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Insulin Therapy and Amylinomimetics
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Insulin Therapy and Amylinomimetics

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Questions and Answers

What is the primary benefit of using GLP-1 agonists or its similar contraindications?

  • Moderate A1c reduction (correct)
  • Improving beta-cell function
  • Reducing hypoglycemia
  • Increasing insulin sensitivity

    • What is a common side effect of GLP-1 agonists and its similar contraindications?

  • Hypertension
  • Weight gain
  • Hypoglycemia (correct)
  • Hyperglycemia

    • Which of the following is NOT a benefit of using GLP-1 agonists or its similar contraindications?

  • Increased glucagon secretion (correct)
  • Improved insulin sensitivity
  • Weight loss
  • Reduced cardiovascular risk

    • What is the primary mechanism of action of GLP-1 agonists and its similar contraindications?

    <p>Inhibiting glucagon secretion</p> Signup and view all the answers

    Which of the following insulin types is NOT similar to GLP-1 agonists?

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

    Which type of insulin regimen involves the use of multiple daily injections?

    <p>Basal-bolus regimens</p> Signup and view all the answers

    What is the hormone that is released into the bloodstream along with insulin after a meal?

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

    Which type of insulin therapy is no longer mentioned in the content?

    <p>Inhaled insulin therapy</p> Signup and view all the answers

    What is Pramlintide an analogue of?

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

    What is absent in individuals with Type I diabetes?

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

    At what GFR are loop diuretics less effective?

    <p>$45-60 ml/min/1.73m2$</p> Signup and view all the answers

    What is the only agent currently approved for the treatment of T2D?

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

    What is the name of the class of noninsulin injectable agents?

    <p>Glucagon-Like Peptide 1 Agonists</p> Signup and view all the answers

    Which of the following agents is not a GLP-1 Agonist?

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

    What is the potential side effect of concomitant diuretic use?

    <p>Orthostatic hypotension and electrolyte abnormalities</p> Signup and view all the answers

    Concomitant diuretic use may cause hyperglycemia and electrolyte abnormalities.

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

    Loop diuretics are less effective at a GFR of 60-75 ml/min/1.73m2.

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

    Tirzepatide is the only agent approved for treatment of Type 1 diabetes.

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

    Albiglutide is a DPP-4 inhibitor.

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

    Liraglutide is an insulin sensitizer.

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

    SGLT-2 inhibitors reduce glucose reabsorption in the distal nephron.

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

    SGLT-2 inhibitors increase urinary glucose excretion by up to 90 g/day.

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

    SGLT-2 inhibitors work by stimulating the production of insulin.

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

    SGLT-2 inhibitors are a type of insulin sensitizer.

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

    Sodium-glucose co-transporter 2 inhibitors are used to treat type 1 diabetes.

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

    Dextrose IV is always required for unconscious patients.

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

    GLP-1 increases pancreatic insulin secretion.

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

    Sitagliptin is a type of SGLT-2 inhibitor.

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

    A blood glucose level of 2 mg/dl is a sign of hypoglycemia.

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

    Vildagliptin is a type of insulin sensitizer.

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

    What GFR are loop diuretics less effective at?

    <p>45-60 ml/min/1.73m2</p> Signup and view all the answers

    What is the name of the only agent currently approved for treatment of T2D?

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

    What is the potential side effect of concomitant diuretic use?

    <p>Orthostatic hypotension and electrolyte abnormalities</p> Signup and view all the answers

    What class of noninsulin injectable agents includes lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide?

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

    What is the name of the class of noninsulin injectable agents that includes GLP-1 agonists?

    <p>Noninsulin Injectable Agents</p> Signup and view all the answers

    What is the primary mechanism of action of SGLT-2 inhibitors?

    <p>Inhibiting SGLT2 in the proximal nephron, thereby reducing glucose reabsorption and increasing urinary glucose excretion.</p> Signup and view all the answers

    How much glucose excretion can SGLT-2 inhibitors increase in the urine?

    <p>Up to 80 g/day</p> Signup and view all the answers

    In which part of the nephron do SGLT-2 inhibitors work?

    <p>Proximal nephron</p> Signup and view all the answers

    What is the effect of SGLT-2 inhibitors on glucose reabsorption?

