Diabetes Management and Amylin
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Questions and Answers

What is one of the primary functions of amylin in the body?

  • It acts independently to reduce insulin levels.
  • It stimulates the formation of glucagon.
  • It slows gastric emptying and glucose absorption. (correct)
  • It increases gastric emptying rate.

    • Which of the following best describes the relationship between insulin and amylin?

  • Insulin inhibits the release of amylin.
  • Insulin and amylin have no significant relationship.
  • Amylin is a hormone that works solely without insulin.
  • Amylin functions in conjunction with insulin to regulate blood sugar. (correct)

    • In which types of diabetes is amylin treatment considered an adjunct therapy?

  • Type 1, Type 2, and gestational diabetes.
  • Type 1 and Type 3 diabetes.
  • Type 2 and Type 4 diabetes.
  • Type 1 and Type 2 diabetes. (correct)

    • What effect does amylin have on postprandial glucagon release?

    <p>It prevents postprandial glucagon release.</p> Signup and view all the answers

    How can amylin levels be increased in the body?

    <p>By SC (subcutaneous) injection of amylin analogues.</p> Signup and view all the answers

    Which of the following is NOT a clinical feature of diabetes mellitus?

    <p>Hypertension</p> Signup and view all the answers

    What complication is categorized as an acute complication of diabetes mellitus?

    <p>DKA</p> Signup and view all the answers

    Which treatment is primarily focused on lifestyle changes in managing diabetes?

    <p>Diet control</p> Signup and view all the answers

    Which of the following is an indication for insulin therapy in diabetes management?

    <p>Inadequate control by oral hypoglycemics</p> Signup and view all the answers

    Who co-discovered insulin and was awarded the Nobel Prize for this achievement?

    <p>Frederick Banting</p> Signup and view all the answers

    Which of the following is most commonly associated with type I diabetes?

    <p>Insulin deficiency</p> Signup and view all the answers

    Which type of cell in the pancreatic islets is responsible for secreting glucagon?

    <p>Alpha cells</p> Signup and view all the answers

    What condition is considered a chronic complication of diabetes?

    <p>CVA</p> Signup and view all the answers

    What is the primary effect of insulin on glucose levels in the blood?

    <p>It reduces blood glucose levels.</p> Signup and view all the answers

    Which of the following is NOT a method of diabetes treatment?

    <p>Insulin vaccine</p> Signup and view all the answers

    What is a characteristic feature of Type 1 Diabetes Mellitus?

    <p>Insulin deficiency due to beta cell destruction</p> Signup and view all the answers

    What is the normal fasting blood glucose level range?

    <p>70 - 110 mg/dl</p> Signup and view all the answers

    In which condition is hyperglycemia defined as a blood glucose level greater than 180 mg/dl?

    <p>Diabetes Mellitus</p> Signup and view all the answers

    Which factor is associated with an increased risk of developing Type 2 Diabetes Mellitus?

    <p>Genetic predisposition</p> Signup and view all the answers

    Which of these statements accurately describes Type 2 Diabetes Mellitus?

    <p>It is more common in individuals who are overweight.</p> Signup and view all the answers

    What hormone is primarily secreted by delta cells of the pancreatic islets?

    <p>Somatostatin</p> Signup and view all the answers

    What condition is characterized by low blood glucose levels?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is a common trigger for Type 1 Diabetes Mellitus?

    <p>Viral infections like rubella</p> Signup and view all the answers

    Which insulin preparation is classified as ultra-long acting?

    <p>Degludec</p> Signup and view all the answers

    What is the primary route of administration for insulin?

    <p>Injection</p> Signup and view all the answers

    Which type of insulin has the quickest onset time?

    <p>Fast (Rapid)</p> Signup and view all the answers

    What is a characteristic of conventional therapy for insulin administration?

    <p>Allows more relaxed glucose monitoring</p> Signup and view all the answers

    Why is daily self-monitoring of glucose emphasized in intensive insulin therapy?

