Insulin And Hypoglycaemics Flashcards
What is the term used to describe elevated serum glucose conc.
Hyperglycaemia
The approximate fasting blood glucose concentration in a healthy individual is:
5-7mmol/L
The approximate fasting blood glucose concentration in a diabetic patient is
10mmol/L
Where are insulin secreting cells found?
The pancreas
What is the disease caused by an absolute loss of insulin secreting cells?
Type 1 diabetes
Give an example of an increasing
Glucagon-like peptide
What is the drug sensitive type of diabetes with early (<20years) onset
Maturity-onset diabetes of the young
Name a class of drugs which changes ion channel properties (diabetes)
Sulphonylureas
Drug(s) which alter the transcriptional profile of insulin-sensitive genes
Thiazolindinediones
What is the disease that arises when tissues become resistant to insulin
Type II diabetes
Where is the location of the principle site of glucose storage
Liver
Which two types of diabetes drugs are insulin sensitisers A. SGLT2 inhibitors B. Biguanides C. GLP-1 Rs agonists D. Thiazolidinediones
B & D
Which type of diabetic drug works by promoting glucose loss A. DPP4 inhibitors B. Biguanides C. SGLT2 inhibitors D. Alpha-glucose inhibitors
SGLT2 inhibitors
Which of the following types of diabetes drugs are insulin secretagogues A. DPP4 inhibtors B. Alpha-glucosidase inhibitors C. GLP-1 Rs agonists D. Sulphonylureas E. SGLT2 inhibitors
DPP4 inhibitors
GLP-1 Rs agonists
Sulphyonylureas/meglitinides
Which type of diabetic drug works by delaying glucose absorption?
Alpha-glucosidase inhibitors
What is the approximate blood glucose level of hypoglycaemia
<3mmol/L
What cannot substitute glucose, meaning glucose delivery is critical to function
CNS
Most tissues can utilise non-glucose molecules as substitutes of glucose, like….
Fatty acids and amino acids
What is used as a diagnostic of diabetes mellitus
Glucosuria
A rise in blood sugar is recognised by what
Pancreatic B-cells
The human pancreas has approximately how many islets of langeuhan?
1.5 million
True or false, pancreatic B-cells are not associated with the vasculature
False, they are very closely approximated with the blood vessels
Insulin acts on a number of large tissues;
Liver
Muscle
Adipocytes
CNS
Is the CNS involved in the homeostasis of blood glucose
No. Rise in blood sugar is detected by pancreatic B-cells which then release insulin
How does glucose enter the pancreatic B cells
Via glucose transporter
True or false, glucose has to be metabolised in the pancreatic B cells, this uses energy which acts as a signal
True
When the pancreatic B cell depolarises following the shut down of K channels, which ion floods into the cell pushing insulin out by exocytosis
Calcium
Which drugs are molecules which close the K channel, mimicking the actions of glucose and are used to treat type II diabetes
Insulin secretagogues
Which drugs work by opening the K channel, inhibiting the actions of glucose and are used to treat congenital hyperinsulinism
Hyperglycaemia inducing drugs
Glucose-stimulated insulin release is a 2 stage process. In stage 1 all the insulin stored in pancreatic B cells is released. Stage 2 is the synthesis of new insulin molecules. Which stage do people with type II diabetes lose?
Stage 1
A fall in blood glucose is detected by which cells
Pancreatic alpha cells
When hypoglycaemia is detected by the pancreatic alpha cells, what substance do they release which principally acts on the liver
Glucagon
What substance is used medically to reawaken the unconscious patient
Glucagon
Which system has a direct link to the pancreas
Digestive system
During digestion the small intestine releases incretin hormones which stimulates pancreatic B cells to release insulin. Which hormones are realised?
GLP-1 (glucagon like peptide-1)
GIP (gastric inhibitory peptide)
What stimulates the release of GLP-1 and GIP from the small intestine which stimulates pancreatic beta cells to release insulin
Sugars and fats
Which type of diabetes is where insulin-producing cells are failing and/or tissues are insensitive to insulin
Type 2 DM
Which type of diabetes is where insulin-producing cells are destroyed and insulin must be provided
Type 1 DM
True or false, T1DM is an autoimmune disease
True
T1DM accounts for what percentage os DM cases
5-15%
What are some risk factors for T2DM
Ageing
Obesity
Ethnicity
Family history
Which type of diabetes is a polygenic disorder
T2DM
What is the common feature of T1DM and T2DM A. Decreased insulin signalling B. Elevated glucose C. Elevated lipids D. Insulin resistance
B. Elevated glucose
What are the 3 basic insulin preparations of insulin therapy for T1DM
Short duration (rapid onset)
Intermediate action
Longer lasting
Insulin therapy often contains what - which helps bind to the insulin
Zinc
Insulin aspart, insulin glulisine and insulin lispro are all what type of insulin therapy
Rapid action, short duration
How can the rapid action insulin therapies insulin aspart, insulin glulisine and insulin lispro be administered
IV
Subcut
What type of insulin therapy is isophane insulin
Intermediate action
What type of insulin therapy do the following drugs belong to; protamine zinc insulin, insulin zinc suspension, insulin detemir and insulin glargine
Longer lasting. Slow onset and lasts for long periods
Short duration insulin therapies such as, insulin aspart, insulin glulisine and insulin lispro have an onset of what time?
30-60 mins
Short duration insulin therapies such as, insulin aspart, insulin glulisine and insulin lispro have a peak action of what time?
2-4 hours
What is the duration of Short duration insulin therapies such as, insulin aspart, insulin glulisine and insulin lispro
8 hours
Short duration insulin therapies such as, insulin aspart, insulin glulisine and insulin lispro are injected when?
Just before, with or just after food. Only lasts long enough for that mean
Intermediate/longer duration insulin therapy such as; isophane insulin, insulin detemir, insulin glargine, insulin zinc suspension and protamine zinc insulin have of onset of what time?
1-2 hours
What is the peak action of Intermediate/longer duration insulin therapy such as; isophane insulin, insulin detemir, insulin glargine, insulin zinc suspension and protamine zinc insulin?
4-12 hours
What is the duration of Intermediate/longer duration insulin therapy such as; isophane insulin, insulin detemir, insulin glargine, insulin zinc suspension and protamine zinc insulin
16-35 hours
Biphasic insulin aspart, biphasic insulin lispro and biphasic isophane insulin are all what rules of insulin therapy?
Mixture of intermediate and fast acting
What is the onset and duration of the following insulin therapies; Biphasic insulin aspart, biphasic insulin lispro and biphasic isophane insulin
Rapid onset
Long-lasting
Why is insulin injected?
It is a peptide and would be ingested in the stomach
How do portable insulin infusion pumps work?
Give a continuous short acting insulin and a patient activated bolus dose at meal times
What are 3 common side effects of hyperglycaemia-inducing glucagon therapy
Headache
Nausea
Rapid heart rate
DPP4 inhibitors, GLP-1 receptor agonists and sulphonylureas/meglitinides are all what type of hypoglycaemic therapy
Insulin secretagogues
Which hypoglycaemic therapy works by boosting insulin release by enhancing aspects of the normal physiology of glucose-stimulated insulin secretion
Sulphonylureas
Gliclazide and tolbutamide are what kind of short acting hypoglycaemic therapy
Sulphonylureas
Chlorpropamide, glibenclamide, glipizide and glimepiride are all what type of long acting hypoglycaemic therapy
Sulphonylureas
What is the administration regime of the hypoglycaemic therapy sulphonylureas eg. Gliclazide?
OD or BD with or shortly before a meal
