Insulin and Hypoglycemic Agents

Question 1

which glucose transport does insulin mediated uptake of glucose?

what tissues is it located in?

Answer 1

GLUT4

muscle and adipose tissue

Question 2

what stimulates gluconeogenesis:

AA, glycerol, lactate –> glucose

Answer 2

glucagon (+)

insulin (-)

Question 3

what stimulates glyogenesis

Answer 3

insulin

glucose –> glycogen

Question 4

what stimulates glycogenolysis

Answer 4

glucagon

Question 5

what stimulates glycolysis

Answer 5

insulin

glucose –> pyruvate

Question 6

random blood gluocse concentration of ___ can indicate DM

Answer 6

200 mg/dL or above

Question 7

fasting plasma glucose of ___ can indicate DM

Answer 7

126 mg/dL

Question 8

2 h plasma glucose of ___ can indicate DM

A1c >_ ____

Answer 8

200 mg/dL

6.5%

Question 9

how does the kinetics of insulin have less of a preferential effect on hepatic metabolism

Answer 9

diffusion into peripheral tissues rather than portal circulation

Question 10

therapeutic goal of insulin therapy

Answer 10

fasting blood glucose 90-120 mg/dL

Question 11

what insulin therapy has rapid action and short acting

Answer 11

insulins lispro, aspart, glulisine

Question 12

is human regular insulin and technosphere inhaled insulin long or short acting

Answer 12

short

Question 13

which insulin therapy has intermediate duration

Answer 13

human NPH

Question 14

what insulin therapy has long acting duration

Answer 14

insulin glargine, detemir, degludec

Question 15

what can cause lipohypertrophy as a SE in insulin therapy

Answer 15

fat deposition at injection site

Question 16

what can cause lipoatrophy as a SE in insulin therapy

Answer 16

fat loss at injection site

Question 17

what insulin therapy is associated with weight gain, which with weight loss

Answer 17

Long acting = weight gain

inhaled = weight loss

Question 18

(+) regulation of insulin release

Answer 18

glucose

AA

incretins (Glp1)

Epi/B2-adrenergic stimulation

vagus stimulation

Question 19

(-) regulation of insulin release

Answer 19

NE/alpha2-adrenergic stim

amylin

Question 20

most common complication with insulin therapy is hypoglycemia. What are sx produced by ANS?

Answer 20

tachycardia

sweating

tremors

nausea

hunger

Question 21

most common complication with insulin therapy is hypoglycemia. What are neuroglycopenic sx?

Answer 21

irritability

confusion

seizure

coma

death

Question 22

tx of hypoglycemia

Answer 22

glucose or glucagon

Question 23

administration of glucagon for hypoglycemia?

Answer 23

injected - b/c peptide

Question 24

1st line agent for DM tx

Answer 24

metformin

Question 25

key points of metformin (biguanides)

Answer 25

• does not produce hypoglycemia

- not dependent on beta cell fxn

Question 26

MOA of metformin

Answer 26

decrease hepatic glucose output**

increase peripheral glucose utilization

Question 27

Adverse effects of metformin

Answer 27

Diarrhea

N&V

Question 28

which generation of sulfonylureas and meglitinides are most often used?

Answer 28

2nd generation - glimepiride, glipizide, glyburide

sulfonylureas

Question 29

MOA of sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)

Answer 29

inhibition of ATP-sensitive potassium channel of beta cell, resulting in insulin release

Question 30

Adverse effects of sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)

Answer 30

weight gain

GI

hypoglycemia

Question 31

what are the glucosidase inhibitors

Answer 31

acarbose

miglitol

Question 32

who is acarbose and miglitol contraindicated for?

Answer 32

pts with GI disease

Question 33

if someone has hypoglycemia while on a glucosidase inhibitor how should it be treated

Answer 33

with oral glucose

Question 34

what should glucosidase inhibitors be taken with

Answer 34

a meal

Question 35

what are the oral antidiabetic agents

Answer 35

Metformin

sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)

glucosidase inhibitors (acarbose, miglitol)

thiazolidinediones (pioglitazone, rosigllitazone)

Question 36

MOA of pioglitazone and rosiglitazone

Answer 36

decrease peripheral resistance by activating peroxisome proliferator-activated receptor-gama

effect on glucose metabolism, insulin signaling

Question 37

Adverse effects of pioglitazone and rosiglitazone (thiazolidinediones)

Answer 37

Cardiovascular (MI)

Question 38

how is amylinomeimetic - pramlintide adminsistered

Answer 38

injected (synthetic peptide)

Question 39

MOA of pramlintide (amylinomimetic)

Answer 39

inhibit glucagon release

inhibit gastric emptying

anoretic effect

Question 40

what agents are incretins

Answer 40

exenatide**

liraglutide

Question 41

how are incretins administered

Answer 41

injected

Question 42

MOA of incretins (exenatide, liraglutide)

Answer 42

• potentiate insulin secretion
• inhibits glucagon release
• inhibits gastric emptying
• anorectic effect

Question 43

SE of incretins

Answer 43

Nausea

hypoglycemia

Question 44

what drugs are the dipeptidyl peptidase inhibitors

- inhibit incretin degradation

Answer 44

sitagliptin**

saxagliptin

linagliptin

Question 45

how are DPP inhibitors administers (“-gliptin”)

Answer 45

oral

Question 46

SE of DPP inhibitors (“-gliptin”)

Answer 46

Nasopharyngitis

URI

HA

Question 47

what are the sodium glucose transporter 2 (SGLT2) inhibitors?
- inhibit renal glucose reabosroption

Answer 47

• canagliflozin**
• dapagliflozin
• empagliflozin

think “FLO” for excretion

Question 48

SE of SGLT2 inhibitors?

Answer 48

(“-flozin”)

UTI

Hypotension

Hypoglycemia

Question 49

which drug discussed can be used for both type I and type II

Answer 49

pramlinitide