Insulin Flashcards
What are the types of neurons supplied to the pancreas release insulin
- Para sympathetic
- sympathetic
What type of sympathetic receptors present on insulin and what are their effects
- Beta - 2 increases insulin blood glucose level falls
- alpha-2 causes hyperglycaemia by inhibiting the release of insulin
Which hormones Promote the secretion of insulin
- Glycogen like peptide one
- gastrointestinal inhibitory peptide
- gastrin
- secretin
- cholecystokinin
What are the actions of insulin
- Inhibits hepatic glycogenolysis and gluconeogenesis. Inhibits Lipolysis in adipose tissues
- it has is it enhances the entry of amino acids into muscles and promotes protein synthesis.
- pronounce peripheral utilization of glucose and K+ uptake into the cells
What is the mechanism of action of insulin
- Insulin binds to specific receptors on the cell membrane. 2-alpha and 2-beta receptor subunits. Binding of alpha subunit activates tyrosine kinase activity of beta subunits result in phosphorylation of tyrosine residues in the receptor
- this results in a complex series of phosphorylation dephosphorylation reactions, promote entry of glucose into the cell and mediates various actions of glucose.
Why is insulin not effective orally
Because it is destroyed by proteolytic enzymes in the gut
Classified Insulin preparations based on duration of action
- Rapid acting insulin
- short acting insulin
- intermediate acting insulin
- long acting insulin
Name types of rapid acting insulins
- Insulin lispro
- Insulin aspart
- Insulin glulisine 
Name types of short acting insulin
Regular soluble insulin (crystalline)
Name Intermediate acting insulin
NPH (isophane)
Name types of long acting insulin
- Insulin Glargine
- insulin Detemir
Which type of insulin gives us a cloudy solution and is complex with protamine and zinc
Intermediate acting insulin NPH
Which type of insulin should be avoided In pregnant diabetics and cannot be mixed with other insulins because of its pH
Long acting insulin- insulin Glargine
What protein does insulin detemir bind to 
Albumin
Name mixed insulin preparation
- Intermediate acting insulin + regular insulin/rapid acting insulin
- NPH + regular acting insulin
-  NPL + lispro
Name the premixed combinations of NPL and insulin lispro
- 75% NPL/ 25% insulin lispro
- 50% NPL/50% insulin lispro
What are the Indications for using insulin
- Type one diabetes Mellitus
- Diabetic ketoacidosis
- nonketotic hypoglycaemic coma
- diabetes during pregnancy
- stress of surgery, infections and trauma in diabetics
- patient with type two diabetes mellitus in addition to oral anti diabetic drugs
What are the sites of administration for insulin
Subcutaneously In the
1. Abdomen
2. buttocks
3. anterior thigh
4. dorsal arm
What is the treatment of hypo glycaemia in diabetics
- 50 ML of 50% dextrose IV
- glucagon 1 mg IV or adrenaline 0.2 mg s.c
What are the complications of insulin therapy
- Hypoglycaemia
- allergic reactions
- lipodystrophy
- insulin resistance
- oedema
What is diabetic ketoacidosis
It is a complication of type one diabetes mellitus and its a medical emergency. Its precipitating factors are:
1. infection
2. trauma
3. severe stress
4. etc.
What is the clinical features of diabetic ketoacidosis
- Anorexia
- nausea, vomiting
- polyuria
- abdominal pain
- hypotension
- tachycardia, hyperventilation
- altered consciousness
- coma 
Name is steps for management of diabetic ketoacidosis
- Insulin replacement: Regular insulin IV 0.2 to 0.3 U/kg followed by 0.1 U/kg/hr IV
- Fluid replacement: Normal saline infused IV at 1 L/hr . Rate is slowly decreased. When blood glucose rages 250 mg/dL, 5% glucose in 1/2 Saline is administered to prevent cerebral oedema and hypoglycaemia
- Potassium to correct acidosis. KCl 10 to 20 mEq/hr administered after four hours of insulin therapy
- Sodium bicarbonate IV if required
- Phosphate, if hypo phosphate anaemia is present
- Antibiotics if there is infection
What is hyperosmolar nonketotic diabetic coma. What is the treatment
It’s a medical emergency. Severe hyperglycemia, hyper osmolarity and dehydration. 
