Insulin

Question 1

Name ultrafast actin insulin.

Name 3 rapid acting insulins.

When should these be injected before eating?

Answer 1

FiAsp

Lispro, Glulisine and Aspart

Inject just prior to eating.

Question 2

What determines how fast insulin becomes absorbed?

Answer 2

Insulin molecules form hexamers in SC tissue - only their monomeric form can be absorbed.

Engineered so that they aggregate less

Question 3

Name 3 short acting insulins.

Name three intermediate acting insulin.

Answer 3

Humulin S
Porcine neutral
Hyperion Bovine

Humulin I
Porcine Isophane
Inhuman Basal

Question 4

What is the longest acting insulin?

Answer 4

Degludec

Question 5

Give some ADRs of insulin.

Answer 5

Hypoglycaemia 
Hyperglycaemia 
Lipodystrophy - lipohypertrophy/ lipoatrophy 
Painful injections 
Insulin allergies (preservatives)

Question 6

If someone becomes hypoglycaemia and unconscious - Tx?

Answer 6

IV glucose or IM glucagon

Question 7

Give two explanations for hyperglycaemia.

Answer 7

Insulin given on the previous night fails to last long enough
Release of counter regulatory hormones ie adrenaline, glucagon and glucocorticoids.

Question 8

What two factors are important in keeping adherence for patients with TII diabetes?

What is the general target for glycated Hb in TII diabetics?

Answer 8

Weight gain
Risk or perceived risk of hypoglycaemia.

6.5-7.5%

Question 9

Give 3 ADRs of metformin.

Advantage?

Contraindications?

Answer 9

GI upset
Lactic acidosis
B12 deficiency

Limits weight gain.
CVD event risk decrease

CKD, hepatic disease

Question 10

Name two sulfonylureas.

Advantage of using Gliclazide?

MOA.

2 side effects.

Answer 10

Gliclazide
Glimepiride

Hepatic metabolism so can be used in renal impairment.

Bind to Katp channels on pancreatic B cells stimulating them to increase insulin release.

Hypoglycaemia
Weight gain

Question 11

Acarbose MOA.

Side effects

Answer 11

Alpha glucosidase inhibitor

Flatulence
Loose stools
Diarrhoea

Question 12

MOA glitazones.

Name two.

Pioglitazone draw backs?

Other one’s drawbacks?

Answer 12

PPARgamma - increased insulin sensitivity in adipose, muscle and hepatic
Deceased hepatic glucose production

Pioglitazone
Rosiglitazone

Weight gain
Fluid retention 
heart failure
Osteoblast inhibition (osteoporosis risk) 
Bladder cancer 

CVS concerns.

Question 13

What cells make GLP-1?

Affect on stomach and brain?

What cells make GIP?

What are GIP and GLP-1 known as?

Why did incretin mimetics have limited effects?

Answer 13

Decreased food intake through increased satiety
Decrease gastric emptying

K cells

Incretins.

DPP-4 breaks them down

Question 14

Name three GLP1 agonists.

Why weight loss?

ADRs?

Another advantage?

Answer 14

Exenatide
Liraglutide
Lixisenatide

Because GLP-1s increase satiety.

Nausea, loose stools, diarrhoea
GOR risk
Pancreatitis and pancreatic carcinoma

Low risk of hypoglycaemia.

Question 15

name four DPP-4 inhibitors.

Side effects?

Comment on weight?

Answer 15

Sitagliptin
Vildagliptin
Saxagliptin
Linagliptin

GI symptoms
Pancreatitis

Weight neutral.

Question 16

MOA glifozins?

Two advantage?

Name 3.

ADRs.

Answer 16

SGLT-2 inhibitors

Blood pressure reduction
Weight loss
Low hypoglycaemia risk

Dapaglifozin
Canaglifozin
Empaglifozin

Polyuria
Hypoglycaemia risk low
UTIs

Question 17

Name two drugs which cause weight gain.

Name one associated with a little bit of weight loss.

One associated with weight loss.

Answer 17

Sulfonylureas
Glitazones

Metformin

Glifozins
Pramlintide