Cology, Insulin

Front 1

glucose is a precursor for:

Back 1

lipids

aa

nucleic acids

compounds synthesized from vitamins

Front 2

not made from glucose

Back 2

essential aa

essential fatty acids

Front 3

body requires min of -- of glucose/day

Back 3

190mg/day

Front 4

metabolic syndrome characterized by

Back 4

elevated glucose

Front 5

metabolic syndrome:

Back 5

cv

neuropathy

retinopathy

hyperlipidemia

pvd

Front 6

DM

random plasma glucose:

Back 6

>200 mg/dl

Front 7

DM

fasting glucose

Back 7

> 126mg/dl

Front 8

DM

glucose tolerance test

Back 8

>200 mg/dl

2 hrs after ingestion

Front 9

weight loss due to

Back 9

utilization of other tissues

Front 10

thirst due to

Back 10

increased urination

Front 11

polyuria due to

Back 11

osmotic diuretic due to elevated glucose

Front 12

which dm needs exogenous insulin for survival

Back 12

type 1

Front 13

t/f

dm 2 require inuslin most of the time

Back 13

f

only 20-30%

Front 14

type 1 cause of death

Back 14

renal failure

Front 15

type 2 cause of death

Back 15

macrovascular disease

Front 16

risk factors for dm

type 1

Back 16

genetic

viruses

family hx

Front 17

risk factors for dm type 2

Back 17

family hx

ethnicity

obesity

life style

Front 18

t/f

elevated glucose/dm can increase the risk of mi/stroke

Back 18

t

cuz affect bl vessels

Front 19

pancreas A cell mobilizes fuel via --- and -- in the liver

Back 19

gluconeogenesis

glycogenolysis

Front 20

pancrease A cell secretes

Back 20

proglucagon

glucagon

Front 21

b cells promote -- ----

promote ----

Back 21

fuel storage

growth

Front 22

b cells secrete

Back 22

proinsulin

insulin

c-peptide

amylin

Front 23

d cells inhbit ---- cells

Back 23

secretory

Front 24

D cell secretory products

Back 24

somatostatin

regulate gastrin

Front 25

f cells facilitate --- processes

Back 25

digestive

Front 26

f cells secretory products

Back 26

pancreatic polypeptide

(used in digestion)

Front 27

DM lost b cells are replaced by

Back 27

amyloid plaques

Front 28

what antiviral cytokine do macrophages produce?

Back 28

IFN-alpha (pg63 Parham)
interferons IFN alpha and beta are secreted by cells infected by viruses
Recall IFN-gamma stimulates macrophages to kill to bacteria- DON'T CONFUSE!

Front 29

precursor of glucagon

Back 29

proglucagon

(secreted by A cells)

Front 30

type 1

extensive and selective loss of -- cells from pancrease

Back 30

B cells

Front 31

type 1:

--- disease

Back 31

autoimmune

(type 1A)

Front 32

dm 1:

80% of pts have antibodies to -- --- antigens at dx

Back 32

islet cell antigens

Front 33

antibodies directed to both -- and membrane bound antigens as well as -----

Back 33

cytoplasmic

insulin

Front 34

proinsulin convert to insulin and ---- in ---

Back 34

c peptide

golgi

Front 35

insulin has -- aa

-- peptide chanins linked by --- bridge

Back 35

51

peptide (A and B)

disulfide

Front 36

insulin stored in -- cells as 2 atoms of --- and 6 molecules of ---

Back 36

Beta

zinc

insulin

Front 37

t/f

more insulin than c peptide released in response to elevated glucose

Back 37

f

insulin and c-peptide released in equal amounts

Front 38

fx of c peptides

Back 38

no known function

can serve as an index of insulin secretion

Front 39

insulin degradation via ---- of -- bonds them -----

Back 39

hydrolysis

disulfide

proteolysis (insulinase)

Front 40

t/f

liver clears insulin more than kidneys

Back 40

t

liver: 60%

kidney: 40%

Front 41

t1/2 of insulin:

Back 41

3-9 minutes

Front 42

once pancreas exposed to elevated glucose

what binds on beta cells

Back 42

Glut-2 transporter

Front 43

once glut 2 binds

it's -- and --- to ---- via tca cycle

Back 43

internalized

oxidized

Front 44

once ATP is elevated what occurs w/ the atp-dependent K channels

Back 44

it closes

Front 45

due to a decreased outflow K flow, the cell depolarizes and the the voltage gated --- channels open

Back 45

Ca

Front 46

what stimulates exocytosis of insulin granule into blood

Back 46

elevated Ca

Front 47

which meds block atp dependent k channles on beta cells

stimulating insulin release

Back 47

sulfonylureas

cause K channels to close

Front 48

insulin stimulates --- uptake in to target tissues via glut ----

Back 48

glucose

4

Front 49

INSULIN initiates --- cascade w/in cells

translocates glucose transporters from --- cell to -----

Back 49

phosphorylation

inside

to cell surface

Front 50

glucose enters cell thru --- ---

Back 50

facilitated diffusion

Front 51

glucose used for energy or ----

Back 51

stored

Front 52

glut1 is found in

Back 52

all tissues

rbc

brain

Front 53

glut 1 fx

-- uptake of gluocse

transport across ---

Back 53

basal

BBB

Front 54

glut 2 located in

-- cells of the pancreas

Back 54

B cells of pancreas

liver

kidney

Front 55

glut 3 located in the

Back 55

brain

kidney

placenta

Front 56

glut 2 fx

regulation of -- release

Back 56

insulin

Front 57

glut 3 fx

uptake into --

Back 57

neurons

Front 58

glut 4 located in the :

Back 58

muscle

adipose

Front 59

glut 4 fx:

