Drugs Used In Diabetes

Question 1

Semi-synthetic Insulin label

Answer 1

EMP

Question 2

Bio-Synthetic Insulin label

Answer 2

PRB, CRB or PYR

Question 3

What is Isophane Insulin

Answer 3

Complexed with protamine

Question 4

What is Biphasic Isophane

Answer 4

Mix of protamine insulin and soluble insulin

Question 5

New Human Insulin Analogues

Answer 5

Aspart, Glulisine, Degludec, Lispro, Gargine, Determir

Question 6

Rapid acting example and counselling point

Answer 6

Novorapid - take 5mins before eating, during or straight after

Question 7

Short acting example and counselling point

Answer 7

Actrapid/ Humulin S - take 15 mins before eating

Question 8

Analogue mixture example and counselling point

Answer 8

Novomix 30 - 5mins before eating, during or straight after

Question 9

Medium and Long acting examples and counselling point

Answer 9

Medium - Insulatard
Longer - Levemir and lantus
Inject at night

Question 10

Mixture example and counselling point

Answer 10

Humulin M3 - 20/30 mins before food

Question 11

+ve and -ve of multiple regimen

Answer 11

Flexible - can delay meals
More injections

Question 12

+ve and -ve of Twice daily regimen

Answer 12

Less injections
Fixed times for injections, not flexible- needs constant food intake.

Question 13

Name classes of drugs affecting Insulin SECRETION (SMGD)

Answer 13

Sulphonylureas
Meglitinides
GLP-1 agonists
DPP-4 inhibitors

Question 14

Name classes of drugs affecting cellular Energy METABOLISM (MP)

Answer 14

Metformin
PPAR-y agonists

Question 15

Name classes of drugs affecting absorption and reabsorption of GLUCOSE (SG)

Answer 15

SGLT-2 inhibitors
alpha-Glucosidase Inhibitors

Question 16

Mechanism of action of Sulphonylureas and Meglitinides

Answer 16

Block the ATP-sensitive K+ clannels causing depolarisation in the cell, therefore votage gated Ca2+ channels open and conc. of Ca2+ increases. Ca2+ released from cell by exocytosis in vesicles/granules with insulin.
Risk of hypoglycaemia as insulin conc. increased without glucose/

Question 17

Mechanism of action of GLP-1 Agonists

Answer 17

GLP-1 increases the glucose-dependent secretion of insulin.
It acts on the GLP-1 G-protein coupled receptors (GPCR) in B-cells
G alpha S

Question 18

Mechanism of action of DPP-4 Inhibitors

Answer 18

GLP-1 has a short half life.
DPP-4 inactivates GLP-1 in plasma.
Therefore, inhibitor inhibits breakdown of GLP-1 allowing the insulin secretion to increase.

Question 19

Mechanism of action of Metformin

Answer 19

Inhibits complex 1 in mitochondria , therefore less ATP is made which activates AMPK, causing lipolysis and inhibits fat synthesis and transcription of gluconeogenesis enzymes.
Increases function of insulin receptors.
Reduces gluconeogenesis in liver.
Increases peripheral glucose uptake and utilization.

Question 20

Mechanism of action of PPAR-y

Answer 20

Regulates transcription of genes involved in fatty acid storage and glucose metabolism.
Therefore, increases sensitivity to insulin by increasing transcription of genes involved in insulin signalling and therefore increases effectiveness of insulin.

Question 21

Mechanism of action of SGLT-2 Inhibitors

Answer 21

Inhibitors decrease reabsorption of glucose in proximal kidney and therefore increase concentrations of glucose in the urine.

Question 22

Mechanism of action of Alpha-Glucosidase Inhibitors

Answer 22

Alpha-glycosidase breaks down maltose to glucose in GIT. Inhibiting this prevents maltose -> glucose. Therefore, decreases glucose absorption after a meal.

Question 23

Where is Insulin secreted from

Answer 23

B-cells of islet of langerhans

Question 24

What does insulin target

Answer 24

Tyrosine kinase receptors

Question 25

How is glucose concentration controlled with insulin

Answer 25

Glucose up taken by GLUT-2 transporter in B-cells
Increased glucose causes insulin release to decrease concentration

Question 26

What is GLUT-4

Answer 26

A transporter that in the presence of glucose- moves to membrane from within the cell to allow glucose to move into cell for utilization

Question 27

Where is glucagon secreted from

Answer 27

A-cells of islet of langerhans

Question 28

What does glucagon do

Answer 28

Increases concentration of glucose and fatty acids by catabolism.