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

    What is the site of action of SGLT-2 inhibitors?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    What is the preferred treatment for unconscious patients when IV access cannot be established and they are experiencing hypoglycemia?

    <p>Glucagon, 1 g intramuscularly</p> Signup and view all the answers

    What is the blood glucose level that indicates hypoglycemia?

    <p>Less than 2 mg/dl</p> Signup and view all the answers

    What is the mechanism of action of DPP-4 inhibitors, a type of insulin sensitizer?

    <p>Inhibiting the breakdown of GLP-1, which increases pancreatic insulin secretion</p> Signup and view all the answers

    What is the name of an example of a DPP-4 inhibitor, a type of insulin sensitizer?

    <p>Sitagliptin (Januvia)</p> Signup and view all the answers

    What is the treatment of choice for unconscious patients who can receive IV fluids?

    <p>Dextrose IV</p> Signup and view all the answers

    Loop diuretics are less effective at a GFR of ______ ml/min/1.73m2.

    <p>45-60</p> Signup and view all the answers

    The class of noninsulin injectable agents that includes lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide is called ______ Agonists.

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

    Concomitant diuretic use may cause ______ and electrolyte abnormalities.

    <p>orthostatic hypotension</p> Signup and view all the answers

    The only agent currently approved for the treatment of T2D is ______.

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

    ______ is a type of noninsulin injectable agents that includes GLP-1 agonists.

    <p>Glucagon-Like Peptide 1</p> Signup and view all the answers

    SGLT-2 inhibitors reduce glucose reabsorption in the ______ nephron.

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

    SGLT-2 inhibitors increase urinary glucose excretion by up to ______ g/day.

    <p>80</p> Signup and view all the answers

    Sodium-glucose co-transporter 2 inhibitors work by ______ SGLT2 in the proximal nephron.

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

    A blood glucose level of ______ mg/dl is a sign of hypoglycemia.

    <p>less than 70</p> Signup and view all the answers

    Dextrose IV is always required for ______ patients.

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

    If the blood glucose level is less than ______ mg/dl, it indicates hypoglycemia.

    <p>2</p> Signup and view all the answers

    Glucagon, ______ g intramuscularly, is preferred in unconscious patients when IV access cannot be established.

    <p>1</p> Signup and view all the answers

    DPP-4 inhibitors, a type of insulin sensitizer, work by inhibiting the breakdown of ______ secreted during meals.

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

    Dextrose IV may be required for ______ patients.

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

    An example of a DPP-4 inhibitor, a type of insulin sensitizer, is ______.

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

    Match the following GLP-1 agonists with their names:

    <p>Lixisenatide = Noninsulin Injectable Agents Exenatide = Noninsulin Injectable Agents Liraglutide = Noninsulin Injectable Agents Albiglutide = Noninsulin Injectable Agents</p> Signup and view all the answers

    Match the following symptoms with the treatment they require:

    <p>Hypoglycemia = Dextrose IV Unconscious patients without IV access = Oral glucose Unconscious patients with IV access = Dextrose IV Electrolyte abnormalities = Discontinuation of loop diuretics</p> Signup and view all the answers

    Match the following classes of agents with their mechanism of action:

    <p>Insulin sensitizers = Increase insulin secretion DPP-4 inhibitors = Increase insulin secretion SGLT-2 inhibitors = Reduce glucose reabsorption GLP-1 agonists = Increase insulin secretion</p> Signup and view all the answers

    Match the following agents with their class:

    <p>Sitagliptin = DPP-4 inhibitors Vildagliptin = DPP-4 inhibitors Liraglutide = GLP-1 agonists Albiglutide = GLP-1 agonists</p> Signup and view all the answers

    Match the following SGLT-2 inhibitors with their effects:

    <p>SGLT-2 inhibitors = Stimulate glucose production</p> Signup and view all the answers

    Match the following agents with their mechanism of action:

    <p>SGLT-2 inhibitors = Inhibiting glucose reabsorption in the proximal nephron DPP-4 inhibitors = Stimulating the production of insulin GLP-1 agonists = Increasing pancreatic insulin secretion Insulin sensitizers = Reducing glucose production in the liver</p> Signup and view all the answers

    Match the following treatments with their corresponding conditions:

