insulin and hypoglycaemia

Question 1

values for hypoglycaemia?

Answer 1

less than 3mmol/L of glucose

Question 2

normal, healthy fasting glucose levels?

Answer 2

3-5mmol/L glucose

Question 3

values for hyperglycaemia?

Answer 3

more than 10mmol/L of glucose

Question 4

describe glucosuria:

Answer 4

when elevated glucose levels saturate the glucose reuptake mechanism in the kidney; leading to osmotic diuresis, increases thirst and urine production, dehyrdration, unconsciousness and death

Question 5

action of insulin?

Answer 5

acts on target cells such as the liver, muscle, adipocytes and CNS to lower blood glucose levels

Question 6

where is insulin produced?

Answer 6

pancreatic B cells

Question 7

action of glucagon?

Answer 7

glucagon increases blood glucose levels, endogenous glucose production occurs in the liver

Question 8

where is glucagon produced?

Answer 8

in the pancreatic a-cells of the islets of langerhan

Question 9

different cell types within islets of langerhan and what they produce?

Answer 9

a cells; release glucagon, b cells; release insulin, PP cells; release pancreatic polypeptide, cells that release grehlin, and cells that release somatostatin.

Question 10

what are incretin hormones?

Answer 10

hormones that increase insulin. e.g. glucagon-like peptide 1 (GLP1) and gastric inhibitory peptide (GIP)

Question 11

where are incretin hormones found, and what is their function?

Answer 11

found in the endocrine cells of the GI tract; they circulate the blood and signal secreting cells to release insulin

Question 12

other insulin functions?

Answer 12

promote hypoglycaemia, increases; glucose uptake, storage and utilization, protein synthesis, triglyceride synthesis, gene expression, growth hormones. it decreases; proteolysis, lipolysis and lipid oxidation

Question 13

describe the process of insulin lowering blood glucose levels?

Answer 13

high blood sugar –> b-cells release insulin into the blood –> insulin binds to receptors on target cells –> biochemical / signal transduction cascade of events –> glut4 transporter activated –> glucose transported out of the blood stream, into the muscle –> blood sugar levels decrease

Question 14

affects of glucose on the liver?

Answer 14

turns stored glycogen into glucose, increases endogenous glucose production and allows fat cells to be broken down.

Question 15

what is diabetes mellitus?

Answer 15

type one; when the pancreas does not produce enough insulin. type two; when the body cannot effectively use insulin. this leads to hyperglycaemia.

Question 16

strategies for the treatment of T1DM;

Answer 16

insulin therapy, islet/pancreas transplantation, prevention

Question 17

four preparations for insulin therapy?

Answer 17

short duration - e.g. insulin aspart, intermediate action e.g. iosphone insulin, long lasting e.g. protamine zinc insulin and biphasic insulin preparation

Question 18

how is insulin administered?

Answer 18

subcutaneous injection, 3-4 times per day.

Question 19

aim of glucagon therapy?

Answer 19

hyperglycaemia inducing. first aid treatment for severe hypoglycaemia. it acutely raises plasma glucose levels

Question 20

side effects of glucagon therapy?

Answer 20

headache and nausea

Question 21

function of insulin secretagogues I?

Answer 21

boost insulin release, enhance normal physiology of glucose-stimulated insulin secretion

Question 22

examples of insulin secretagogues I?

Answer 22

sulphonylureas, meglitinides

Question 23

function of insulin secretagogues II and examples?

Answer 23

exenatide, liraglutide; boost insulin release by enhancing normal physiology of incretin-mediated insulin secretion

Question 24

function of secretagogues III and examples?

Answer 24

boost insulin release by enhancing normal physiology of incretin-mediated insulin. e.g. gliptins

Question 25

action of insulin sensitizers?

Answer 25

improve the sensitivity of target organs to insulin.

Question 26

examples of insulin sensitizers?

Answer 26

thiazolidendlone; activate gene transcription. and biguanides EG. METFORMIN; activate enzymes and prevent hepatic production of glucose

Question 27

examples of a-glucosidase inhibitors?

Answer 27

acarbose, glucobay

Question 28

function of acarbose?

Answer 28

converts oligosaccharides to glucose

Question 29

what is a SGLT2?

Answer 29

sodium-coupled glucose transporter

Question 30

action of SGLT2 and examples?

Answer 30

cause excess glucose to be eliminated in the urine, reducing hyperglycaemia. e.g. dapagliflozin

Question 31

which treatments for T2DM are administered orally?

Answer 31

insulin secretagogues I, diazoxide, secretagogues III, insulin sensitisers

Question 32

how are secretagogues II administered?

Answer 32

subcutaneous injection

Question 33

side effects of insulin secretagogues II ?

Answer 33

n&v, diarrhoea, dyspepsia, abdo pain, reflux, reduced appetite, headache, dizziness, agitation, asthenia, sweating

Question 34

side effects of insulin secretagogues III?

Answer 34

vomiting, dyspepsia, gastritis, oedema, headache, dizziness, fatigue, respiratory tract infection, UTI, sinusitis, gastroenteritis, nasopharyngitis