Insulin Flashcards
Which of the following is an insulin-secretagogue used in the treatment of diabetes?
- Glibenclamide
- Metformin
- Diazoxide
- Acarbose
GLIBENCLAMIDE (is a Sulphonylureas Meglitinides)
It’s a Potassium ATP Channel Inhibitor - long acting
Boosts insulin release by enhancing all the normal physiology of glucose stimulated insulin release.
ORAL before meals 1/2x Daily
Insulin resistance will cause:
- reduction of glucose transport into muscle and adipose tissue
- inhibition of hepatic glucose production
- dyslipidemia due to inhibition of fatty acid transport into mitochondria
- hypertrophy of the pancreatic beta cells
reduction of glucose transport into muscle and adipose tissue
Can result in Keto-acidosis as the body is burning fat and protein for weight loss
How does Exanatide work?
-Activating the glucagon-like peptide 1 (GLP-1) receptor
- Acting on adipocytes to increase insulin sensitivity
- Slowing the absorption of polysaccharides
- Sensitising the liver and muscle cells to insulin
-Activating the glucagon-like peptide 1 (GLP-1) receptor
It’s a Insulin Secretagogue and boosts insulin release by enhancing normal physiology incretin mediated insulin release. (Incretin Memetic)
SC injection given with other therapies. SE n/v and diarrhea, GORD, headache dizziness.
Name some INSULIN SECRETAGOGUES
- K ATP Channel Inhibitors (Sulphonylureas, Meglitinides)
- DPP-4 Inhibitors (Gliptins)
- GLP-1 Receptor Agonists (Exantide, Liraglutide)
Which of the following is NOT a principal target for the actions of insulin?
- The brain
- The liver
- The muscles
- Adipose tissue
THE BRAIN
Describe the Process of Gluocse Stimulated Insulin Release
And therefor target for diabetes drugs
Food Intake -------------- Digestion ------------- Glucose Uptake by B cells -------------- Inhibition of K ATP channels ------- Depolorisation of the cell ------------ Calcium Unfux ------- Insulin Release
What drugs raise the half life of serum GLP-1 which therefore boosts insulin release…
GLIPTINS (GLP for GLIptins)
For example
SITAGLIPTIN
VIOAGLIPTIN
`When are Hyperglycemia therapies such as DIAZOXIDE used?
They’re used for congenital hyperinsulin sensitivity in infants, insulinomas and sever cases of transient hypoglycemia.
GIVEN ORALLY with Chlorothiazide
What do SGLT2 Inhibitors stand for and how do they work…
Sodium Coupled Glucose Transporter Inhibitors (Dapaliifozin, Canaglifozin)
The SCGT reabsorbs glucose so if you inhibit this it causes excess glucose to be excreted in the urine.
(zin bit like wizz ;P )
Name some SGLT2 Inhibitors
Dapaglifozin
Canglifozin
Empaglifozin
(end in ZIN like Wizz ;) because they cause glucose in urine)
What do these T2DM terms stand for:
GDM
NDM
MODY
Gestational Diabetes Mellitus
Neonatal Diabetes Mellitus
Maturity Onset Diabetes Mellitus
Name the 3 basic Insulin Preparations for T1DM
- Short Duration; Rapid onset of Action (insulin aspart, glulisine and lispro)
- Intermediate Action (Isophane Insulin-human bovine or atrificail)
- Longer Lasting: Slower in Onset and Lasts for long periods (zinc insulins, insulin determir & glargine
Insulin ASPART, Insulin GLULISINE and Insulin LISPRO are all what type of insulin for T1DM
SHORT ACTING:
- Rapid onsed 30-60 mins
- Peak acion: 2-4 Hours
- Duration 8 hours
- Inject before food
Name some Intermediate Insulins for T1DM
Insulin DETERMIR,
Insulin GLARGINE,
Insulin ZINC SUSPENSION, ISOPHANE insulin,
PROTAMINE ZINC Insulin
Onset 1-2 hours. Peak action 4-12 hours, Duration 16-53 Hours
What is a healthy fasting glucose level? aka Normoglycemia
3-5mmol/L healthy fasting value (normoglycaemia)
Which pancreas cells release Glucagon and which release Insulin?
