The endocrine system of the pancreas comprises the (...), which contain four types of cells that synthesize and secrete different polypeptide hormones

Insulin is produced by the (...), which constitute most of the islet and form its central core.

Insulin is composed of two (...) joined by two (...).

Proinsulin is converted to insulin when the (...) is removed, which occurs within the secretory granules of the pancreatic β cell.

C peptide has no known biologic function, but it can serve as an (...).

Insulin is a member of a family of related peptides known as (...).

(...) is the principal stimulus to insulin secretion in humans.

The classic action of insulin is to (...).

Insulin decreases the blood glucose production by increasing glucose (...), increasing glucose (...), and decreasing glucose (...).

The important target tissues for regulation of glucose homeostasis by insulin include (...) cells.

Insulin affects the activities of various enzymes involved in intracellular use and storage of (...).

Insulin may be given (...).

Endogenous insulin is secreted into the (...) circulation; injected insulin is delivered into the (...) circulation.

The insulin receptor is composed of two (...) and two (...) linked by (...).

There is evidence that insulin acts by synthesis of second messengers of the (...) class.

(...) is a group of syndromes characterized by hyperglycemia.

Virtually all forms of DM are due to either a decrease in the (...) or a decrease in the (...).

(...), occurs during pregnancy and resolves after parturition, but is important because it is a predictor of future risk of diabetes.

(...) is an autoimmune disease of the pancreatic β cell, resulting in degeneration and an absolute lack of insulin.

In (...), impaired glucose metabolism in muscle and liver results in relative insensitivity to insulin.

At elevated blood glucose concentrations, hemoglobin is glycosylated on its amino terminal valine residue to form the glycosyl valine adduct, termed (...).

Because the half-life of HbA_1c is the same as that of (...), its concentration can be used to assess the severity of the glycemic state over the previous (...).

Type 1 diabetes mellitus must be treated with (...); type 2 diabetes mellitus may be treated with a combination of (...).

(...) insulin analogues have amino acids are substituted, or reversed.

List the ultrashort-acting insulin preparations. (3)

(...) insulins are short-acting preparations.

List the regular, short-acting insulin preparations. (2)

The intermediate-acting (...) insulin preparations contain particles and are cloudy suspensions at neutral pH.

List the intermediate-acting, NPH insulin preparations. (2)

(...) insulin analogues have groups added to alter their kinetics.

List the long-acting insulin preparations. (3)

Most commercial preparations of insulin are supplied in solution at a concentration of (...).

Insulin absorption is usually most rapid from the (...), followed by the arm, buttock, and thigh.

(...) is the most common adverse reaction to insulin.

List the symptoms of hypoglycemia. (8)

What class of drug are the following?

1. chlorpropamide
2. tolazamide
3. glimepiride
4. glipizide
5. glyburide

Sulfonylureas are effective only in patients with (...).

Sulfonylureas stimulate release of insulin by blocking (...) in pancreatic β cells.

Sulfonylureas have a (...) structure, which is the basis for (...) with certain antibacterial drugs.

List the adverse effects of sulfonylureas. (7)

List some drugs that increase the effect of sulfonylureas. (6)

List some drugs that decrease the effect of sulfonylureas. (6)

Sulfonylureas cause a (...) effect by decreasing the activity of aldehyde dehydrogenase.

What class of drug are the following?

1. repaglinide
2. nateglinide

Meglitinides are effective only in patients with (...).

Meglitinides stimulate release of insulin by blocking (...) in pancreatic β cells.

(...) is the major adverse effect of repaglinide and is most likely to occur if a meal is delayed or skipped or in patients with hepatic insufficiency.

Drugs that inhibit (...) may potentiate the effect of nateglinide.

(...) drugs may potentiate the hypoglycemic effects of repaglinide.

(...) is currently the only biguanide approved for use in the United States.

Biguanides stimulate (...) thereby decreasing blood glucose concentrations by several different actions.

Unlike sulfonylureas and meglitinides, biguanides do not cause (...) or (...) and do not depend on (...).

List the common adverse effects of metformin. (6)

Metformin may cause a decrease in vitamin (...) levels, possibly by decreasing absorption.

(...) is a rare but serious complication of biguanides that is fatal in roughly 50% of patients in which it occurs.

Biguanides are contraindicated in patients with renal disease, hepatic disease, or conditions predisposing to tissue anoxia because of concern regarding (...).

What class of drug are the following?

1. pioglitazone
2. rosiglitazone

Thiazolidinediones act by increasing insulin sensitivity in tissues by acting on (...).

The thiazolidinediones depend on (...) for their activity.

Thiazolidinediones now carry a “black box” warning of (...).

List the adverse effects of thiazolidinediones. (6)

Pioglitazone can decrease the plasma concentration of (...).

Hormones secreted from the gastrointestinal tract that have been shown to stimulate insulin secretion are known as (...).

(...) is an incretin that has been shown to augment glucose-dependent insulin secretion.

GLP-1 is rapidly inactivated by (...).

Incretin-related drugs that act by either stimulating (...) or inhibiting (...).

What class of drug are the following?

1. exenatide
2. albiglutide
3. dulaglutide
4. liraglutide

What class of drug are the following?

1. sitagliptin
2. saxagliptin
3. linagliptin

What class of drug are the following?

1. canagliflozin
2. dapagliflozin
3. empagliflozin

The SGLT2 inhibitors block (...) which facilitates (...) in the kidney.

List the adverse effects of SGLT2 inhibitors. (5)

(...) is a peptide produced by pancreatic β cells and cosecreted with insulin that has a role in the maintenance of glucose homeostasis.

(...) is an analogue of amylin that is approved in the United States.

(...) facilitate digestion of complex starches, oligosaccharides, and disaccharides into monosaccharides, allowing them to be absorbed from the small intestine.

What class of drug are the following?

1. acarbose
2. miglitol

α-glucosidase inhibitors are competitive, reversible inhibitors of intestinal (...), which delays (...).

List the adverse effects of α-glucosidase inhibitors.

The gastrointestinal adverse effects of α-glucosidase inhibitors are due to (...).

Treatment of hypoglycemia in patients taking α-glucosidase inhibitors should be with (...), because breakdown of (...) may be inhibited.

Evidence suggests that interaction of insulin with its receptor leads to the release of (...), which enter the cell and act as mediators of insulin action.

(...) and (...) have been shown to delay the onset and reduce significantly the progression of diabetic nephropathy.

(...) is synthesized in the α cells of the pancreatic islets.

Glucagon increases blood glucose concentration by decreasing (...), stimulating (...), and increasing (...) in the liver.

Glucagon may be given parenterally in the emergency treatment of (...).

Major risk factors for type 2 diabetes are (...) and (...).

List the oral complications of diabetes.

Morning appointments are usually better for diabetic patients because that minimizes the chance of (...).

Since (...) may cause an increase in blood glucose levels, short appointments may be helpful in preventing an increase in blood glucose levels.

It is suggested that the patient’s blood glucose should be less than (...) before any invasive therapy is started.

Use of local anesthetic with (...) may cause transient hyperglycemia.

(...) drugs have the potential to raise blood glucose levels.