1. A.

Medical Abbreviations

ABBREVS DEFINITION
CC Chief Complaint
HPI history of present illness
yo Year old
Mg/dl Milligrams per deciliter
PMH past medical history
DM diabetes mellitus
HTN hypertension
FH Family history
CAD coronary artery disease
SH Social history
Meds medications
mg milligram
po Per os (by mouth)
QD quaque die (every day / daily)
BID bis in die (twice a day)
EC ASA Enteric coated aspirin
NKDA no known drug allergies
ROS Review of Systems
PE Physical examination
Gen general
WDWN well developed and well nourished
NAD no acute distress
VS Vital signs
BP Blood pressure
P pulse
RR Respiratory rate
T temperature
Wt weight
kg kilogram
Ht height
HEENT head, ears, eyes, nose, and throat
PERRLA pupils equal, round, reactive to light and
accommodation
EOMI extraocular movements intact
R & L Right and left
Cor Latin word for the heart
RRR regular rate and rhythm
M/r/g murmurs, rubs, and gallops
A & P auscultation and percussion
Abd Abdomen/abdominal
NT/ND Non-Tender, Non-Distended
Genit/Rect Genitourinary/rectal
MS/Ext Musculoskeletal / Extremities
MTPs metatarsophalangeal joints
Neuro Neurological
DTRs deep tendon reflex
Labs laboratory
Na sodium
K potassium
Cl chloride
CO2 Carbon dioxide
BUN Blood Urea Nitrogen
SCr Serum Creatinine
Glu Glucose
Ca Calcium
Phos Phosphate
AST Aspartate aminotransferase
ALT alanine aminotransferase
Alk phos Alkaline phosphatase

T.bili Total Bilirubin

T. chol total cholesterol

LDL Low-density lipoprotein

HDL HIGH density lipoprotein
Trig triglycerides
HbA1c glycosylated or glycated hemoglobin
mEq/L Milliequivalents Per Liter
Mg/dl milligrams per deciliter

IU/L International units per liter

U units
UA urine analysis
FBG fasting blood glucose
BG blood glucose
NCEP The National Cholesterol Education
Program

References:
http://www.resourcepharm.com/pre-reg-pharmacist/medical-abbreviations.html#r
https://www.abbreviations.com/EC+ASA
https://www.allacronyms.com/_medical/COR
https://www.medicinenet.com/script/main/art.asp?articlekey=11858

B. Medical terms

 Check up :
a thorough physical examination; includes a variety of tests depending onthe
age and sex and health of the person

 Diabetes or Diabetes Mellitus: chronic disease associated with abnormally high

levels of the sugar glucose in the blood. The signs and symptoms of both types
of diabetes include increased urine output and decreased appetite as well
as fatigue.

 Outpatient clinic: An outpatient department or outpatient clinic is the part of

a hospital designed for the treatment of outpatients, people with health problems
who visit the hospital for diagnosis or treatment, but do not at this time require
a bed or to be admitted for overnight care.

 Blood glucose - The main sugar that the body makes from the food in the
diet. Glucose is carried through the bloodstream to provide energy to all cells
in the body.

 Calorie: energy that comes from food. People with diabetes are advised to follow
meal plans with suggested amounts of calories for each meal and/or snack.

 Treadmill: a device having an endless belt on which an individual walks or runs

in place that is used for exercise and in tests of physiological functions

 Type 2 diabetes: a type of diabetes in which the insulin produced is either not
enough or doesn’t work properly in the body. When there is not enough insulin
or the insulin is not used as it should be, glucose cannot get into the body’s
cells for use as energy. This causes blood glucose to rise.

 Hypertension: is a condition when your systolic blood pressure is higher than

120 mmHg and your diastolic blood pressure is above 80 mmHg, averaged over time.

 Hyperlipidemia: Elevated lipid (fat) levels in the blood. Hyperlipidemia can

be inherited and increases the risk of disease of the blood vessels leading
to stroke and heart disease.
 Emphysema: is a lung condition featuring an abnormal accumulation of air due
to enlargement and destruction of the lung's many tiny air sacs resulting in the
formation of scar tissue.

 family medical history: is a record of health information about a person and

his or her close relatives. A complete record includes information from three
generations of relatives, including children, brothers and sisters, parents,
aunts and uncles, nieces and nephews, grandparents, and cousins.

 Tobacco: A South American herb (Nicotiana tabacum) whose leaves contain 2 to

8 percent nicotine and serve as the source of both smoking and
smokeless tobaccoand the basis of great health hazards.

 alcoholic drink: is a drink that contains ethanol, a type of alcohol produced

by fermentation of grains, fruits, or other sources of sugar. Alcohol is
a depressant, which in low doses causes euphoria, reduces anxiety, and improves
sociability. In higher doses, it causes drunkenness, stupor, unconsciousness,
or death. Long-term use can lead to alcohol abuse, cancer, physical dependence,
and alcoholism.

 Nocturia: aka nocturnal polyuria, is the medical term for excessive urination
at night.

 Polyuria: The excessive passage of urine (at least 2.5 liters per day for an adult)
resulting in profuse urination and urinary frequency (the need to urinate
frequently). It is a classic sign of diabetes mellitus that is under poor control
or is not yet under treatment.

