DM Drugs Flashcards

1
Q

What do C peptides indicate?

A

Endogenous insulin (It is cleaved off to release active insulin)

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2
Q

Describe the insulin release pathway in B cells

A
  1. Uptake via GLUT2
  2. Glycolysis releases ATP
  3. ATP Potassium channel closes, membrane depolarisation
  4. Calcium channel opens, Ca2+ influx
  5. Insulin exocytosis
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3
Q

Describe the insulin signalling pathway

A
  1. Insulin binds to tyrosine kinase receptors, dimerisation and autophosphorylation of tyrosine kinase
  2. IRS-1 -> PI 3-kinase -> PIP3 -> Akt -> phosphorylation cascade
  3. Glycogen synthase activity increase, GLUT4 recruitment to membrane
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4
Q

GLUT2 vs GLUT4

A

GLUT2 is insulin-independent, constitutively expressed in B cells. Low affinity (high Km)
GLUT4 is insulin-dependent, expressed in muscle and fat cells. High affinity (low Km)

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5
Q

Where is the major site for insulin clearance?

A

Kidneys

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6
Q

Approach to treating T1D

A

Mimic normal pancreatic secretion, including:
Basal insulin- Background insulin to suppress hepatic gluconeogenesis during fasting state
Prandial insulin- Lower glucose spikes after eating

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7
Q

Rapid-acting insulin analogues: Names, advantage

A

Lispro, aspart, glulisine

Fast absorption kinetics, short DOA leads to lower incidence of hypoglycemia

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8
Q

Human insulin: indications

A

Only during emergency, IV

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9
Q

Intermediate-acting insulin: Name, advantage, disadvantage

A

Neutral protamine hagedorn (NPH)
Can be mixed with rapid-acting insulin
Highest risk of hypoglycemia (long peak effect as it acts as both basal and prandial insulin), patients need to eat meal at peak timing

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10
Q

Long-acting insulin: Name, advantage, disadvantage, indications

A

Glargine, detemir
No plasma peak, reduced risk of hypoglycemia, used as background insulin
Cannot mix with other insulins (glargine is formulated at an acidic pH)

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11
Q

If NPH is administered just before breakfast, what other drugs do the patient need to take?

A

Bfast spike needs to be taken care of (since NPH spikes around lunch)- give rapid acting

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12
Q

Where is the optimum site of injection?

A

Abdomen (fastest absorption due to blood flow)

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13
Q

How does depth of injection affect absorption?

A

Absorbed better in muscles due to greater vascularisation

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14
Q

Steroids and DM: Precaution

A

Steroids exacerbate hyperglycemia. Need to monitor blood glucose closely or increase insulin

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15
Q

Main ADRs of insulin injections, corresponding risk factors

A

Hypoglycemia (especially in old age or renal impairment)

Lipodystrophy (either atrophy or hypertrophy if injection site not rotated)

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