pancreatic hormones and anti-diabetic drugs part I

pcol exam 3

what is the generic for Glucophage

metformin

what is the generic for Glucotrol XL

glipizide

what is the generic for Actos

pioglitazone

what is the generic for Micronase

glyburide

what is the generic for Amaryl

glimepiride

what is the generic for Januvia

sitagliptan

what is the generic for Onglyza

saxagliptin

what is the generic for Tradjenta

linagliptin

what is the generic for Nesina

Alogliptin

what is the generic for Victoza

liraglutide

what is the generic for Bydureon

exenatide

what is the generic for Tanzeum

albiglutide

what is the generic for Trulicity

dulaglutide

what is the generic for Adlyxin

lixisenatide

what is the generic for Aspart

novolog

what is the generic for Lantus

glargine

what is the generic for Lispro

humalog

what is the generic for Humulin

regular insulin

what is the generic for Humulin N or Novolin N

NPH

what is the generic for Levemir

detemir

what is the generic for Tresiba

degludec

what is the generic for Precose

acarbose

what is the generic for Glyset

miglitol

what is the generic for Symlin

primlintide

what is the generic for Starlix

nateglinide

what is the generic for Prandin

repaglinide

what is the generic for Invokana

canagliflozin

what is the generic for Farxiga

dapagliflozin

what is the generic for Jardiance

empagliflozin

what is diabetes mellitus

group of metabolic diseases characterized by glycemia due to defects in insulin secretion, insulin action, or both

what is gluconeogenesis

metabolic process that synthesizes glucose from non-carbohydrate sources in the liver and kidneys

what is glycogenesis

formation of glycogen from excess glucose for storage

what is glycogenolysis

metabolic breakdown of glycogen into glucose

what is glycolysis

conversion of glucose into pyruvate to yield ATP for energy

what is another name for type 1 diabetes

insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes

when does type 1 diabetes usually develop

during childhood, adolescence, or <30 years old

what are the risk factors for type 1 diabetes

genetic predisposition

environmental stimuli

viruses

autoimmune diseases

how does type 1 diabetes develop

organ-specific autoimmune destruction of pancreatic islet cells

what is another name for type 2 diabetes

non-insulin dependent diabetes mellitus, adult-onset DM

what commonly precedes a type 2 diabetes diagnosis

insulin resistance

what is hyperinsulinemia

insulin-resistance that needs higher plasma levels of insulin to achieve the same physiological effects

what can cause hyperinsulinemia

increased hepatic glucose production, abnormal lipid metabolism, adipose tissue releasing free fatty acids

what are the risk factors for type 2 diabetes

obesity or sedentary lifestyle

first degree relative with diabetes

high risk ethnic groups

metabolic syndrome

delivered baby >9 lbs

HTN

HDL <35 or TG >250

history of vascular disease

what are the 3 P’s of diabetes

polyuria

polydipsia

polyphagia

what are signs and symptoms of diabetes

3 P’s

weight loss — more common in T1D

dry skin

weakness

nocturia

blurred vision

fatigue

headache

ketoacidosis — more common in T1D

what is the lab value for significant hypoglycemia

<54 mg/dL

what are symptoms of hypoglycemia

shaking

sweating

anxious

dizziness

hunger

tachycardia

impaired vision

weakness, fatigue

headache

irritable

what are the symptoms of hyperglycemia

extreme thirst

frequent urination

dry skin

hunger

blurred vision

drowsiness

nausea

what is a normal HgA1C

4-5.6%

how often should A1C be monitored in patients with controlled diabetes

twice a year

how often should A1C be monitored in patients with uncontrolled diabetes

quarterly

what is the numerical correlation of A1C to BG

1% increase in A1C → BG + 28

ex: 6% = 126 mg/dL, 7% = 154 mg/dL

what is an A1C for diabetes

> 6.5

what is an A1C for prediabetes

5.7-6.4

what is a fasting plasma glucose for diabetes

> 126

what is a fasting plasma glucose for prediabetes

100-125

what is a 2 hr post prandial glucose for diabetes

> 200

what is a 2 hour post prandial glucose for prediabetes

140-199

what is the A1C treatment goal for diabetes

<7

what is the preprandial (fasting) plasma glucose treatment goal for diabetes in non-pregnant patients

