weight with biguanides.

Answer 21

True

Question 22

What is the general mode of action for metformin (biguanides)?

Answer 22

Opposes glucagon

Attenuates cAMP/PKA signaling in response to glucagon

Question 23

The popular theory for metformin is that it works through activation of what enzyme?

Answer 23

AMP-dependent protein kinase (AMPK)

Question 24

____________ decrease insulin resistance, and are agonists of the PPAR-gamma.

Answer 24

Thiazolidinediones

Question 25

What is the role of PPAR-gamma?

Answer 25

Regulate fatty acid storage and glucose metabolism

Question 26

What happens when PPAR-gamma is activated?

Answer 26

Stimulate lipid uptake and adipogenesis by fat cells

Question 27

_________ act by inhibiting the digestion of glucose.

Answer 27

Alpha-glucosidase inhibitors

Question 28

T/F: Secretagogues will work on type I diabetics.

Answer 28

False

Must have functional beta cells