Pharmacology - Treatment of Diabetes 1 Flashcards
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
diabetes mellitus
3 complications of diabetes
microvascular - retinopathy
macrovascular - atherosclerosis
neuropathy
which type of diabetes is known as insulin dependent
a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus
a.type 1
pancreatic B cells are destroyed , no insulin is made
which type of diabetes is known as non insulin dependent diabetes
a.type 1
b.type 2
c.diabetes insipidus
d.diabetes mellitus
type 2
insulin stops working at its target tissue (muscle)
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
a.type 1
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
b.type 2
the majority of insulin resistant people ………….. develop diabetes
a.do
b.dont
b.dont
what are insulin levels measured using
a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA
c. C peptide ELISA
what are insulin levels measured using
a.A peptide ELISA
b. B peptide ELISA
c. C peptide ELISA
c. C peptide ELISA
during insulin production which chain is cleaved between the proinsulin and insulin stage
a. A
b.B
c.C
c.C
preproinsulin -> proinsulin -> insulin
why is c chain ELISA used
measure the mature insulin as the c chain is only cleaved when insulin is formed not preproinsulin / proinsulin
what is the main trigger for insulin secretion
a. blood glucose
b. glucagon like peptide
c.vagal stimulation
a. blood glucose
how many phases do beta cells release insulin in
a.1
b.2
c.3
d.4
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)
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
c.portal vein
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
c.5-6 mins
what transporters allow for glucose to enter the pancreatic b cell
a.Glut 1
b.Glut 2
c.Glut 3
d.Glut 4
b.Glut 2
what enzyme metabolises glucose to make ATP
a.protein kinase
b.glucophosphatase
c.glucokinase
d.glycogen synthase
c.glucokinase
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
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
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
c.glut 4
glucose utilised as glycogen, protein synthesis , lipids
what protein is released from insulin receptors when insulin binds
a. ATP
b.AMP
c.IRS
c.IRS
insulin receptor substrate proteins
what are the 3 main targets of insulin
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
insulin is needed by all patients with..
a.type 1 diabetes
b.type 2 diabetes
c.diabetes mellitus
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
how is insulin administerd
a.orally
b.subcutaneously
d.buccal
b.subcutaneously
inject either side of the bellybutton
can get inhaled insulin
what do people with diabetes measure their blood glucose with
glucometer
done regularly
/18 to get European level from American units
x18 to get American level from European
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
a.alter rate of absorption by increase particle size
insulin lispro and insulin aspart are examples of which type of insulin
a.fast onset, short acting
b.slow onset, long acting
a.fast onset, short acting
onset 3o mins
peak 2-4 hrs
injected 1/2 per day
insulin zinc suspension, protamine insulin are examples of what type of insulin
a.fast onset, short acting
b.slow onset, long acting
c.intermediate
c.intermediate
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
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
factors affecting rate of absorption of insulin
abdomen> arm> buttocks> thigh
exercise (increased bf at side)
amount go insulin
depth of injection
whether or not the insulin is degraded
hypoglycaemia (sweating, shaky, cranky, dizzy) is treated with what if the patient is conscious
a.sweet drinks
b. food
c.iv glucagon
d.insulin
a.sweet drinks
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
c.iv glucagon
a build up of fat at the site of insulin injection is known as..
a.lypodystrophy
b.lipohypertrophy
c.lipoatrophy
a.lypodystrophy
increased fat cells at the insulin injection is known as..
a.lypodystrophy
b.lipohypertrophy
c.lipoatrophy
b.lipohypertrophy
true or false insulin effects serum potassium levels
a.true
b.false
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
which type of syringe should be used to administer insulin
a.insulin syringe in graduated units
b.insulin syringe in ml
a.insulin syringe in graduated units
calculations importants as given in units of insulin
what happens when diabetic people don’t take insulin,
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
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
treatment of DKA
EMERGENCY
IV insulin
IV fluids
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
b.when blood pH increases and venous ketones reduce
