Pharmacology - Treatment of Diabetes 1

Question 1

a metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism as a result of defects in insulin secretion, action or both

Answer 1

diabetes mellitus

Question 2

3 complications of diabetes

Answer 2

microvascular - retinopathy
macrovascular - atherosclerosis
neuropathy

Question 3

which type of diabetes is known as insulin dependent

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

Answer 3

a.type 1

pancreatic B cells are destroyed , no insulin is made

Question 4

which type of diabetes is known as non insulin dependent diabetes

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

Answer 4

type 2

insulin stops working at its target tissue (muscle)

Question 5

patient with diabetes onset in childhood, malnourished appearance the genetic predisposition for this type of diabetes is moderate which type most likely

a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus

Answer 5

a.type 1

Question 6

diabetic patient middle aged, obese , genetic predisposition for this type of diabetes is very strong which type most likely

a.type 1
b.type 2
c.diabetes insipidus

Answer 6

b.type 2

Question 7

the majority of insulin resistant people ………….. develop diabetes

a.do
b.dont

Answer 7

b.dont

Question 8

what are insulin levels measured using

a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA

Answer 8

c. C peptide ELISA

Question 8

what are insulin levels measured using

a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA

Answer 8

c. C peptide ELISA

Question 9

during insulin production which chain is cleaved between the proinsulin and insulin stage

a. A
b.B
c.C

Answer 9

c.C

preproinsulin -> proinsulin -> insulin

Question 10

why is c chain ELISA used

Answer 10

measure the mature insulin as the c chain is only cleaved when insulin is formed not preproinsulin / proinsulin

Question 11

what is the main trigger for insulin secretion

a. blood glucose
b. glucagon like peptide
c.vagal stimulation

Answer 11

a. blood glucose

Question 12

how many phases do beta cells release insulin in

a.1
b.2
c.3
d.4

Answer 12

b.2

rapid 1st phase triggered by increased glucose levels

slow sustained second phase of newly formed vesicles triggered independently of glucose (mop up any remaining glucose)

Question 13

insulin is released in a pulsatile fashion into what structure (lots removed by first pass in liver)

a. IVC
b.abdominal aorta
c.portal vein
d.SVC

Answer 13

c.portal vein

Question 14

what is the half life of insulin in the circulation

a.1-2 hrs
b. 5-6 hrs
c.5-6 mins
d.2-3 mins

Answer 14

c.5-6 mins

Question 15

what transporters allow for glucose to enter the pancreatic b cell

a.Glut 1
b.Glut 2
c.Glut 3
d.Glut 4

Answer 15

b.Glut 2

Question 16

what enzyme metabolises glucose to make ATP

a.protein kinase
b.glucophosphatase
c.glucokinase
d.glycogen synthase

Answer 16

c.glucokinase

Question 17

what channel is blocked when ATP is produced from glucose in the B cell

a.ATP sensitive sodium channel
b.ATP sensitive potassium channel
c. ATP sensitive calcium channel

Answer 17

b.ATP sensitive potassium channel

sofulureas mimic ATP for treatment of diabetes

depolarisation ,
opens voltage gated calcium channels
calcium in
vesicles fuse with plasma membrane
granule release of insulin into blood stream

Question 18

when insulin binds to receptors on the cell surface membrane it uses a signal transduction pathway to uptake glucose into muscle, fat and liver cells via which transporter

a.glut 1
b.glut 2
c.glut 4
d.glut 3

Answer 18

c.glut 4

glucose utilised as glycogen, protein synthesis , lipids

Question 19

what protein is released from insulin receptors when insulin binds

a. ATP
b.AMP
c.IRS

Answer 19

c.IRS

insulin receptor substrate proteins

Question 20

what are the 3 main targets of insulin

Answer 20

liver
muscle
fat

remove glucose from circulation and store it

insuline crosses BBB but glucose uptake in brain not glucose dependent glut 1 and 2 transporters

Question 21

insulin is needed by all patients with..

