Endocrine Flashcards
Explain the roles of insulin…
Insulin is an anabolic hormone
It is responsible for lipogenesis, glycogenesis, inhibits lipolysis and proteolysis, enhances protein synthesis
What happens if there is an inadequate supply of insulin to promote absorption of glucose from the bloodstream?
Glucose levels will become really high and cause side effects like blurred vision, headache, fatigue, increased thirst.
What is ketoacidosis?
So if there is a lack of insulin and corresponding elevation in glucose, there is rapid lipolysis in the adipose tissue and you get excess fatty acids which are converted to ketone bodies in the liver, this is ketoacidosis.
With ketoacidosis you get: hyperventilation, nausea, vomiting, abdo pain and ultimately coma.
What is the treatment for type 1 diabetes…
A combination of Insulina, short acting’s and long clings etc… depending on their regime.
Give examples of rapid and short acting insulin’s, and give the duration of their action…
Rapid acting= novorapid
Short acting= actrapid and humulin S
Rapid acting= work in 5-15 mins, should inject before eating, they peak at 60 mins and last for like 4-6 hours
Short acting= work in 30-60 mins, should inject 15-30 mins before eating several times daily
They peak at 2-3 hours and last for about 8-10 hours
What isisophane insulin, what is its onset?
A short acting insulin, the onset is 30-60 mins and you should inject at least 15-30 mins before eating several times daily
They peak at about 2-3 hours and last for about 10
What are the long acting insulin’s, when do they work?
Insulin Degludec
Insulin glargine
Glucagon
Very slow onset: 2-66 hours and duration is 24 hours
What class of drug is metformin, what it’s used for and how does it work?
Biguinade
Used for type 2 diabetes
Metformin lowers your blood sugar by improving the way your body handles insulin, usually prescribed for diabetes when diet and exercise hasn’t worked.
It decreases hepatic gluconeogenesis and decreases insulin resistance.
Limits weight gain (remember when your giving insulin, insulin causes lipogenesis and inhibits lipolysis)
Decreases CVS events (diabetes is a microvascular disease)
What are the symptoms you get with metformin use?
Get GI symptoms- nausea/loose stools/diarrhoea/vit B12 deficiency/ lactic acidosis (rare)
What patients should you not give metformin to?
Shouldn’t give to people who are being treated for heart failure, have recently had an MI, have severe probs with circulation and breathing difficulties.
Because it is renally excreted, you have to stop if they have CKD
Liver problems- prevents liver taking up lactate.
What class of drug is a Gliclazide and how does it work?
It is a sulphonylurea, stimulates beta cells to release insulin and decreases the microvascular risk.
Why might sulphonylurea be used?
So sulphonylurea is metabolised by the liver, rather than the kidney therefore it can be used in CKD.
It is also useful for short periods and you can take patients on and off it.
How do glucagon like peptide 1 receptor analogues work, give examples of GLP1 analogues…
They end in TIDES like pepTIDE
Exenatide, liraglutide
They upregulate intracellular cAMP, resulting in the release of insulin given elevated blood glucose concentrations.
Glucagon secretion is also decreases in a glucose dependant fashion.
What are some side effects you get with GLP1 agonists?
You get GI symptoms: nausea/loose stools/diarrhoea/pancreatitis
GORD
As you can inject- painful