    <p>Dextrose IV = Hypoglycemia in unconscious patients SGLT-2 inhibitors = Type 2 diabetes Loop diuretics = Heart failure GLP-1 agonists = Type 1 diabetes</p> Signup and view all the answers

    Match the following agents with their type:

    <p>Sitagliptin = DPP-4 inhibitor Liraglutide = GLP-1 agonist Vildagliptin = Insulin sensitizer Albiglutide = SGLT-2 inhibitor</p> Signup and view all the answers

    Match the following parameters with their corresponding values:

    <p>Blood glucose level indicating hypoglycemia = 2 mg/dl GFR at which loop diuretics are less effective = 60-75 ml/min/1.73m2 Urinary glucose excretion increased by SGLT-2 inhibitors = 80 g/day Part of the nephron where SGLT-2 inhibitors work = Proximal nephron</p> Signup and view all the answers

    Match the following agents with their effects:

    <p>SGLT-2 inhibitors = Increase urinary glucose excretion DPP-4 inhibitors = Stimulate insulin secretion GLP-1 agonists = Increase pancreatic insulin secretion Insulin sensitizers = Reduce glucose production in the liver</p> Signup and view all the answers

    Match the following symptoms with their corresponding blood glucose levels:

    <p>Hypoglycemia = $2 mg/dl$ Hyperglycemia = $&gt; 200 mg/dl$ Normal blood glucose = $70-140 mg/dl$ Ketoacidosis = $&gt; 300 mg/dl$</p> Signup and view all the answers

    Match the following treatments with their corresponding routes of administration:

    <p>Dextrose IV = Intravenous Glucagon = Intramuscular Sitagliptin = Oral DPP-4 inhibitors = Oral</p> Signup and view all the answers

    Match the following insulin sensitizers with their mechanisms of action:

    <p>DPP-4 inhibitors = Inhibit the breakdown of GLP-1 SGLT-2 inhibitors = Increase urinary glucose excretion Metformin = Decrease glucose production in the liver Thiazolidinediones = Increase insulin sensitivity in muscle and adipose tissue</p> Signup and view all the answers

    Match the following DPP-4 inhibitors with their brand names:

    <p>Sitagliptin = Januvia Saxagliptin = Onglyza Linagliptin = Tradjenta Vildagliptin = Galvus</p> Signup and view all the answers

    Match the following SGLT-2 inhibitors with their effects on glucose reabsorption:

    <p>SGLT-2 inhibitors = Reduce glucose reabsorption DPP-4 inhibitors = Increase insulin secretion GLP-1 agonists = Increase insulin secretion Insulin = Increase glucose uptake in muscle and adipose tissue</p> Signup and view all the answers

    Study Notes

    Insulin Therapies

    • There are three types of insulin therapies: “split-mixed” insulin, basal-bolus regimens using multiple daily injections (MDI), and continuous subcutaneous insulin infusion (CSII) pump therapy.

    Amylinomimetics

    • Pramlintide is an analogue of amylin, a small peptide hormone released by the β cells of the pancreas along with insulin after a meal.
    • Amylin is completely absent in individuals with Type I diabetes.

    Pramlintide: Benefits and Risks

    • Benefits: moderate A1c reduction.
    • Risks/side effects: hypoglycemia, contraindications similar to GLP-1 agonists.
    • Concomitant use of diuretics may cause orthostatic hypotension and electrolyte abnormalities; loop diuretics may need to be discontinued.

    GLP-1 Agonists

    • Agents: lixisenatide, exenatide, liraglutide, albiglutide, and dulaglutide.
    • GLP-1 agonists are noninsulin injectable agents.
    • Tirzepatide is the only agent currently approved for treatment of T2D.

    Kidney Function and GFR

    • Patients with a GFR of 45-60 ml/min/1.73m2 may be less effective at responding to certain treatments.

    GLP-1 Agonists

    • GLP-1 (Glucagon-Like Peptide 1) Agonists are noninsulin injectable agents used to treat T2D.
    • Examples of GLP-1 Agonists include lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide.
    • Tirzepatide is the only agent currently approved for T2D treatment and is weight neutral.