a.type 1 diabetes
b.type 2 diabetes
c.diabetes mellitus

Answer 21

a.type 1 diabetes

in type 2 diabetes for intercurrent events eg surgery/infection
used in emergency to treat Ketoacidosis
in pregnancy

USED IN EMERGENCY TREATMENT OF HYPERKALAEMIA as a side effect is lowered potassium

Question 22

how is insulin administerd

a.orally
b.subcutaneously
d.buccal

Answer 22

b.subcutaneously

inject either side of the bellybutton

can get inhaled insulin

Question 23

what do people with diabetes measure their blood glucose with

Answer 23

glucometer
done regularly

/18 to get European level from American units

x18 to get American level from European

Question 24

what is the principle of insulin preparations a.alter rate of absorption by increase particle size b.alter rate of absorption by increase particle conc

Answer 24

a.alter rate of absorption by increase particle size

Question 25

insulin lispro and insulin aspart are examples of which type of insulin a.fast onset, short acting b.slow onset, long acting

Answer 25

a.fast onset, short acting onset 3o mins peak 2-4 hrs injected 1/2 per day

Question 26

insulin zinc suspension, protamine insulin are examples of what type of insulin a.fast onset, short acting b.slow onset, long acting c.intermediate

Answer 26

c.intermediate

Question 27

insluin zinc suspension crystal form, insulin glargine (mantis) is an example of what type of insulin formation a.fast onset, short acting b.slow onset, long acting c.intermediate

Answer 27

b.slow onset, long acting once per day reduced risk of nighttime hypoglycaemia best therapy is mix of short and medium lasting injected before meals

Question 28

factors affecting rate of absorption of insulin

Answer 28

abdomen> arm> buttocks> thigh exercise (increased bf at side) amount go insulin depth of injection whether or not the insulin is degraded

Question 29

hypoglycaemia (sweating, shaky, cranky, dizzy) is treated with what if the patient is conscious a.sweet drinks b. food c.iv glucagon d.insulin

Answer 29

a.sweet drinks

Question 30

hypoglycaemia (sweating, shaky, cranky, dizzy) is treated with what if the patient is unconscious a.sweet drinks b. food c.iv glucagon d.iv insulin

Answer 30

c.iv glucagon

Question 31

a build up of fat at the site of insulin injection is known as.. a.lypodystrophy b.lipohypertrophy c.lipoatrophy

Answer 31

a.lypodystrophy

Question 32

increased fat cells at the insulin injection is known as.. a.lypodystrophy b.lipohypertrophy c.lipoatrophy

Answer 32

b.lipohypertrophy

Question 33

true or false insulin effects serum potassium levels a.true b.false

Answer 33

a.true decreases potassium levels stimulates potassium uptake into cells via sodium k atpase iv insulin can lead to hypokalaemia used in emergency to treat hyperkalemia, or diabetic Ketoacidosis

Question 34

which type of syringe should be used to administer insulin a.insulin syringe in graduated units b.insulin syringe in ml

Answer 34

a.insulin syringe in graduated units calculations importants as given in units of insulin

Question 35

what happens when diabetic people don't take insulin,

Answer 35

glucose not processed liver produces more glucose glucose accumulates in the blood stream body finds alternative source of energy from fat breakdown fat breakdown produces ketone which build up in the blood ketones and glucose in urine a lot of water is lost too, can lead to dehydration and worsened Ketoacidosis

Question 36

vomiting, excessive thirst, increased urination, rapid breathing, fruity smelling breath , stomach pain, drowsiness and increased HR are all symptoms of what a.hyperglycaemia b. diabetes mellitus c.diabetes insipidus d.diabetic ketoacidosis e.hypoglycaemia

Question 37

treatment of DKA

Answer 37

EMERGENCY IV insulin IV fluids

Question 38

when do you stop IV insulin in cases of diabetic acidosis a.when blood glucose returns to normal b.when blood pH increases and venous ketones reduce

Answer 38

b.when blood pH increases and venous ketones reduce