Pancreas and Insulin
This page describes a Qedoc learning module or quiz entitled "Pancreas and Insulin". You can download the module from this page to put on your computer. You can also launch the module straight off the web using the launch quiz link on the right-hand side of this page. Another way to access this quiz is to install the Qedoc Quiz Player and bring up its directory of downloadable quizzes. Whichever way you choose to use it, it's free.
This module may contain medicine-related material. Please refer to our medical disclaimer.
Structure, storage, release, actions of insulin. Categories of diabetes. Treatment: insulin, oral hypoglycaemics (sulphonylureas, biguanides, thiazolidinediones, repaglinide, inhibitors of alpha glucosidases). Hypoglycaemia: acute and chronic, treatment with glucose, glucagon, diazoxide.
The module contains the following activities:
- All Questions
- Diabetes mellitus
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- Knockout mice lacking IRS-1 are hyporesponsive to insulin (insulin-resistant) but do not become diabetic because of robust B-cell compensation with increased insulin secretion. By contrast, mice lacking IRS-2 fail to compensate and develop overt diabetes, implicating the IRS-2 gene as a candidate for human type 2 diabetes
- Insulin increases synthesis of fatty acid and triglyceride in adipose tissue and in liver. It inhibits lipolysis, partly via dephosphorylation (and hence inactivation) of lipases.It also inhibits the lipolytic actions of adrenaline, growth hormone and glucagon by opposing their actions on adenylate cyclase.
- The main effects of insulin are to increase facilitated transport of glucose via the Glut-4 transporter, and to stimulate glycogen synthesis and glycolysis. Insulin increases glucose uptake by Glut-4 in adipose tissue as well as in muscle, enhancing glucose metabolism.
- In Europe, both rosiglitazone and pioglitazone are contraindicated for use with insulin because of concern that these combinations increase the risk of heart failure, although in the USA thiazolidinediones are widely used in combination with insulin.
- The main undesirable effect of insulin is hypoglycaemia. This is common and, if very severe, can cause brain damage The treatment of hypoglycaemia is to take a sweet drink or snack or, if the patient is unconscious, to give IV glucose or IM glucagon
- Oral glucose causes greater insulin release than does the same amount of glucose administered IV because many GI hormones influence insulin secretion, including? [all of which stimulate insulin secretion. are released by eating]
- Diabetic neuropathy is associated with accumulation of osmotically active metabolites of glucose, produced by the action of aldose reductase, but aldose reductase inhibitors have been disappointing as therapeutic drugs.
- Glibenclamide is best avoided in the elderly and in patients with even mild renal impairment because of the risk of hypoglycaemia, because several of its metabolites are excreted in urine and are moderately active.
- Chlorpropamide causes flushing after alcohol because of a disulfiram-like effect and has an action like that of antidiuretic hormone on the distal nephron, giving rise to hyponatraemia and water intoxication.
- GLP1 is rapidly inactivated. Continuous infusion improves diabetic control but is impractical for routine use. Alternative strategies include the use of stable analogues such as a GLP1 agonist. Name one.
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