80-130

what is the preprandial (fasting) plasma glucose treatment goal for diabetes in pregnant patients

< 95

what is the 1 hour post prandial treatment goal for diabetes in pregnant patients

< 140

what is the 2 hour post prandial glucose treatment goal for diabetes in non-pregnant patients

< 180

what is the 2 hour post prandial glucose treatment goal for diabetes in pregnant patients

< 120

what are some complications of diabetes mellitus

2-4 fold increase in cardiovascular mortality

end stage renal disease

blindness

non-traumatic lower extremity amputations

how are advanced glycation end products formed

by non-enzymatic reaction between glucose, lipids, and amino acids

what expedites the formation of advanced glycation end products

hyperglycemia and oxidative stress

what do advanced glycation end products (AGEs) cause

impaired endothelial function

changes in vessel wall structure

thickening in basement membrane

increased vascular permeability

prothrombotic state

decreased blood flow

damage of retina, nephron, and peripheral/central nerves

what type of functions does the pancreas have

endocrine and exocrine

what is the exocrine function of the pancreas

secrete digestive enzymes and bicarbonate

what is the endocrine function of the pancreas

secrete hormones into general circulation via portal blood

what are the 5 pancreatic cell types

alpha

beta

delta

PP or F

G

what do alpha pancreatic cells do

release glucagon

what do pancreatic beta cells do

release insulin and amylin

what do pancreatic delta cells do

release somatostatin

what do pancreatic PP or F cells do

release pancreatic polypeptides

what do pancreatic G cells do

release gastrin

what is somatostatin

hormone produced in pancreas, GI, and hypothalamus that has inhibitory effect on the secretion of insulin, glucagon, GH, TSH, and GI hormones

what causes somatostatin release

high plasma levels of glucose, amino acids, and fatty acids

when do alpha cells secrete glucagon

when blood glucose levels are low

when do beta cells secrete insulin

when blood glucose is high

what processes does insulin release stimulate

glucose uptake in muscle and adipose tissue

glycolysis

glycogen synthesis

protein synthesis

uptake of ions

what processes does insulin release inhibit

gluconeogenesis

glucogenolysis

lipolysis

ketogenesis

proteolysis

what is the starting molecule in biosynthesis of insulin

pre-proinsulin

what is pre-proinsulin converted to in the rough endoplasmic reticulum

proinsulin

how is proinsulin converted into insulin

by proteolytic cleavage in the golgi apparatus — remove C chain

what are the two chains of insulin

A — 21 amino acids

B — 30 amino acids

what is the usual concentration of C peptide in patients without diabetes

0.5-2 ng/mL

what is the concentration of C peptide in patients with type 1 diabetes

<1 ng/mL

what is the concentration of C peptide in patients with type 2 diabetes

>1 ng/mL

how does glucose stimulate insulin secretion

glucose enters beta cells via GLUT2 → increase ATP → Ca²⁺ enters cell → insulin secretion stimulated

how is glucose stored in skeletal muscles

insulin stimulates translocation of glucose through GLUT4 → glucose stored as glycogen

where is GLUT1 located

all tissues, especially RBC and brain

what is GLUT1 responsible for

basal uptake of glucose and transport across BBB

where is GLUT2 located

pancreatic beta cells, liver, kidney, and gut

what is GLUT2 responsible for

regulation of insulin release, glucose homeostasis

where is GLUT3 located

brain, kidney, placenta, other tissue

what is GLUT3 responsible for

uptake into neurons and other tissues

where is GLUT4 located

muscle and adipose tissue

what is GLUT4 responsible for

insulin-mediated uptake of glucose