NU 578 UNIT 4 EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
/. Insulin use - Answer-Insulin is used to treat all patients with type 1 and many with type
2 diabetes. consists of two amino acid chains (a acidic and b basic) linked by two
disulfide bridges. it is synthesized in the pancreas by b ce;;s within islets of langerhans.
insulin is released by rise in blood sugar (eating a. meal).
Anaolic reaction (insulin promotes conservation of energy and buildup of energy stores)
/.Insulin metabolic actions - Answer-Insulin promotes glucose into glycogen, amino
acids assembled into proteins, fatty acids into triglycerides.
Insulin deficiency promotes glycogen into glucose, proteins into amino acids, and fats
into glycerol.
/.Metformin use - Answer-Biguanide
used for type 2 DM. oral anti diabetic. may be used with other drugs. can be used for
prevention of type 2 diabetes, GDM, PCOS.
Reduces GI absorbance of glucose and hepatic production of glucose. Does not
stimulate insulin release from the pancreas.
Increases HDL, decreases BP, promotes weight loss.
/.DPP-4 Inhibitors (gliptins) - Answer-go to pancreas and increase insulin release.
Example is Sitaglitpin
/.Sodium Glucose cotransporter 2 inhibitors (SGLT-2 inhibitors). (gliflozins) - Answer-
Example: empagliflozin
increases urine excretion of glucose, taken PO, reduces cardiovascular risk of type 2
diabetes.
SE: yeast infections and genital gangrene
/.Incretin Mimetics ('tides) - Answer-injectables that slow gastric emptying, causes
weight loss and help an overwhelmed pancreas.
/.solfonylureas - Answer-stimulate pancreas to release more insulin. range in onset,
duration, and potency and are only used for type 2 diabetes. there are first generation
and second generation. second are more potent and doses are lower and drug drug
interactions are less common
AE: hypoglycemia
, /.Acarbose - Answer-a glucosidase inhibitor
oral anti diabetic agent that inhibits breakdown of oligosaccharides into
monosaccharides. this delays digestion and prolongs absorption of carbs and
decreases postprandial hyperglycemia!!
ADR: FI upset and flatulence.
take this with first bite of each meal.
/.Insulin Complications/ Drug Interactions - Answer-hypoglycemia caused by overdose.
hypoglycemic agents (sulfonylureas, glinides, and alcohol), hyperglycemia agents, b
adrenergic blocking agents.
/.Sitagliptin - Answer-DP4 inhibitor.
stimulates glucose dependent release of insulin and suppresses postprandial release of
glycogen. both actions help keep BG from climbing to ohhight. used for type 2 dm
AE: URI, headache, inflammation of nasal passages, pancreatitis, hypersensitivity
reactions.
/.Canagliflozin - Answer-SGC2 inhibitor
reduces reabsorption of glucose and increases urinary glucose excretion
AE: UTI, yeast infection, increased urination
DDI: uridine 5 diphospho glucuronosyltransferase inducers can decrease effects. when
used with diuretic can cause dehydration
/.How does insulin deficiency promote hyperglycemia - Answer-increased
glycogenolysis, increase glucomeogemesis, and reduced glucose utilization.
Glycogenolysis generates free glucose by breaking down glycogen.
/.Metformin SE - Answer-GI upset and acidosis.
don't use in patients with renal disease or liver disease. d/c before using iodinated radio
contrast media. wait 48 hours after to restart.
/.Insulin therapy dosing schedules - Answer-Twice daily premixed: twice daily regimen
can be used to provide basal and prandial insulin coverage. if given with breakfast and
dinner, no mealtime coverage
Intensive basal/bolus strategy: type 1 uses this. use of long acting insulin in addition to
short acting. short acting with meals.
SOLUTIONS
/. Insulin use - Answer-Insulin is used to treat all patients with type 1 and many with type
2 diabetes. consists of two amino acid chains (a acidic and b basic) linked by two
disulfide bridges. it is synthesized in the pancreas by b ce;;s within islets of langerhans.
insulin is released by rise in blood sugar (eating a. meal).
Anaolic reaction (insulin promotes conservation of energy and buildup of energy stores)
/.Insulin metabolic actions - Answer-Insulin promotes glucose into glycogen, amino
acids assembled into proteins, fatty acids into triglycerides.
Insulin deficiency promotes glycogen into glucose, proteins into amino acids, and fats
into glycerol.
/.Metformin use - Answer-Biguanide
used for type 2 DM. oral anti diabetic. may be used with other drugs. can be used for
prevention of type 2 diabetes, GDM, PCOS.
Reduces GI absorbance of glucose and hepatic production of glucose. Does not
stimulate insulin release from the pancreas.
Increases HDL, decreases BP, promotes weight loss.
/.DPP-4 Inhibitors (gliptins) - Answer-go to pancreas and increase insulin release.
Example is Sitaglitpin
/.Sodium Glucose cotransporter 2 inhibitors (SGLT-2 inhibitors). (gliflozins) - Answer-
Example: empagliflozin
increases urine excretion of glucose, taken PO, reduces cardiovascular risk of type 2
diabetes.
SE: yeast infections and genital gangrene
/.Incretin Mimetics ('tides) - Answer-injectables that slow gastric emptying, causes
weight loss and help an overwhelmed pancreas.
/.solfonylureas - Answer-stimulate pancreas to release more insulin. range in onset,
duration, and potency and are only used for type 2 diabetes. there are first generation
and second generation. second are more potent and doses are lower and drug drug
interactions are less common
AE: hypoglycemia
, /.Acarbose - Answer-a glucosidase inhibitor
oral anti diabetic agent that inhibits breakdown of oligosaccharides into
monosaccharides. this delays digestion and prolongs absorption of carbs and
decreases postprandial hyperglycemia!!
ADR: FI upset and flatulence.
take this with first bite of each meal.
/.Insulin Complications/ Drug Interactions - Answer-hypoglycemia caused by overdose.
hypoglycemic agents (sulfonylureas, glinides, and alcohol), hyperglycemia agents, b
adrenergic blocking agents.
/.Sitagliptin - Answer-DP4 inhibitor.
stimulates glucose dependent release of insulin and suppresses postprandial release of
glycogen. both actions help keep BG from climbing to ohhight. used for type 2 dm
AE: URI, headache, inflammation of nasal passages, pancreatitis, hypersensitivity
reactions.
/.Canagliflozin - Answer-SGC2 inhibitor
reduces reabsorption of glucose and increases urinary glucose excretion
AE: UTI, yeast infection, increased urination
DDI: uridine 5 diphospho glucuronosyltransferase inducers can decrease effects. when
used with diuretic can cause dehydration
/.How does insulin deficiency promote hyperglycemia - Answer-increased
glycogenolysis, increase glucomeogemesis, and reduced glucose utilization.
Glycogenolysis generates free glucose by breaking down glycogen.
/.Metformin SE - Answer-GI upset and acidosis.
don't use in patients with renal disease or liver disease. d/c before using iodinated radio
contrast media. wait 48 hours after to restart.
/.Insulin therapy dosing schedules - Answer-Twice daily premixed: twice daily regimen
can be used to provide basal and prandial insulin coverage. if given with breakfast and
dinner, no mealtime coverage
Intensive basal/bolus strategy: type 1 uses this. use of long acting insulin in addition to
short acting. short acting with meals.