    SGLT-2 Inhibitors

    • SGLT-2 (Sodium-Glucose Co-transporter 2) Inhibitors work by inhibiting SGLT2 in the proximal nephron, reducing glucose reabsorption and increasing urinary glucose excretion by up to 80 g/day.
    • Dextrose IV may be required for unconscious patients, and Glucagon, 1 g intramuscularly, is preferred in unconscious patients when IV access cannot be established.

    Insulin Sensitizers - DPP-4 Inhibitors

    • DPP-4 (Dipeptidyl Peptidase IV) Inhibitors work by inhibiting the breakdown of GLP-1 secreted during meals, which increases pancreatic insulin secretion.
    • Examples of DPP-4 Inhibitors include Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin, and Vildagliptin.

    Kidney Function and GFR

    • Patients with a GFR of 45-60 ml/min/1.73m2 may be less effective at responding to certain treatments.

    GLP-1 Agonists

    • GLP-1 (Glucagon-Like Peptide 1) Agonists are noninsulin injectable agents used to treat T2D.
    • Examples of GLP-1 Agonists include lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide.
    • Tirzepatide is the only agent currently approved for T2D treatment and is weight neutral.

    SGLT-2 Inhibitors

    • SGLT-2 (Sodium-Glucose Co-transporter 2) Inhibitors work by inhibiting SGLT2 in the proximal nephron, reducing glucose reabsorption and increasing urinary glucose excretion by up to 80 g/day.
    • Dextrose IV may be required for unconscious patients, and Glucagon, 1 g intramuscularly, is preferred in unconscious patients when IV access cannot be established.

    Insulin Sensitizers - DPP-4 Inhibitors

    • DPP-4 (Dipeptidyl Peptidase IV) Inhibitors work by inhibiting the breakdown of GLP-1 secreted during meals, which increases pancreatic insulin secretion.
    • Examples of DPP-4 Inhibitors include Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin, and Vildagliptin.

    Kidney Function and GFR

    • Patients with a GFR of 45-60 ml/min/1.73m2 may be less effective at responding to certain treatments.

    GLP-1 Agonists

    • GLP-1 (Glucagon-Like Peptide 1) Agonists are noninsulin injectable agents used to treat T2D.
    • Examples of GLP-1 Agonists include lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide.
    • Tirzepatide is the only agent currently approved for T2D treatment and is weight neutral.

    SGLT-2 Inhibitors

    • SGLT-2 (Sodium-Glucose Co-transporter 2) Inhibitors work by inhibiting SGLT2 in the proximal nephron, reducing glucose reabsorption and increasing urinary glucose excretion by up to 80 g/day.
    • Dextrose IV may be required for unconscious patients, and Glucagon, 1 g intramuscularly, is preferred in unconscious patients when IV access cannot be established.

    Insulin Sensitizers - DPP-4 Inhibitors

    • DPP-4 (Dipeptidyl Peptidase IV) Inhibitors work by inhibiting the breakdown of GLP-1 secreted during meals, which increases pancreatic insulin secretion.
    • Examples of DPP-4 Inhibitors include Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin, and Vildagliptin.

    Kidney Function and GFR

    • Patients with a GFR of 45-60 ml/min/1.73m2 may be less effective at responding to certain treatments.

    GLP-1 Agonists

    • GLP-1 (Glucagon-Like Peptide 1) Agonists are noninsulin injectable agents used to treat T2D.
    • Examples of GLP-1 Agonists include lixisenatide, Exenatide, Liraglutide, Albiglutide, and Dulaglutide.
    • Tirzepatide is the only agent currently approved for T2D treatment and is weight neutral.

    SGLT-2 Inhibitors

    • SGLT-2 (Sodium-Glucose Co-transporter 2) Inhibitors work by inhibiting SGLT2 in the proximal nephron, reducing glucose reabsorption and increasing urinary glucose excretion by up to 80 g/day.
    • Dextrose IV may be required for unconscious patients, and Glucagon, 1 g intramuscularly, is preferred in unconscious patients when IV access cannot be established.

    Insulin Sensitizers - DPP-4 Inhibitors

    • DPP-4 (Dipeptidyl Peptidase IV) Inhibitors work by inhibiting the breakdown of GLP-1 secreted during meals, which increases pancreatic insulin secretion.
    • Examples of DPP-4 Inhibitors include Sitagliptin (Januvia), Saxagliptin, Linagliptin, Alogliptin, and Vildagliptin.

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