    <p>To enable tighter control of blood glucose levels</p> Signup and view all the answers

    What is the typical duration of action for intermediate-acting insulin?

    <p>10-20 hours</p> Signup and view all the answers

    Which of the following insulin types is most likely to have a decreasing risk of hypoglycemia?

    <p>Long-acting insulins</p> Signup and view all the answers

    In a daily insulin schedule, when should short-acting insulin be administered before meals?

    <p>Before lunch and dinner</p> Signup and view all the answers

    What is the peak time for short-acting insulin after administration?

    <p>2-3 hours</p> Signup and view all the answers

    What is a potential consequence of intensive insulin therapy compared to conventional therapy?

    <p>Higher risk of hypoglycemia</p> Signup and view all the answers

    Which type of insulin mimics the response of natural insulin release in the body?

    <p>Mixed types</p> Signup and view all the answers

    When is it advisable to administer long-acting insulin in a daily schedule?

    <p>Before bed</p> Signup and view all the answers

    What is a common characteristic of the absorption of subcutaneous insulin?

    <p>Highly variable between individuals</p> Signup and view all the answers

    What is the primary action of SGLT-2 inhibitors like gliflozins?

    <p>Inhibit renal glucose reabsorption</p> Signup and view all the answers

    Which of the following is a potential adverse effect associated with gliflozins?

    <p>Ketoacidosis</p> Signup and view all the answers

    What is the mechanism through which gliflozins result in glycosuria?

    <p>Inhibition of SGLT-2</p> Signup and view all the answers

    Gliflozins are primarily used for which type of diabetes?

    <p>Type 2 diabetes only</p> Signup and view all the answers

    What is a common risk associated with the use of gliflozins regarding urinary tract infections?

    <p>Increased UTI due to glucose in urine</p> Signup and view all the answers

    What occurs as a result of excessive glucose loss in urine from gliflozins?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which of the following statements regarding gliflozins is correct?

    <p>They are associated with the risk of toe necrosis.</p> Signup and view all the answers

    Which of these antidiabetic agents acts as insulin secretagogues?

    <p>GLP-1 analogues</p> Signup and view all the answers

    What is the sodium-glucose cotransporter 2 (SGLT-2) responsible for?

    <p>Renal glucose reabsorption</p> Signup and view all the answers

    What do gliflozins ultimately lead to in terms of glucose levels in the blood?

    <p>Decrease blood glucose levels</p> Signup and view all the answers

    Which factor enhances the absorption of insulin injected into a specific site?

    <p>Depth of injection</p> Signup and view all the answers

    Which of the following insulin delivery methods is considered the most advanced?

    <p>Insulin pumps</p> Signup and view all the answers

    What is a major risk associated with sulfonylureas?

    <p>Hypoglycemia</p> Signup and view all the answers

    In which patient population are Biguanides particularly advantageous?

    <p>Obese patients with type 2 DM</p> Signup and view all the answers

    Which mechanism of action is associated with Meglitinides?

    <p>Increase insulin secretion by β-cells</p> Signup and view all the answers

    What is a common side effect of Metformin?

    <p>Lactic acidosis</p> Signup and view all the answers

    Which statement is true regarding Type 1 diabetes medications?

    <p>Insulin is essential</p> Signup and view all the answers

    What is the mechanism of action for Thiazolidinediones (TZDs)?

    <p>Improve insulin sensitivity in tissues</p> Signup and view all the answers

    Which drug class is contraindicated during pregnancy due to teratogenic effects?

    <p>Sulfonylureas</p> Signup and view all the answers

    What distinguishes first-generation from second-generation sulfonylureas?

    <p>They differ in their chemical structure</p> Signup and view all the answers

    Which of the following regarding insulin resistance is accurate?

    <p>It implies body cells are unresponsive to insulin</p> Signup and view all the answers

    What is the main role of insulin pumps?

