Pancreatic Hormones

Question 1

Cell Types with the corresponding secretory products

Answer 1

Alpha cells (20%) Glucagon, Proglucagon
Beta cells (75%) Insulin, Proinsulin, Amylin, C- peptide
Delta cells (3-5%) Somatostatin
G cell (1%) Gastrin
F cell (1%) Pancreatic peptide

Question 2

Type I DM

• Type IA
• Type IB

Answer 2

Type I DM: Insulin Dependent Diabetes Mellitus
Type IA: Immune mediated DM
Type IB: Idiopathic

Question 3

Diagnosis of DM :
- Symptomatic

• Asymptomatic

Answer 3

A. Symptomatic
- RBS (Random Blood Sugar) 
- RBS >200mg ( 11.1 mmol/L)
B. Asymptomatic
- FBS (Fasting Blood Sugar) 
- FBS >126mg/dL or >7mmol/L on atleast 2 separate occasions
- OGTT (Oral Glucose Tolerance Test)
- Using a 75g Glucose challenge 2 hrs. post prandial blood sugar
-    >200mg on atleast 2 occasions
- HbA1c (Glucosylated Hb) 
- Index of blood sugar control for atleast 3 months
>6.5% for atleast 2 occasions

Question 4

Pathology of Type I DM

Pathology of Type II DM

Answer 4

Type I: Destruction of B cells leading to absolute Insulin deficiency

Type II: Inadequate insulin secretion from B cells
Insulin resistance

Question 5

(2) Insulin release patterns

Answer 5

1. Pulsatile in small amounts every 10 minutes
   - BASAL INSULIN RELEASE
2. Large oscillations every 80-150 minutes
   - w/ food intake and affected by food intake
   - PRANDIAL INSULIN RELEASE

Question 6

Type III DM

Type IV DM

Answer 6

Type III DM: Pancreatitis/ Pacreatectomy/ Non- pancreatitic

Type IV DM: Gestational DM
- Insulin resistance in the placental hormones during LAST TRIMESTER

Question 7

M.O.D.Y

Answer 7

Maturity Onset Diabetes of the Young
- Mutation in the Glucokinase gene
in young and non obese patient

Question 8

INSULINOPATHIES

Answer 8

Heterozygous inheritance of a defective gene

Release of insulin but do not bind to the receptor

Question 9

Process by the golgi apparatus where it is hydrolyzed into insulin

Answer 9

PROINSULIN

Question 10

A residual connecting segments called ________ by removal of 4 AMINO ACIDS

Answer 10

C peptide

Question 11

Insulin receptors

Answer 11

ARBS
Alpha subunits - recognition
Beta subunits - Spans the membrane

Question 12

Glucose Transporters 1

Answer 12

GLUT 1 (RBC/ Brain)
- Basal uptake of Glucose transport across the BBB

Question 13

GLUT 2

Answer 13

(Ligu na kid)
- Liver/ GUT/ Kidney
Regulation of insulin release
Glucose homeostasis

Question 14

GLUT 3

Answer 14

(PaKaBa)
- Placenta/ Kidney/ Brain
Uptake into neurons and other tissues

Question 15

GLUT 4

Answer 15

(M—AD)
- Muscle/ Adipose tissues
Insulin mediated uptake of Glucose

Question 16

GLUT 5

Answer 16

Absorption of Fructose
(Gusto ng Kid)
- GUT/ Kidney

Question 17

Rapid Acting Insulin

- Decreases the late postmeal hypoglycemia

Answer 17

Insulin Lispro(Humulog)/ Aspart (Novolog)
OA: 5- 15 mins/ 10-20 mins
peak: 1 hr
DOA: 3-5 hrs

Question 18

Short Acting Insulin

Answer 18

Regular Insulin
OA: 30 mins
peak: 2-3 hrs
DOA: 5-8 hrs
- (+) DKA

Question 19

Intermediate Insulin

Answer 19

NPH (Isophane)
OA: 60-120 mins
LENTE INSULIN (30% Amorphous & 70% crystalline)

Question 20

Long acting Insulin

Answer 20

• Glargine
• Detemir
  OA: 1-1.5 hrs
  peak: soluble peakless
  DOA: 4-5 up to 11-24 hrs

Question 21

Given before breakfast

Answer 21

MIXED (SA & IA)
30% SA
70% IA

Question 22

Given before lunch and dinner

Answer 22

Regular Insulin
before meal: Regular
w/ meal : Lispro

Question 23

Given at bedtime

Answer 23

IA

• Controls the NOCTURNAL HEPATIC GLUCOSE
• Improves the glucose tolerance
  ass. w/ wt. loss > daytime

Question 24

Insulin secretagogues

Answer 24

Sulfonylureas

Meglitinides

Question 25

Sulfonylureas

Answer 25

1st gen (Inc. a/e Dec. potency)
2nd gen (vice versa)

Question 26

Disulfiram like effect

Answer 26

Chlorpropamide (32 hrs half life)

- Diabenese

Question 27

Used in mild moderate renal insufficiency

Answer 27

Gluguidone

Question 28

Shortest half life

Answer 28

GLIPizide (Glucotrol XR)

Max DD: 20mg

Question 29

Controls the post prandial glucose excursions

- No direct effect on insulin exocytocis

Answer 29

Repaglinide (Benzysuccinic acid derivative)

Question 30

Rare a/e of Meglitinides

Answer 30

SJS/ TEN

Question 31

MOA of Insulin secretagogues

Answer 31

Opens Ca channel

Closes the K channel

Question 32

MOA of BIGuanides

Answer 32

Glucose –> Lactate
Stimulates Gluconeogenesis & Glycolysis
Dec. Glucagon levels

Question 33

A/E of BIGuanides

Answer 33

B12 abs decrease
Diarrhea
GI ntolerance

Question 34

MOA of Thiazolidinediones

Answer 34

Increase insulin resistance

Question 35

Location of TZDS

Answer 35

Liver/ Fats/ Muscles

Question 36

Drug Interaction between Sulfonyureas & a glucosidase inhibitors

Answer 36

Additive effect

Question 37

C/I of a glucosidase inhibitors

Answer 37

IBS (Chrons Disease)

Question 38

Amylin analog

Answer 38

PRAMLINTIDE

- SQ

Question 39

MOA of Amylin analog

Answer 39

Modulates the post prandial glucose lvls

Suppress the glucagon release

Question 40

GIP (Glu- dependent INSULINOTROPIC peptide)

GLP1 (Glucagon like peptide- 1)

Answer 40

GIP: K cells

GLP1: L cells

Question 41

DPP4 Inhibitor

Answer 41

Sitagliptin (Januvia)

Question 42

SGLT2

MOA:

Answer 42

Dapagli- FOZIN (1st drug developed)

MOA: Inh. the glucose absorption in Renal Proximal Tuule

Question 43

MOA of Glucagon

Answer 43

Increase CAMP/ Gluconeogenesis/ Ketogenesis

Glycogenolysis

Question 44

Use of Glucagon

Answer 44

Type I DM
B Blocker overdose
X- Ray visulaization of the bowel: relaxes the smooth muscle