-- mediated -- uptake

Back 59

insulin

glucose

Front 60

glut 5 located in the ---

Back 60

gut

kidney

Front 61

glut 5 fx

absorption of ---

Back 61

absorptio of fructose

Front 62

insulin in liver

stimulates

storage as ----

conversion of ----, ---, ----

Back 62

glycogen

fatty acids

VLDL

adipose

Front 63

insulin in liver

inhibits:

----genolysis

-----neogenesis

conversion of fatty acids to -----

Back 63

glycogenolysis

gluconeogenesis

conversion of fatty acids to ketones

Front 64

insulin in skeleta muscle:

stimulates

storage as -----

storage of ---- as protein

Back 64

glycogen

aa

Front 65

insulin in skeletal muscle

inhibits:

-- degradation
to aa

Back 65

protein

Front 66

insulin in adipose tissue:

stimulates storage of ---- as TG's

Back 66

fatty acids

Front 67

insulin in adipose tissue:

inhibits:

converstion :

Back 67

TGs to fatty acids

Front 68

# of formulations available of insulin

Back 68

~17

Front 69

insulins differ in

Back 69

time to onset

duration of action

solubility

Front 70

pharmocokinetic profile altered by

varying -- conc

adding ----

insulin -----

Back 70

zinc (no longer available)

protamine

analogs

Front 71

origins of insulin:

Back 71

beef, pork, beef/pork mixture

Front 72

why is beef insulin no longer available

Back 72

antigenic

Front 73

pork available available:

Back 73

w/ special order

Front 74

insulin:

human, recombinant in -- or ---

Back 74

e coli

yeast

Front 75

ultra short acting insulin

Back 75

lispro

aspart

glulisine

Front 76

short acting insulin

Back 76

regular

Front 77

intermediate acting

Back 77

nph

Front 78

intermediate acting insulin

Back 78

NPH

Front 79

longer acting

Back 79

lente

ultralente

PZI

(insulin combo w/ zinc. . . no longer available)

Front 80

ultra long acting

Back 80

glargine

detemir

Front 81

lispro doa due to:

Back 81

2 aa swithced

and

cut 30

Front 82

aspart doa due to

Back 82

add aspart

Front 83

insulin glulisine:

--- for ASN at B3 and -- for lys at B29

Back 83

Lys

Glu

Front 84

insulin detemir:


----- added tolysine at position 29 and thr at 30 is ----

Back 84

14 chain fatty acid (myristic acid)

missing

Front 85

what does nph and regular cover when combined

Back 85

reg: breakfast

nph: lunch

reg: dinner

nph: nocturnal

Front 86

what does long and regular cover whem combined

Back 86

long: basal

reg: q meal

Front 87

insulin delivery system:

Back 87

injection

portable pen injector

continous sq infusion

inhaled insulin

aerolized insulin

sl insulin

Front 88

what best mimics endogenous insulin

Back 88

insulin pump

Front 89

indications for insulin:

all newly dxed type -- patients

Back 89

type 1

Front 90

indications for insulin:

-- women w/ type 2 dm or women who develop -- ----

Back 90

pregnant

gestational dm

Front 91

lispro doa due to:

Back 91

2 aa swithced

and

cut 30

Front 92

aspart doa due to

Back 92

add aspart

Front 93

insulin glulisine:

--- for ASN at B3 and -- for lys at B29

Back 93

Lys

Glu

Front 94

insulin detemir:


----- added tolysine at position 29 and thr at 30 is ----

Back 94

14 chain fatty acid (myristic acid)

missing

Front 95

what does nph and regular cover when combined

Back 95

reg: breakfast

nph: lunch

reg: dinner

nph: nocturnal

Front 96

indications for insulin

dm ------

Back 96

ketoacidosis

Front 97

indications for insulin

hyperglycemic -- --- ---

Back 97

hyperglycemic hypersomolar nonketotic coma

Front 98

indications for insulin

hyper---

Back 98

hyperkalemia

Front 99

drugs which decrease hypoglycemia effect of insulin

Back 99

oral contraceptives

corticosteroids

dobuatmine

epinephrine

niacin

smoking

thiazides

thyroid hormones

Front 100

drugs which potentiate hypoglycemia effect of insulin

Back 100

etoh

alpha-blockers

anabolic steroids

beta blockers

mao inhibitors

Front 101

complications of insulin:

Back 101

hypoglycemia

Front 102

complications of insulin:

---pathology

insulin -----

--- insulin ------

Back 102

immunopathology

insulin allergy (IgE)

immune insulin resistance (IgG)

Front 103

complications of insulin:

--- at injection site

Back 103

lipodystrophy

so rotate sites

Front 104

goals of insulin tx

maintain --- ---- in acceptable range prevent -----

Back 104

blood glucose

hyperglycemia

Front 105

goals of insulin tx


prevent long-term ----- complications

Back 105

microvascular

Front 106

goals of insulin tx

minimize incidence of ------

Back 106

hypoglycemia

Front 107

ada's fasting glucose plasma

nondiabetic:

Back 107

<110

Front 108

ada's fasting glucose plasma

goal

Back 108

80-120

Front 109

ada's fasting glucose plasma

action suggested

Back 109

<80

or

>140

Front 110

ada postprandial glucose

nondiabetic

Back 110

<120

Front 111

ada postprandial glucose

goal

Back 111

100-140

Front 112

ada postprandial glucose

actions suggested:

Back 112

<100

>160

Front 113

glycosylated hemoglobin

nondiabetic

Back 113

4-6

Front 114

glycosylated hemoglobin

goal

Back 114

<7

Front 115

glycosylated hemoglobin

action suggested

Back 115

>8