Pancreatic Hormones Flashcards
Prohormone of insulin
proinsulin
Result of proinsulin cleavage
insulin and C-peptide
Uses of C-peptide
differentiate DM Type 1 and Type 2
diagnose MEN
rule out factitious hypoglycemia
assess PCOS insulin resistance
C-peptide in insulinoma
Elevated
C-peptide in factitious hypoglycemia
Not elevated
Glucose receptors in the brain
Glut 1 and Glut 3
Glucose receptors in the red cells
Glut 1
Glucose receptors in the pancreas, liver, kidney and gut
Glut 2
Glucose receptors in the brain, kidney and placenta
Glut 3
Glucose receptors in the brain and RBC
Glut 1
Glucose receptors in muscle or adipose
Glut 4
Glucose receptors in the gut and kidnet
Glut 5
Insulin-mediated glucose uptake
Muscle and Adipose (Glut 4)
Rapid acting Insulin
Lispro, Aspart, Glulisine
Short acting Insulin
Regular
Intermediate acting Insulin
NPH, Lente
Long acting Insulin
Ultralente, Glargine, Detemir, Lantus
Side effect of insulin at injection site
lipodystrophy
Masks signs of hypoglycemia (tachycardia, tremor, sweating)
Beta-blockers
Contained in ALL insulin preparations
Zinc
Rapid acting insulin peak
0.25 - 0.50
Short acting insulin peak
0.5 - 3
Intermediate insulin acting peak
8 - 12
Long acting insulin peak
8 - 16
Ultralong acting insulin peak
No peak
Duration of Rapid acting insulin
3 - 4
Duration of Short acting insulin
5 - 7
Duration of Intermediate acting insulin
18 - 24
Duration of Long acting insulin
18 - 28
Duration of Ultralong acting insulin
> 24
Paradoxical improvement of DM in patients with ESRD
Prolonged half life due to decreased clearance
Hypoglycemia resulting from CNS glucose deprivation
Neuroglycopenic Symptoms
Hypoglycemia resulting from CNS-mediated sympathoadrenal discharge
Neurogenic Symptoms
Risk for hypoglycemia with insulin
ESRD
Elderly
< 7 years old
Early morning hyperglycemia:
High evening dose intermediate insulin peak at 3 am (hypoglycemia) stimulating counter-regulatory hormones causing pre-breakfast hyperglycemia
Somogyi Effect
Early morning hyperglycemia:
Low evening dose of intermediate insulin stimulating early counter-regulatory hormones therefore mild hyperglycemia at 3 am and pre-breakfast
Waning of Insulin Dose
Early morning hyperglycemia:
Growth hormone spike at 6 am to 7 am cause insulin resistance and eventual pre-breakfast hyperglycemia
Dawn Phenomenon
Early morning hyperglycemia:
Low evening dose of intermediate insulin stimulating early counter-regulatory hormones therefore hyperglycemia at 3 am and moderate hyperglycemia pre-breakfast due to growth hormone spike
Combined Waning of insulin dose and Dawn Phenomenon
Somogyi Effect treatment
decrease evening insulin dose
Waning of Insulin Dose treatment
increase evening insulin dose
Dawn Phenomenon treatment
increase evening insulin dose
Period in DM Type 1 where insulin therapy causes insulin requirements of the body to decrease due to its TRANSIENT activation of residual pancreatic beta cells
Honeymood period
Strategy for insulin therapy:
Fixed long acting insulin + Pre-meal short acting insulin
BASAL-BOLUS
Strategy for insulin therapy:
Continuous long acting insulin + Varied short acting insulin depending on preprandial CBG
Sliding Insulin Scale
Route of administration of Insulin
IV and subcutaneous
Exubera
Inhaled insulin at Phase III trial
Route of Insulin administration comparable to IV and SC routes
Inhalation
Insulin secretagogues
Sulfonylurea and Meglitinide
Insulin secretagogues MOA
Closes K channel of pancreatic B cells stimulating depolarization and release of endogenous insulin
First generation Sulfonylurea
Chlorpropamide, Tolbutamide, Tolazamide
Second generation Sulfonylurea
Glipizide, Gimepiride, Glibenclamide, Gliclazide
Contraindicated in hepatic and renal impairment
2nd generation Sulfonylurea and Biguanides
T/F: Hypoglycemia is less in 2nd generation sulfonylurea
True
Meglitinide
Repaglinide, Nateglinide, Mitiglinide
Insulin secretagogue use for patients with sulfa allergies
Meglitinide
Insulin secretagogue with least incidence of hypoglycemia
Nateglinide
Insulin secretagogue that may be used in CKD
Nateglinide
Biguanide
Metformin
Biguanide MOA
Slows gut absorption of glucose
Inhibit hepatic and renal gluconeogenesis
Increase peripheral glucose uptake and glycolysis
Reduce plasma glucagon and DM risk
First line drug for DM Type 2
Metformin
Diabetes risk reduction drug
Metformin, Thiazolidinedione, Alpha Glucosidase Inhibitor
PCOS DOC
Metformin
Obese Diabetics DOC
Metformin
Positive side effect of Biguanides
Weight loss
Thiazolidinedione
Pioglitazone, Rosiglitazone, Troglitazone
Thiazolidinedione MOA
Increase insulin sensitivity binds PPAR-Y receptor
Inhibit hepatic gluconeogenesis
Increase peripheral glucose uptake
Reduce DM risk
Reduces fasting and post prandial hyperglycemia
Biguanide and Thiazolidinedione
Thiazolidinedione withdrawn from market
Troglitazone and Rosiglitazone
Side effect of Troglitazone and Rosiglitazone
Congestive Heart Failure
Contraindication of Thiazolidinedione
Liver disease
Prengnacy
CHF
Thiazolidinedione that reduce cardiovascular events and mortality
Pioglitazone
Alpha Glucosidase Inhibitors
Acarbose, Miglitol, Voglibose
Alpha Glucosidase Inhibitors MOA
Inhibits intestinal alpha glucosidases enzyme (cannot convert complex carbs to monossacharides)
Reduce post prandial hyperglycemia ONLY
T/F: Acarbose has a low glucose-lowering effect
True
Side effect of alpha glucosidase inhibitor
Gastrointestinal disturbance
Hypoglycemia
Treatment of alpha glucosidase inhibitor induced hypoglycemia
IV dextrose
Contraindication of alpha glucosidase inhibitor
Renal impairment
Amylin analog antidiabetic
Pramlintide
Pramlintide MOA
Supress glucagon release
Reduce appetite
Delay gastric emptying
Incretin modulator
GLP-1 agonist and DPP-4 inhibitor
GLP-1 agonist
Exenatide
Exenatide route of administration
Injectable
Antidiabetic with anorectic effect
Pramlintide
Antidiabetic combined with insulin as injectable
Pramlintide
Exenatide MOA
Inhibit glucagon secretion
Augment glucose-stimulated insulin release
Delay gastric emptying
Produce SATIETY
Most common side effect of GLP-1 agonist
Acute pancreatitis
DPP-4 inhibitor
Sitagliptin
DPP-4 inhibitor MOA
Degrades GLP-1 and other incretins
Most common side effect of DPP-4 inhibitor
URTI
Hormone for beta-blocker overdose
Glucagon
Hormone for bowel imaging
Glucagon
Hormone for SEVERE hypoglycemia
Glucagon
Glucagon Effects
Increase HR and contractility
Increase hepatic gluconeogenesis
Increase hepatic glycogenolysis