Treating tyoe 1 and 2 diabetes

Question 1

what is the by-product of insulin?

Answer 1

C-peptide

can be used as a biomarker

Question 2

what is the treatment for type 1 diabetes?

Answer 2

insulin injections

Question 3

what are the types of insulin?

Answer 3

rapid, short, intermediate or long acting

biphasic insulin preparations

Question 4

rapid acting insulin

Answer 4

acts for 2 hours

e.g. aspart lispro and glulisine

Question 5

short acting insulin

Answer 5

acts for 6 hours

regular/soluble insulin

Question 6

intermediate acting insulin

Answer 6

acts for 18 hours

NPH/isophane insulin

Question 7

long acting insulin

Answer 7

acts for 20-24 hours

glargine or detemir

Question 8

biphasic preparations

Answer 8

mixture of short/ rapid acting and intermediate acting insulin

Question 9

regular human insulin

Answer 9

forms hexamers around zinc ions which slows absorption

Question 10

how to make different preparations of insulin

Answer 10

insulin analogues with different durations of actions can be made by modifying regular insulin using recombinant technology

Question 11

what are the most common regimens for type 1 diabetes?

Answer 11

twice daily regiment

basal-bolus regimen

Question 12

twice daily regimen

Answer 12

injecting a mixture of shorter acting insulin and intermediate acting insulin twice - biphasic preparation twice a day
injected before breakfast and dinner

Question 13

basal bolus regimen

Answer 13

long-acting insulin delivered 1 or 2 times a day with a rapid-acting insulin administered before meals
requires need for carbohydrate counting

Question 14

how is insulin delivered?

Answer 14

subcutaneous injection by patient/carer

Question 15

which insulin regimen is used for school children with T1DM?

Answer 15

biphasic twice daily regimen

as can be administered at home

Question 16

other insulin administration techniques

Answer 16

insulin pump

Question 17

insulin pump

Answer 17

delivers basal flow of insulin throughout day
bolus delivered before meals
requires counting and inputting of carbohydrate intake

Question 18

closed loop systems

Answer 18

ongoing development

it automatically reads blood glucose and releases appropriate amount of insulin

Question 19

alternative treatment options for type 1 diabetes

Answer 19

isolated islet or whole organ - pancreatic transplant

Question 20

islet transplantation

Answer 20

injection of isolated islets into portal vein

islets do endocrine job of pancreas in the liver

Question 21

who is considered for pancreatic transplant?

Answer 21

those who experience episodes of unexpected dangerously low blood sugar levels despite good insulin control
those with severe kidney disease

Question 22

what are the core defects of type 2 diabetes?

Answer 22

ominous octet

Question 23

ominous octet

Answer 23

increased hepatic glucose production 
decreased glucose uptake
increased lipolysis 
decreased incretin effect
increased glucagon secretion 
increased glucose reabsorption by kidney
neurotransmitter dysfunction 
decreased insulin secretion

Question 24

what are the treatment options for type 2 diabetes?

Answer 24

lifestyle changes - diet and exercise, weight loss, smoking cessation and reduced alcohol intake
oral medications
insulin

Question 25

oral medications for T2DM

Answer 25

``` metformin GLP-1 agonists DPP-4 inihibitors sulphonylureas thiazolidinediones alpha-glucosidase inhibitors SGLT2 inhibitors ```

Question 26

metformin target organs

Answer 26

liver intestines kidneys peripheral cells

Question 27

how does metformin work?

Answer 27

decreases intestinal absorption of glucose increases peripheral glucose uptake and utilisation decreases hepatic glucose production - increases insulin sensitivity of liver affects mitochondrial activity

Question 28

GLP-1 agonist target organs

Answer 28

brain gut pancreatic islets

Question 29

how do GLP-1 agonists work?

Answer 29

block inactivation of incretin hormones - GLP-1 leading to higher levels of incretins so there is increased insulin secretion can help weight loss and reduce appetite

Question 30

DPP-4 inhibitors target organs

Answer 30

fat pancreas liver kidneys

Question 31

how does DPP-4 inhibitors work?

Answer 31

increase efficacy of GLP-1 by reducing the breakdown of it

Question 32

what organs do sulphonylureas target?

Answer 32

pancreas

Question 33

sulphonylureas mode of action

Answer 33

induce insulin secretion by beta cells by blocking potassium ion channels which depolarises the cells and causes influx of calcium ions which causes vesicles containing insulin to release the insulin

Question 34

what are the target organs of thiazolidinediones?

Answer 34

adipose tissues | other peripheral tissues

Question 35

how do thiazolidinediones work?

Answer 35

``` increases lipogenesis enhances fatty acid and glucose uptake promotes sodium reabsorption in collecting ducts promotes insulin sensitivity can cause weight gain ```

Question 36

target organs of alpha-glucosidase inhibitors

Answer 36

small intestines

Question 37

target organs for SSGLT2 inhibitors

Answer 37

kidneys

Question 38

mode of action of alpha-glucosidase inhibitors

Answer 38

inhibit hydrolysis of complex carbohydrates in the small intestines

Question 39

mode of action of SSGLT2 inhibitors

Answer 39

inhibit reabsorption of glucose in PCT so there is an increase in urinary glucose excretion