Insulin

Question 1

What is the role of insulin (4 statements)

Answer 1

uptake of glucose into liver, muscle and adipose tissue
decrease
decrease hepatic glucose (gluconeogenesis inhibition)
promotes uptake of fats
inhibits glycogenolysis

Question 2

what has Recombinant DNA technology allowed us to do to insulin thearpy ? what specially has been done ?

Answer 2

produce analogues - allows for different pharmokinetic properties to make it fast/slow acting .
Absorption of insulin from subcutaneous tissue

Question 3

describe the structure of insulin

Answer 3

look up picture
Short A chain
long b Chain

Question 4

what is the main aa added to ultra fast acting insulin ?

Answer 4

Asparte - FiAsp

Question 5

What is the rough onset , peak and duration of rapid acting insulin ?
when should you take this insulin?
Name 1 rapid acting insulin

Answer 5

onset = 5-15 mins
Duration = 4-6 hours
Peak = 60 Mins
take before eating 
Novorapid

Question 6

What is the rough onset , peak and duration of fast acting insulin ?
when should you take this insulin?
Name 1 fast acting insulin

Answer 6

onset = 30-60 mins
peak = 2-3 hours
duration = 8-10 hours
15 - 30 min before meals 
Actrapid, Humulin S

Question 7

What is the rough onset , peak and duration of intermediate acting insulin ?
name 1 intermediate acting insulin

Answer 7

onset = 2-4 hours
peaks = 4-8 hours
duration = 12-20 hours
Isophane insulin

Question 8

What is the rough onset , peak and duration of long acting acting insulin ?
Insulin degludec, Insulin glargine

Answer 8

slow onset = 2-6 hours
duration = up to 24 hours
very long up to 50+ hours

Question 9

what is insulin pump therapy ?

Answer 9

sensor augmented pump with threshold sensor

Question 10

what are the ADRs of insulin

Answer 10

Hypo/hyper glycaemia
lipodystrophy
Painful injection
allergies

Question 11

what are key challenges for adherence for treatment of type 2 diabetes ?

Answer 11

perceived risk of hypoglycaemia

fear of weight gain

Question 12

when is HbA1c % seen at risk of hypoglycaemia ?

Answer 12

7.5%

Question 13

how does metformin work ?

why is it useful in severe diabetics ?

Answer 13

decrease glucneogenesis in liver
decrease insulin resistance = limits weight
can combine with other meds

Question 14

What are some side effects of metformin?

Answer 14

GI symptoms , lactic acidosis , vit B12 deficiency, Kidney problems

Question 15

how do sulphonylureas work?

name 1 sulphonurea

Answer 15

stimulate beta cells to release insulin

Gliclazide and glimepiride

Question 16

what are some side effects of sulponylureas ?

Answer 16

weight gain , hypogylyceamia

Question 17

how does Acarbose work ?

Answer 17

alpha glucosidase inhibitor

inhibits breakdown of carbs to glucose via the alpha glucosidase on brush borders

Question 18

what are the side effects of Acarbose ?

Answer 18

Flatulence , loose stools and diarrhoea

Question 19

how do Glitazones work ?

Name the 1 Glitazone

Answer 19

increase insulin sensitivity in muscles and adipose tissue and decrease gluconeogenesis output by activating PPARs
Pioglitazone , Rosiglitazone

Question 20

What some ADRs of Glitazone ?

Answer 20

Weight gain, fluid retention , HF , bone metabolsim and bladder cancer

Question 21

what are the physiological effects of GLP-1?

where is it secreted ?

Answer 21

Increase insulin synthesis and biosynthesis and glucose uptake in muscles
Decrease- Glucagon secretion, glucose production, gastric emptying and food intake (satiety induced )
intestinal cells

Question 22

Name 2 GLP-1 therapies

Answer 22

Exenatide , liraglutide

Question 23

how do Gliptins work ?

name 2 gliptins

Answer 23

Inhibit DPP-4 an enzyme that breaks down GLP-1

Linagliptin, Sitagliptin,

Question 24

how does Canagliflozin/Dapagliflozin work ?

Answer 24

SGLT2 inhibitors in the PCT leading to urinary excretion of glucose

Question 25

What are ADRs of GLP-1 agonists ?

Answer 25

GI symptoms, nausea , loose stools , GORD