Diabetes

Question 1

Describe the role of insulin. (3)

Answer 1

Stimulates the uptake of glucose into the liver, muscle and adipose.
Descrease hepatic glucose output by inhibiting gluconeogenesis.
Inhibits glycogenolysis.

Question 2

Describe the two main types of insulin that can be given in type one diabetes. (2)

Answer 2

Animal - porcine and bovine

Human recombinant - modified structure to change delivery rate.

Question 3

Describe the 6 main analogies of insulin. (6)

Answer 3

Ultrafast, rapid acting, short acting, intermediate acting, long acting, very long acting.

Question 4

Describe the ultrafast analogue of insulin. (3)

Answer 4

Onset: 5-10 minutes
Peak: 30 minutes
Duration: 2h

Question 5

Describe the rapid acting analogue of insulin. (3)

Answer 5

Onset: 5-15 minutes
Peak: 1h
Duration: 4-6h

Question 6

Name two rapid acting analogues of insulin. (2)

Answer 6

Aspart, Lispro

Question 7

Describe the short acting analogue of insulin. (3)

Answer 7

Onset: 30-60min
Peak: 2-3h
Duration: 8-10h

Question 8

Name a short acting analogue of insulin. (1)

Answer 8

Actrapid

Question 9

Describe the intermediate acting analogue of insulin. (3)

Answer 9

Onset: 2-4h
Peak: 4-8h
Duration: 12-20h

Question 10

Name one intermediate acting analogue of insulin. (1)

Answer 10

Insulatard

Question 11

Describe the long acting analogue of insulin. (3)

Answer 11

Onset: 1h
Peak: plateau 2-20h
Duration: 24h

Question 12

Name one long acting analogue of insulin. (1)

Answer 12

Glargine

Question 13

Describe the very long acting analogue of insulin. (3)

Answer 13

Onset: 1h
Peak: plateau 1-40h
Duration: over 42h

Question 14

Name one very long acting analogue of insulin. (1)

Answer 14

Degludec

Question 15

Explain why insulin prescribing errors are common. (2)

Answer 15

There are so many different types, strengths and delivery methods.

Question 16

Describe and explain the adverse effects of insulin therapy. (10)

Answer 16

Hypoglycaemia - too much insulin
Hyperglycaemia - too little insulin
Lipodystrophy - lipohypertrophy around injection sites.
Painful injections - need to vary sites.
Insulin allergies - rare, often preservative related.

Question 17

Describe the treatments available for type two diabetes treatment (3)

Answer 17

Lifestyle changes - diet management, exercise
Non-insulin therapies
Bariatric surgery

Question 18

Describe the aim of treatments of type 2 diabetes. (1)

Answer 18

HbA1c of 6.5-7.5 %

Question 19

Describe metformin. 
MoA (2)
Other outcomes (2)
Side effects (3)
Contraindications (1)
Advantages (1)

Answer 19

Reduced insulin resistance, reduced hepatic gluconeogenesis.
Limits weight gain, reduced CVS events.
GI symptoms, lactic acidosis (serious), B12 deficiency (rare)
Not to be used in CKD
Low cost.

Question 20

Describe sulphonylureas.
MoA (2)
ADRs (2)
Advantages (2)

Answer 20

Stimulates beta cells to produce more insulin, limits microvascular complications.
Side effects include Weight gain and hypoglycaemia.
Advantages of sulphonylureas include low cost and hepatic metabolism meaning can be given in CKD.

Question 21

Give the two names that are associated with the same drug that causes an increase in insulin sensitivity. (2)

Answer 21

Thiazolidinediones

Glitazones

Question 22

Describe the ADRs of glitazones. (5)

Answer 22

Weight gain
Fluid retention
Heart failure
Bladder cancer 
Bone metabolism issues

Question 23

Describe glucagon-like peptide-1 therapies. (2)

Answer 23

Increases insulin secretion from beta cells and reduces glucagon production from alpha cells.

Question 24

Describe dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors).
MoA (3)
Disadvantage (1)

Answer 24

Increase the activity of GLP-1 (glucagon-like peptide-1) to increase insulin secretion from beta cells, and reduces glucagon production from alpha cells.
Expensive

Question 25

Describe the ADRs of GLP-1 therapies and DPP-4 inhibitors. (4)
Explain why the ADRs are similar in these drugs. (3)

Answer 25

Nausea and diarrhoea, reflux, hypoglycaemia, avoid in low GFR.
Both of these drugs have similar mechanisms of action because they both increase the activity of GLP-1 to increase insulin and reduce glucagon.

Question 26

Name the common feature of all names of DDP-4 inhibitors. (1)

Answer 26

-liptin

Question 27

Describe the other name for glifozins. (1)
Describe the MoA. (2)
Describe the ADRs. (2)

Answer 27

Sodium-glucose cotransporter 2 inhibitors.
Selective inhibition of SGLT2 in PCT to increase urinary excretion of glucose.
LUTI and polyuria.

Question 28

Describe the main treatment for very severe hypoglycaemia. (1)

Answer 28

Glucagon therapy.