Same as diabetic keto acidosis except the patient needs more and faster fluid replacement
What are the drug interactions of insulin
- Betta blockers
- silicylates
What happens if insulin and Beta blockers are used at the same time
The blockers cause delay recovery from hypoglycaemia
What is the interaction between insulin and salicylates
Suicide Lakesex exert hypoglycaemic effect by increasing sensitivity of pancreatic Beta cells to glucose and potentiating insulin secretion
Name oral Antidiabetic drugs
- Sulfonylureas -
i) First generation: tolbutamine, choloropropamide
ii) Second generation: Glyburide, Glipizide, gliclazide, glimrpiride - Biguanide - MetFormin
-  Meglitinide Analogue - repaglinide
- D- phenylalanine Derivative - Nateglinide
- Thiazonlidinediones- pioglitazone , rosiglitazone
- Alpha- glucosidase inhibitors acarbose, Miglitol, voglibose. 
Name newer antidiabetic drugs
- GLP-1 analogue: exenatide
- DPP-4 inhibitors: sitagliptin, saxagliptin
- Others: pramlintide
What is the mechanism of action of sulphonylureas
- Stimulates in secretion from beta cells of pancreas
- Increase the sensitivity of peripheral tissues to insulin by increasing number of insulin receptors
- Reduce the release of glucagon 
Which drug increases the release of ADH it is useful in neurogenic diabetes insipidus
Chloropropamide
Which active metabolite accumulates in Renal failure
Glibenclamide (glyburide)
Which drug can be used in type two diabetes but not in type one
MetFormin
What are the contraindications of using metFormin
Hepatic insufficiency and alcoholism
Which drug causes fluid retention, weekend in precipitate CHF
- Rosiglitazone
- Pioglitazone
Which drugs side effects include flatulence, fullness and diarrhoea
Acarbose
Which drug may cause allergic reaction
- Sitagliptin
- Saxagliptin 
What are the adverse effects of Sulfonylureas drugs
- Hypoglycaemia
- G.I. disturbances like nausea, vomiting, diarrhoea and flatulence
- Weight gain
- allergic reactions including photosensitivity, skin rashes, itching
- Teratogenicity
- intolerance to alcohol
What are the drugs That cannot be taken with Sulfonylureas
- Salicylates/ sulphonamides
- propranolol
- rifampicin, phenobarbitone
- warfarin, Sulphonamides
What is the effect of taking Sulfonylureas  With salicylates/sulfonamides
Increase free plasma concentration of sulfonyureas can cause hypoglycaemia
Why can’t sulphonylureas be taken with propanol
Inhibits glycogenolysis inhibits recovery from hypoglycaemia
Why can’t rifampicin and phenobarbitone be given with sulphonylurea
They are enzyme inducers and accelerate the metabolism of sulphonylureas and reduce its effects
What is the interaction of warfarin and sulphnomides with sulfonylurea
Inhibit metabolism of sulfonylurea can cause hypoglycaemia
What is the mechanism of action of metaformin
Activate enzyme AMP dependent protein Kinase.
What Is the effect of AMP On the body
- Decreased hepatic gluconeogenesis
- Increased peripheral utilization of glucose in skeletal muscles and fat. Increased glycogen storage in skeletal muscles and fat.
- Inhibition of alimentary absorption of glucose
What are the adverse effects of metaformin
- Metallic taste
- lactic acidosis
- vitamin B 12 deficiency due to malabsorption
- anorexia, nausea, vomiting, diarrhea, weight loss and skin rashes
Which drug also has the effect to reduceserum triglycerides and increase HDL levels
Pioglitazone
Which drug may give the adverse effect of bladder cancer and hepatotoxicity
Pioglitazone 
Which class of into diabetics reduces intestinal absorption of carbohydrates and should be given before food
Alpha glucosidase inhibitors
