Diabetes Flashcards
What is the half life of insulin?
3-5 mins
How does an increase in glucose lead to insulin release?
Increase of glucose increases ATP, which leads to a slight depolarization and influx of Ca, causing insulin to be released
What type of receptor is the insulin receptor?
Tyrosine protein kinase, phosphorylates IRS (insulin receptor substrates) leading to downstream pathways
What happens in type 1 diabetes?
Beta cells are selectively destroyed resulting in insulin deficiency
What happens in type 2 diabetes?
Tissue resistance is build against insulin resulting in no insulin action
What are the 2 diagnostic criteria for diabetes?
Elevated glucose -> fasting plasma glucose, oral glucose tolerance test
Increased Hemoglobin A1C (glycosylated hemoglobinm more long term snapshot)
What is the first line treatment of diabetes?
Well balanced diet
Exercise for weight loss
Education: rationale behind controlling glucose intake
Why can’t you take an insulin pill?
1st pass metabolism
What are the different types of insulin, and what do they do?
Regular: dimerizes, but needs to be monomeric to act
Rapid acting: unable to dimerize
Regular short acting: can’t dimerize
NPH: protamine makes it soluble (lower peak but lasts longer)
Long acting: Low peak but constant action
What drugs can you take for Type 2 diabetes?
Metformin (biguanides) - goto for type2 sulfonylureas GLP1 receptor agonists DDP4 inhibitors Thiazolidinediones SGLUT2 inhibitors Alpha-glucosidase inhibitors
What does Metformin do?
Supresses hepatic glucose production (increases AMPK activation)
inactivating glucagon receptor
What do sulfonylureas, GLP1 receptor agonistsm and DDP4 inhibitors do?
Promote insulin secretion
How do sulfonylureas such as Glyburide work?
Blocks the ATP-sensitive K channel
Side effects: loss of efficacy, hypoglycemia, weight gain
How do GLP1 receptor agonists such as Liraglutide work?
Increases cAMP to promote insulin secretion and growth of beta cells, impairs glucagon secretion
How do DDP4 inhibitors such as Sitagliptin work?
Inhibits enzyme that inactivates endogenous incretins
How do Thialidinediones and Amyin analogues work?
Decrease insulin resistance
How do Thiazolidinediones such as Rosiglitazone and Pioglitazone work?
Act on different tissues to increase insulin sensitivity
Side effects weight gain, heart failure, bladder tumor
Binds to TFs for lipid/glucose enzymes
How do amylin analogues such as pramlintide work?
Affects neural transmission to inhibit glucagon secretion
How do SGLUT2 inhibitors such as Canaglifozin work?
Inhibits renal reabsorption of glucose to increase its excretion
Side effects: UTIs (glucose rich urine), orthostatic hypotension (diuretic effect, RAAS_
How do alpha glucosidase inhibitors such as acarbose work?
Blocks intestinal glucose absorption
delays ingestion/digestion of starch
doesn’t cause hypoglycemia because doesn’t touch insulin
Side effects: gastrointestinal