    <p>To deliver a programmable dose of insulin</p> Signup and view all the answers

    Which of the following insulin types is associated with a shorter duration of action?

    <p>Regular insulin</p> Signup and view all the answers

    What is a potential adverse effect of Thiazolidinediones?

    <p>Weight gain</p> Signup and view all the answers

    How does exercise affect insulin absorption?

    <p>Increases insulin absorption</p> Signup and view all the answers

    Study Notes

    Pancreatic Glands

    • Exocrine glands produce pancreatic digestive enzymes via pancreatic acini
    • Endocrine glands form pancreatic islets (Islets of Langerhans) and secrete hormones

    Cells of Pancreatic Islets

    • Alpha cells secrete glucagon
    • Beta cells secrete insulin
    • Delta cells secrete somatostatin
    • PP (F) cells secrete pancreatic polypeptide

    Effects of Glucagon

    • Stimulates glucose production in the liver (gluconeogenesis)
    • Stimulates glycogen breakdown into glucose in skeletal muscles and liver cells (glycogenolysis)
    • Stimulates triglyceride breakdown in adipose tissue and fatty acid release (lipolysis)

    Effects of Insulin

    • Accelerates glucose uptake and utilization by cells.
    • Stimulates glycogen formation (glycogenesis)
    • Stimulates triglyceride formation in adipose tissue (lipogenesis)
    • Stimulates amino acid absorption and protein synthesis

    Insulin vs. Glucagon Actions

    • Insulin lowers blood glucose
    • Glucagon raises blood glucose

    Mechanism of Insulin Action

    • Insulin binds specific insulin receptors on cell membranes
    • This triggers signal transduction and gene expression/growth regulation
    • Glucose utilization (glycogen, lipid, protein synthesis) increases

    Main Target Organs of Insulin

    • Liver
    • Muscle
    • Adipose tissue

    Blood Glucose Levels

    • Normal fasting blood glucose: 70-110 mg/dL
    • Normal 2-hour postprandial blood glucose: <180 mg/dL
    • Hypoglycemia: <70 mg/dL
    • Hyperglycemia: >110 mg/dL (fasting)
    • Impaired glucose tolerance: 110-180 mg/dL
    • Diabetes mellitus: >180 mg/dL

    Types of Diabetes Mellitus

    • Primary DM:
      • Type 1 (Insulin-Dependent DM - IDDM): insulin deficiency
      • Type 2 (Non-Insulin Dependent DM - NIDDM): insulin resistance
    • Secondary DM:
      • Pancreatic disease (e.g., pancreatitis, tumor)
      • Endocrine disease (e.g., Cushing's syndrome)
      • Drug induced (e.g., thiazide diuretics)
      • Infection (e.g., congenital rubella)
    • Gestational DM: during pregnancy

    Primary DM - Type 1 and Type 2

    • Type 1:
      • Abnormality: β-cell destruction, insulin deficiency
      • Incidence: Less common
      • Age of onset: <30 years
      • Etiology: Autoimmune, often with precipitating factor
      • Autoantibodies: commonly present (60-85%)
    • Type 2:
      • Abnormality: β-cell dysfunction, insulin resistance
      • Incidence: More common
      • Age of onset: >40 years
      • Etiology: Multifactorial (genetic and environmental)
      • Autoantibodies: rarely present (<10%)

    Primary DM - Genetics, Body Weight, Diabetic Ketoacidosis, HHS

    • Genetics: Lesser impact in type 1, greater impact in type 2
    • Body weight: Low in type 1, overweight/obese in type 2
    • Diabetic ketoacidosis: More common in type 1
    • HHS: Less common in type 1, more common in type 2
    • Treatment: Insulin for type 1, oral hypoglycemics + insulin for type 2

    Obesity and Type 2 DM

    • Obesity is linked to an increased risk of type 2 diabetes
    • Increased body weight by 10kg increases risk of type 2 DM dramatically (3X)
    • Obesity often leads to earlier onset of type 2 diabetes

    Obesity, Inactivity, and Unhealthy Diet

    • Obesity, inactivity, and unhealthy diet are risk factors for type 2 diabetes in both adults and children.