β-cells; release insulin
α-cell; release glucagon
True or false:
IV glucose load produces a faster insulin response than oral glucose load.
FALSE:
Oral glucose load produces a faster insulin response than intravenous glucose
What are the types of Diabetes?
T1DM
T2DM: GDM, MODY, NDM
Then there are people on the spectrum who aren’t diabetic but are at risk (pre-diabetes)
What time of life are people more susceptible to T1DM?
Childhood
True or false?
In people with Type 1 DM, insulin-producing cells have no b-cells and insulin must be provided
TRUE
How is Glucagon therapy used and name some characteristics of Glucagon therapy.
It’s a HYPERglycemic inducing drug:
Glycogenolysis (glycogen to glucose)
Gluconeogenesis
Lipolysis (fat to FAs)
Used in severe HYPO-glycemia when oral glucose is not possible. It’s given SC,IM,IV and must be reconstituted prior to use.
Name some K ATP Insulin secretagogues that are used for the treatment of T2DM
GlicaZIDE TolbutamIDE ChlopropaMIDE GlipizIDE GlimepRIDE
k ATP inhibitors all end in IDE (ATP/IDE)
Name a common SE of the drug DIAZOXIDE used for the congenital treatment of hyper-insulin sensitivity in infants.
HYPERTRICHOSIS
Excess hair growth!!! But it is reversible if treatment stops
What drug makes you wee out glucose in their urine?
Hint: ZIN (wizz)
SGLT2 Inhibirots - sodium coupled glucose transporter inhibitors
Dapaglifozin
Canaglifozin
Empaglifozin
What drugs target the K ATP channels?
Sulfphonylureas and Meglitinides
What drug raises the half life of serum GLP-1?
GLIPTINS; Sitagliptin, Vioagliptin (ORAL)
What drug is often used for T2DM falls under the ‘Biguanides’ category of insulin sensitizers?
Metformin
It’s preferred as it doesn’t cause weight gain, can be used in children and teens. Can be used in heart failure patients.
It’s often in combined therapies with other drugs like gliptins (glipizide) and K ATP channel inhibitors (repaglinide)
What are the two classes of insulin sensitisers?
- Biguanides (metformin) (metformin is the BIGdog of insulins haha)
- Thiazolidinediones (Roseglitizone, Pioglitazone)
Name some thiazolidiedione Insulin Sensitizers…
hint: DIONE/ ZONE
Rosiglitizone
Pioglitazone
Oral 2x daily. Regular glucose and fat metabolism drugs.
Also : Arandia- had to be banned as it caused Heart SE
What is the basic role of insulin sensitizers?
They increase the sensitivity of target organs to insulin
Can act in different ways (Biguanides, Thiazolidinediones)
What is the difference between insulin sensitizers
Biguanides and Thiazolidinediones?
Biguanides - activate enzymes which prevent heptatic priduction of glucose and overcome insulin resistance by improving insulin sensitivity
Thiazolindinediones - Modify gene transcription
What drugs modify Glucose Breakdown?
Hint: Glucos is in the name
a_Glucosidase Inhibitors
Such as
Acarbose
Glucobay
What is the mechanism of a-Glucosidase Inhibitors?
Such as Acarbose and Glucobay
a-Glucosidase converts oligosaccharides into glucose and by inhibiting this you modify glucose breakdown
Also slows the absorbsion of starchy foods so slows the rise in blood sugars (Acarbose)
What does the name of this drug stand for?
SGLT2
Soduim-Coupled Glucose Transporter2
It role is in glucose reabsorbsion and work by causing excessive glucose to be excreted in the urine which reduces the hyperglycemia levels.
