Drugs and Diabetes Flashcards
What are the important cells within the pancreas ?
ISLET OF LANDERHANS
Alpha - produce glucagon
Beta cell - produce insulin
What is a healthy blood glucose leve ?
Healthy fasting blood glucose 4.0 – 5.4 mmol/L
(upto 7.8 - 2h after meal)
When was insulin discovered ?
Where did it orginate
1921
Beef and pork sources.
Nomal HBA1C levels ?
42MMOL BELOW NORMAL
42- 48 at Risk
Diabetic 48mmol/mol (6.5%)
What bacteria was made to make insulin ?
The E. coli expression system was the first expression system used to produce human insulin in 1978, with the use of recombination technology in the two-chain method.
What is the insulin mechanism of action ?
1- Need insulin to activate receptors.
2 - Glut 4 opens and some Glut 1.
You need potassium to promote the uptake of k+.
How to give soluble insulin ?
- Most well-known but less used today.
- Look for lipodystrophy.
Explain how to give short-acting insulin and how it work.
Avoids insulin
dimer/hexamer formation
Faster onset, shorter duration of action
Inject directly before a meal
Multiple daily injection with meals
* Longer acting insulin used at night
Long Acting Insulins
Microcrystals has long duration! Good for elderly with poor compliance.
Intermediate Insulins
Precipitation with protamine or zinc to give finely divided amorphous solid or relatively insoluble crystals. Insulin slowly absorbed from a subcutaneous suspension
Isophane Insulin
suspension with protamine
(twice daily)
Insulin Zinc Suspension
30% amorphous, 70% crystalline
(once daily)
Biphasic Insulin
short acting/soluble plus isophane
(mixed well in the syringe)
Explain the insulin duration of action for
- Short-acting
- Soluble
- Intermediate
- Long-acting (Detemir)
- Long-acting (Glargine)
Explain Insulin Degludecultra-long acting)
The newest ultra long acting insulin is insulin degludec by Novo. It contains a fatty acid substituent on the end of the B-chain which form dihexamers. When injected it firstly forms multihexamers in the interstitial space which degrade into dimers and finally into monomers which diffuse into the circulation. It is described as ultra-long acting.
Explain insulin infusion pump ?
Despite the advances in insulin modifications its difficult for intermittent dosing with fingertip blood sampling to mimic food related insulin release
What two types of drugs induce insulin release ?
How many calories does a T2DM need to eat to reverse diabetes ?
Reversal of type 2 diabetes by diet alone (very low calorie 600/day)