Diabetes

Question 1

Insulin effects

Answer 1

Glucose – the most potent stimulant of insulin secretion

• sympathetic activation of adrenergic B2 receptors also induces insulin secretion
  (“Beta 2 tuba”)

-insulin increase hepatic glycogen stores
(“Full liver candy jar”)

• increased glycogenesis
• ​decreased glycogenolysis

-insulin increases glycogen storage and protein synthesis in muscle
(“Glycogen glazed ham”)

-increases triglyceride storage in adipocytes
(“Full fatty donut jar”)

-insulin decreases serum K+
(“Old lady Eating banana candy”)

• increased Na+/K+ ATPaase in skeletal muscle drives K+ into the cells

Question 2

Names Insulin Analogs Therapy

Answer 2

Rapid onset , Short acting (“Girls And Lads”)

(Insulin) Glulisine

• *Aspart**
• *Lispro**

Intermediate acting (“Rest Now”)

• *Regular** Insulin
• *NPH** Insulin

Long Acting (“Don’t Go”)

Insulin Detemir
Glargine

Question 3

Rapid acting , Short duration insulin Properties
(“Girls And Lads”)

Glulisine
Aspart
Lispro

Answer 3

• insulin glusine, aspart, and lispro control the postprandial glucose spike
• have rapid onset and short duration of action, mimicking post prandial response.

(“Tall immediate peak on “girls and Lads”)
(“Birds nibbling the peak”)

-these do not polymerize into hexamers so they are absorbed rapidly

Question 4

Intermediate acting insulin therapy Properties
(“Rest Now”)

• *Regular** insulin
• *NPH** insulin

Answer 4

-regular and NPH insulin have a delayed onset and intermediate duration of action (NPH is more delayed) this is due to the formation of dimers and hexamers, taking time to breakdown
(“Delayed peak on the house”)

-Regular insulin is only one to be administered IV
(“Ivy under R”)

• IV regular insulin is useful in the management of DKA (watch K+ levels)
  (“Ivy next to Candy Cane Key”)
• IV regular insulin is useful in the management of hyperkalemia (administer with glucose!)
  (“Ivy next to eaten banana”)

Question 5

Long Acting Insulin Therapy
(“Don’t Go”)

Insulin Detemir
Insulin Glargine

Answer 5

-provide a steady background level of insulin-glargine has no peak (“Roof on hat is long and flat”)

Question 6

General Side Effect of Insulin Therapy

Answer 6

-insulin therapy can cause hypoglycemia
(presents with tachycardia, palpitations, sweating, nausea)
(“Falling candy”)

Question 7

what should be administered in case of severe insulin induced hypoglycemia

Answer 7

-Gluca-gone for when your glucose is gone!

Question 8

other than Insulin Analoges , What other drugs can treat Diabetes ?

Answer 8

Sulfonylureas

• 1st Generation-“amide”
  (“Mother swan in a maid outfit”)

→ Chlorpropamide
→ Tolbutamide

• ​2nd Generation-“ride”
  (“Goslings riding on the mother swan’s back”)
  → Glyburide
  → Glimepiride
  → Glipizide

Meglitinides

• *Repa**glinide
• *Nate**glinide

GLP1- Agonists-“tide”
Exenatide
Liraglutide

DDP4 inhibitors-“gliptin”

Sitagliptin
Saxagliptin
Linagliptin

Question 9

Sulfonylureas/Meglitinides MOA

Answer 9

-bind ATP-dependent K+ channels on beta cells 􏰀 leading to depolarization of beta cells 􏰀 calcium influx 􏰀 release of endogenous insulin
(“Sulfa swan lake behind closed banana gate”)
(“Father goose gliding into the beta cell”)

Question 10

Sulfonylureas Properties

Answer 10

-Sulfa Drugs

1st Generation-“amide”

• *Chlorprop**amide
• *Tolbut**amide
• long duration of action -rarely used

2nd Generation - “ride”

• *Glybu**ride
• *Glimepi**ride
• smaller dosing, long duration of action

Glipizide

• has the shortest duration of action (less risk of hypoglycemia)

Question 11

Meglitinides Properties
(“Father goose gliding into the scene”)
Repaglinide
Nateglinide

Answer 11

-Meglitinides (glinides) are NOT sulfa drugs-can be used in patients with an allergy to sulfa
(“Father goose cannot lay eggs”)

Question 12

Sulfonylureas / Meglitinides Side Effects

Answer 12

• sulfonurease/meglitinides can cause hypoglycemia
• sulfonureas/meglitinides can cause weight gain
• 1st generation sulfonureas (cloropropramide) cause a disulfiram like reaction with ingestion of alcohol

Question 13

Sulfonylureas/Meglitinides are used for…

Answer 13

-sulfonylureas and Meglitinides are oral agents
used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“fat old lady raising 2 fingers”)

Question 14

GLP1 Agonists MOA
(“TIDE” detergent”)

• *Exena**tide
• *Liraglu**tide

Answer 14

Activate GLP 1 receptor

• increase insulin secretion/​increase satiety
• decrease Glucagon /​decrease gastric emptying

(“Langerhansel “Gulp” activated when looking at Hag”)

Question 15

DPP4 inhibitors MOA
(“4 DRIPPNG laundry items hanging”)

• *Sita**gliptin
• *Saxa**gliptin
• *Lina**gliptin

Answer 15

inhibit DPP4 enzyme thus increase GLP-1 activity
(“Laundering old hag letting out endogenous gulps”)

• Dipeptidyl peptidase (DPP4) is an enzyme that usually inactivates GLP-1

Question 16

GLP1 agonists / DPP4 inhibitors Properties

Answer 16

-GLP-1 and DPP-4 inhibitors are oral agents used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“2 fingers hag”)

-GLP-1 agonists and DPP-4 inhibitors increase endogenous insulin release and C-Peptide levels
(“C-Wrapper”)

-GLP-1 agonists and DDP-4 inhibitors decrease glucagon secretion this aids in lowering serum glucose levels
(“Falling empty glucagon packets”)

-GLP-1 and DDP-4 inhibitors decrease gastric emptying leading to increase satiety and delayed glucose absorption
(“Sealed gastric container”)

-GLP-1 agonists and DPP-4 inhibitors do NOT cause hypoglycemia
(“Green candies NOT falling off the tree”)

Question 17

GLP-1 agonists Side Effects

Answer 17

-GLP-1 agonists (exenatide) can cause pancreatitis, seek immediate medical care

(“Creepy detergent lady Squeezing pancreas sponge”)

Question 18

DPP4 inhibitors Side Effects

(“DRIPPNG laundry items hanging”)

Answer 18

-DPP-4 inhibitors (gliptins) can increase risk for upper respiratory infections and nasopharyngitis

(“Clothespin clipping nose of 4 shirt lady “)