Diabetes Insulin

Question 1

Which type of diabetes is more common? How many of these patients are on insulin?

Answer 1

90% pts have type II

20% on insulin to reach goals, most don’t need it

Question 2

How do you differentiate between type I and type II diabetes?

Answer 2

Type II does not have ketoacidosis

Question 3

What percent of beta cells in pancrea must be destroyed to seem symptoms in diabetes?

Answer 3

80-90%

Question 4

How do the levels of insulin released vary between glucose given orally and glucose given iv? Why?

Answer 4

More insulin released when given orally due to the effect of incretins

Question 5

What are the three stimuli that lead to the release of insulin? Which is most important?

Answer 5

Glucose (most important)
Amino acids
Incretins

Question 6

Describe the mechanism of how glucose in the blood leads to insulin release

Answer 6

Glucose enters beta cells in pancreas via GLUT-2 receptors and undergoes glycolysis and TCA producing ATP.
Intercellular ATP closes ATP-dependent K+ channels, less K+ leaves cell and cell depolarizes.
This leads to opening of Ca+2 channels and calcium entry triggers exocytosis of preformed insulin.

Question 7

Describe the shape of the insulin receptor. What type of receptor is this? Discuss subunits

Answer 7

Tyrosine kinase receptor
Composed of two heterodimers, each with an alpha and beta subunit.
Beta subunits span membrane and have the tyrosine kinase activity.
Alpha subunits contain recognition site for insulin

Question 8

Name 5 cellular processes insulin up regulates and one it downregulates

Answer 8

Upregulates: 
glu entry into muscle and fat via GLUT4, glycogen syn in muscle and liver, 
FA syn and TAG storage in adipose,
 glycolysis, 
amino acid uptake/protein syn in muscle

Downregs: gluconeogenesis

Question 9

Name the three rapid acting insulins. Why are they rapid acting?

Answer 9

Insulin lispro, aspart, and glulisine

Don’t form hexamers

Question 10

When is rapid acting insulin given? How is it delivered?

Answer 10

Given 15 min before a meal with a longer acting insulin

SC or IV

Question 11

Which insulin can be given IV in emergency ketoacidosis?

Answer 11

Regular insulin - short acting (soluble crystalline zinc insulin)

Question 12

Name the only short acting insulin. When should it be given? How is it delivered?

Answer 12

Regular insulin (soluble crystalline zinc insulin)
30 min before a meal SC or in emergency ketoacidosis IV

Question 13

Which insulin can never be given IV? Why?

Answer 13

NPH - neutral protamine hagedornIt’s a suspension of regular insulin and protamine, not a solution!

Question 14

When choosing an insulin for a pt, you notice one type is cloudy. What is it and when is it used?

Answer 14

NPH - neutral protamine hagedorn (regular insulin + protamine)
Give with rapid or short acting for mealtime control

Question 15

Name the two long acting insulins

Answer 15

Insulin glargine and insulin detemir

Question 16

Which insulin is soluble in acidic solution but precipitates in neutral pH after SC injection forming a reservoir?

Answer 16

Insulin glargine

Question 17

Which long acting insulin cannot be combined in the same prep with shorter acting insulins? Why?

Answer 17

Insulin glargine

Must be prepped and stored in acidic pH and shorter acting insulins are in neutral pH

Question 18

Which insulin has a highly unpredictable rate of absorption?

Answer 18

NPH - neutral protamine hagedorn

Question 19

Which insulin has a peakless absorption profile and can be given once daily?

Answer 19

Insulin glargine

Question 20

Which insulin has the threonine removed from B30 position and myristate attached to terminal B29 lysine?

Answer 20

Insulin detemir

Question 21

Which insulin has peakless absorption but must be given twice a day?

Answer 21

Insulin detemir

Question 22

What is the only insulin prep that does NOT have zinc?

Answer 22

Insulin glulisine

Question 23

What delivery method of insulin is the most precise way to mimic normal insulin secretion?

Answer 23

Insulin pump

Question 24

How does the risk of hypoglycemia compare between rapid acting insulins and regular insulin?

Answer 24

Risk is LESS with rapid acting (higher risk of hypoglycemia with regular insulin)

Question 25

Three treatments for insulin induced hypoglycemia

Answer 25

Give sugar (oj or candy)
IV glucose (unconscious)
Inject glucagon

Question 26

What was a severe side effect of using animal insulin?

Answer 26

Immediate type hypersensitivity - systemic urticaria due to histamine release from mast cells sensitized by anti-insulin IgE

Question 27

Name three important drugs that can interact with insulin therapy and cause HYPOglycemia

Answer 27

Ethanol - inhibits gluconeogenesis
Beta-blockers - block effects of catecholamines and mask symptoms
Salicylates - potentiate insulin secretion

Question 28

Name four types of drugs that can interact with insulin therapy and cause HYPERglycemia through DIRECT EFFECTS ON PERIPHREAL TISSUE that counteract insulin

Answer 28

Epi
Glucocorticoids
Atypical antipsychotis (clozapine and olanzapine)
HIV protease inhibitor

Question 29

Name 4 drugs that can interfere with insulin therapy and cause HYPERglycemia by INHIBITING insulin secretion

Answer 29

Phenytoin
Clonidine
Ca+2 channel blockers
Diuretics (K+ depletion)

Question 30

How should insulin therapy change in acute illness?

Answer 30

Stop oral agents and give regular insulin

Question 31

Drug of choice to treat diabetes in pregnancy?

Answer 31

Regular insulin

Question 32

Which type of insulin is used in an insulin pump?

Answer 32

Rapid acting