    The Deadly Quartet

    • Obesity, diabetes, hypertension, and dyslipidemia are linked and pose significant health risks.

    Clinical Features of DM

    • Polydipsia (excessive thirst)
    • Polyuria (excessive urination)
    • Nocturia (Frequent urination at night)
    • Glycosuria (glucose in the urine)
    • Complications (detailed in the further notes below)

    Complications of DM

    • Acute: DKA (Diabetic Ketoacidosis), HONK (Hyperosmolar Hyperglycemic Nonketotic Coma)
    • Chronic:
      • Angiopathy
        • Microangiopathy (e.g., Retinopathy, Nephropathy)
        • Macroangiopathy (e.g., CAD, PAD, CVA)
    • Other: Infection and skin issues

    Treatment of DM

    • Diet control
    • Antidiabetic agents
    • Management of complications

    Diet Control

    • Minimize sugar intake or adjust medication/insulin accordingly to control blood sugar
    • Reduce body weight
    • Increase physical activity

    Antidiabetic Agents

    • Insulin (more common with type 1)
    • Oral Hypoglycemics (Type 2)

    Insulin

    • History: Frederick Banting first human trial in 1923
    • Sources: Bovine, Porcine, Human Recombinant
    • Administration: Injection (SC, IV, IM). Alternative methods: Pump
    • Preparations: Fast-acting, short-acting, intermediate-acting, long-acting, ultra-long-acting, mixed types (combinations)
    • Regimens: Conventional therapy (1-2 injections/day) Intensive therapy (multiple daily injections, glucose monitoring, and dose adjustment.)
    • Daily Insulin Schedule (example)
    • Absorption of SC Insulin (highly variable, affected by factors such as site of injection, blood flow, exercise, massage)
    • Alternatives to Insulin Injection (insulin pumps, insulin pens, transdermal, inhaled, and oral formulations)
    • Common Insulin Delivery Devices (insulin syringe, insulin pen, jet injector, insulin pump, inhaled insulin)
    • Complications of Insulin Therapy (systemic and local)
      • Hypoglycemia, insulin allergy, insulin resistance, lipoatrophy, hypertrophy

    Oral Hypoglycemics

    • Sulfonylureas (first generation, second and third generation) ; Mechanism of Action; Pharmacokinetics; Drug interactions; Adverse Effects
    • Biguanides (mechanism of action, indications, advantages, adverse effects [Metformin – commonly used]).
    • Meglitinides (Mechanism of action, Indications, Adverse effects, [repaglinide & nateglinide])
    • Thiazolidinediones (TZDs or glitazones) (Mechanism of action, indications, adverse effects, [Rosiglitazone & Pioglitazone])
    • Alpha-glucosidase inhibitors (Mechanism of action, indications, side effects, [Example Acarbose])
    • Recent Antidiabetic Agents (Glucagon-like peptide-1 (GLP-1), DPP-4, Amylin Analogues, Gliflozins).
      • GLP-1 agonists (Mechanism & Example Exenatide)
      • DPP-4 Inhibitors (Mechanism and examples [Sitagliptin and Saxagliptin])
      • Amylin analogues (Mechanism & Example Pramlintide)
      • Gliflozins (Mechanism, indications, adverse effects, example canagliflozin)

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    Insulin & Anti-diabetic Agents PDF

    Description

    Test your knowledge on diabetes management, focusing on the role of amylin and its relationship with insulin. This quiz covers various aspects of diabetes, including treatment options, complications, and key concepts related to glucose regulation. Perfect for medical students or anyone looking to deepen their understanding of diabetes.

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