Insulin And Other Drugs For Diabetes

Front 1

What is the precursor to insulin?
What peptide can be used to help diagnose causes of hypoglycemia?

Back 1

Pro-insulin
The C-peptide; it connects the A chain of insulin to the B chain

Front 2

Describe the General mechanism of action of Insulin release.

Back 2

1. Glucose uptake into pancreatic beta cells via the GLUT 2 receptor
2. Glucokinase action leads to an increase in the ATP:ADP ratio
3. Increased ATP causes the ATP potassium sensitive channel to close; this leads to cell depolarization
4. Ca2+ influx occurs through the voltage gated Ca2+ channel
5. Depolarized pancreatic beta cells release insulin

Front 3

Name the Insulin agents that have the following effects.

1. Fast onset and short duration
2. Longest acting due to structural modifications
3. Slower than Regular insulin, bound to protamine, variable absorption rate.
4. Identical sequence to human insulin, used IV, short acting

Back 3

1. Lispro, Aspart, Glulisine
2. Glargaline and Determir
3. NPH insulin
4. Regular insulin

Front 4

Which insulin can be given via IV in an emergency?

Back 4

Regular insulin

Front 5

Match each of the following phrases to slow absorption, speed absorption, and the goal of insulin therapy:

1. Occurs by blocking self aggregation
2. Ideal is to mimic normal circulating insulin levels
3. Occurs by binding protamine or by self aggregation

Back 5

1. Speed absorption
2. Goal of insulin therapy
3. Slow absorption

Front 6

T/F
Endogenous insulin is metabolized by the liver

T/F
Injected insulin is metabolized by the liver

Back 6

True

False; 60% is metabolized by the kidney

Front 7

Match each of the statements to "Short-term" or "Long-term" treatment goals of insulin therapy:

1. Relieve hyperglycemia
2. Decrease diabetic complications by keeping glucose close to normal
3. Limited by risk of hypoglycemia and patient compliance
4. Overcome acute ketoacidosis
5. Tight control to prevent complications

Back 7

1. Short-term
2. Long-term
3. Long-term
4. Short-term
5. Long-term

Front 8

What are the risk factors leading to mortality in "tightly-controlled" diabetes patients?

Back 8

Older age
Prior CV problems
Type 2 Diabetes

Front 9

1. What would cause increased heart rate, sweating, hunger, and weakness in a diabetic who is being treated?

2. What are some other problems with insulin therapy?

Back 9

1. Hypoglycemia due to insulin overdose, unplanned exercise, skipped meals; can progress to confusion, coma, seizures.

2. Lipdystrophy at injection site
3. Allergies (rare)
4. Elevated cancer risk

Front 10

Which of the following characteristics are shared by people in DKA and HNKC, and which are specific to DKA?

1. Dehydration
2. Acidosis
3. Electrolyte imbalance due to acidosis
4. Electrolyte imbalance due to dehydration
5. Lethal

Back 10

1. Both
2. DKA
3. DKA
4. Both
5. Both

Front 11

What is the treatment for DKA?

For HNKC?

Back 11

DKA- provide IV regular insulin and replace fluid and electrolytes

HKNC- Provide IV regular insulin and fluid and electrolytes, but use caution with the insulin.

Front 12

When are antidiabetic drugs other than insulin commonly used?

Back 12

When T2DM is not controlled by diet and exercise alone.

Front 13

Match each of the following MOA's to it's proper antidiabetic drug class:

1. Close beta cell potassium channels leading to depolarization and stimulation of more insulin secretion.

2. Binds to PPAR gamma receptor which promotes genes involved in lipid storage, reducing circulating lipids that promote insulin resistance. Acts at adipocyte

3. Slows intestinal absorption of glucose from polysaccharides, lowering postprandial glucose peaks.

4. Increases glucose uptake and reduces hepatic gluconeogenesis, probably by activation of a MAP kinase.

5. Unknown mechanism for glucose benefit

6. Slows GI glucose absorption, reduces appetite, and reduces glucagon secretion

7. Raise circulating incretin levels by blocking incretin degradation by dipeptidyl peptidase-4

8. Various actions including increased insulin secretion, increased beta cell growth, reduced glucagon secretion, slowed gastric emptying, reduced body appetite

Back 13

1. Sulfonylureas (Glyburide, Glimepiride, Glipizide, Replaginide and Nateglinide)

2. Thiazolidinediones (Pioglitazone and Rosiglitazone)

3. Alpha Glucosidase inhibitors (Acarbose and Miglitol)

4. Biguanies (Metformin)

5. Bile Sequestrant Colesevelam

6. Amylin analogue Pramlintide

7. DPP-4 inhibitors (Sitagliptin; anything ending in -liptin)

8. Exenatide, Liraglutide and GLP-1 Actions

Front 14

What is an advantage to the second generation sulfonylureas?

Back 14

Once a day dosing (Glyburide and Glimepiride).

Front 15

T/F
Sulfonylureas are contraindicated in patients with liver failure.

T/F
Sulfonylureas are not contraindicated in patients with kidney failure

Back 15

True- due to liver metabolism

False- for Glyburide and Glipizide

Front 16

Match each of the following statements to either of the secretagogues Replaginide and Nateglinide:

1. Fast onset and short duration of action taken before meals.

2. Hypoglycemia

3. Safest of insulin secretagogues

Back 16

1. Both

2. Replaginide

3. Nateglinide

Front 17

1. What is Metformin used for?

2. T/F
Metformin produces hypoglycemia

3. T/F
Metformin has anticancer and weight loss benefit

4. How is metformin excreted?

Back 17

1. Delays or prevents T2DM onset

2. False

3. True

4. Renal

Front 18

1. What substances/conditions can increase the chance of lactic acidosis with Metformin use?

2. What vitamin deficiency can occur with Metformin use?

Back 18

1. Alcohol, hypoxia, overdose, or renal failure

2. Vitamin B12- leads to megaloblastic anemia, neurologic disease, and glossitis

Front 19

1. T/F
Hypoglycemia is a common occurrence with Pioglitazone and Rosiglitazone use

Back 19

False; it is a rare occurrence with these drugs.

Front 20

Name the drugs associated with each of the following:

1. Contraindicated in pregnancy, hepatic failure, and heart failure.

2. Contraindicated for inflammatory bowel disease and can raise liver enzymes.

3. Can impair absorption of fat soluble vitamins and elevate triglycerides.

4. Hypoglycemia is a major adverse effect

5. Major adverse effect is rare fatal pancreatitis.

6. Adverse effects include increased infections and pancreatitis

7. Increased risk of bone fractures and bladder cancer.

8. Can cause MI and is now rarely used

Back 20

1. Pioglitazone and Rosiglitazone

2. Acarbose and Miglitol (Alpha-glucosidase inhibitors)

3. Colsevelam (Bile acid sequestrant)

4. Pramlintide (Amylin analogue)

5. Exenatide and Liraglutide (Incretins)

6. Sitagliptin (DPP-4 inhibitor)

7. Pioglitazone and Rosiglitazone (Thiazolidinediones)

8. Rosiglitazone

Front 21

T/F

Exenatide has a longer half life then liraglutide

Back 21

False. Exenatide has half life of 2.4 hrs and Liraglutide has half life of 13 hours.

Front 22

T/F

Many of the non-insulin diabetic medications can be used in combination with other oral diabetic meds

Back 22

True

Note that many of these combos can cause hypoglycemia if not carefully monitored.

Front 23

Name the drug that can improve glucose control when used with metformin plus or minus sulfonylureas.

Back 23

Exenatide