 Polydipsia: excessive thirst that lasts for long periods of time; may be a sign
of diabetes.

 Nausea: a stomach distress with distaste for food and an urge to vomit.

 Constipation: Infrequent and frequently incomplete bowel

movements. Constipation is the opposite of diarrhea and is commonly caused
by irritable bowel syndrome (IBS), diverticulosis, and medications. A
high-fiber diet can frequently relieve constipation.

 Diarrhea: A common condition that involves unusually frequent and liquid bowel
movements. There are many infectious and noninfectious causes of diarrhea.
Treatment includes drinking plenty of fluids to prevent dehydration and taking
over-the-counter remedies.

 Hypoglycemia: A low blood level of the sugar glucose. It has many causes including
drugs such as insulin, liver disease, surgical absence of the stomach,
pre-diabetes, and rare tumors that release excess insulin.

 Paresthesia:a sensation of pricking, tingling, or creeping on the skin having

no objective cause and usually associated with injury or irritation of a sensory
nerve or nerve root.

 Dyspnea: Difficult or labored breathing; shortness of breath. Dyspnea is a sign

of serious disease of the airway, lungs, or heart.

 Blurry vision: Lack of sharpness of vision with, as a result, the inability to

see fine detail. Blurred vision can occur when a person who wears corrective lens
is without them.

 Obese: Well above one's normal weight. A person has traditionally been considered
to be obese if they are more than 20% over their ideal weight. That ideal weight
must take into account the person's height, age, sex, and build.
 Fundus Exam: examination of the fundus ( the portion of the inner eye)

 Retinopathy: Any disease of the retina, the light-sensitive membrane at the back
of the eye.

 Deferred: postponed or delayed. suspended or withheld for or until a certain time

 Callus: A localized firm thickening of the upper layer of skin as a result of

repetitive friction. A callus on the skin of the foot has become thick and hard
from rubbing (as a result of repetitive friction).

 A fasting lipid profile test: is a simple blood test. This test requires patients
to abstain from eating eight hours prior to having their blood drawn. The test
provides information on total cholesterol, type of cholesterol and ratios, and
triglyceride levels to develop a profile of the patient's baseline risk of heart
disease.

 Drug therapy: ls also called “pharmacotherapy”, is a general term for

using medication to treat disease

 Dietitian: is an expert in dietetics; that is, human nutrition and the regulation
of diet.

 Nutrition therapy: is the treatment of a medical condition, for example diabetes

mellitus, through changes in diet, by adjusting quantity, quality and methods
of nutrient intake.

 Lipid profile: or ”lipid panel” is a panel of blood tests that serves as an

initial screening tool for abnormalities in lipids, such as cholesterol and
triglycerides.

 Blood pressure: is the pressure of your blood on the walls of your arteries as
your heart pumps it around your body.

 Pre-dinner BG: This refers to your blood sugar levels before a meal (dinner)

 Free thyroxine index - estimation of the free T4 concentration. It is sometimes

referred to as “T7”. It is a calculated value determined from the total T4 test
and some estimation of the level of thyroid hormone binding proteins.

 Microalbuminuria: is a term to describe a moderate increase in the level of urine

albumin. It occurs when the kidney leaks small amounts of albumin into the urine,
in other words, when an abnormally high permeability for albumin in the glomerulus
of the kidney occurs.

 Monofilament: portable test for assessing the loss of protective sensation, and
it is recommended by several practice guidelines to detect peripheral
neuropathy in otherwise normal feet.
References:
https://www.thefreedictionary.com/medical
https://www.medicinenet.com/script/main/art.asp?articlekey=2974
https://my.clevelandclinic.org/health/articles/9829-diabetes-glossary
https://study.com/academy/lesson/what-is-hypertension-htn-definition-symptom
s-causes.html
https://www.healthline.com/health/urination-excessive-at-night

2. Differentiate type 1 from type 2 diabetes mellitus

 Type 1 and type 2 diabetes both occur when the body cannot properly store and
use glucose, which is essential for energy. Sugar, or glucose, collects in the blood
and does not reach the cells that need it, which can lead to serious complications.
Both types of diabetes can lead to complications, such as cardiovascular disease,
kidney disease, vision loss, neurological conditions, and damage to blood vessels
and organs.
Type 1 and type 2 have different causes, but they both involve insulin.
Insulin is a type of hormone. The pancreas produces it to regulate the way blood
sugar becomes energy.
 Risk Factors
- Genetic and environmental factors may trigger both type 1 and type 2 diabetes,
but many people may be able to avoid type 2 by making healthful lifestyle choices.
Research has also suggested that some other environmental factors might play a role.
- Low levels of vitamin D may play a role in the development of both type 1 and type
2 diabetes (certain processes in the body, such as immune function and insulin
sensitivity, do not work as well as they should. According to scientists, this may
increase a person's risk of diabetes.)
- Some researchers have suggested that giving an infant only breast milk, even for
a short time, might help prevent type 1 diabetes in the future.
 Common differences between type 1 and type 2 diabetes

Despite the uncertainty that often surrounds a diagnosis of diabetes, there are
a few common characteristics of each diabetes type.

Type 1 Diabetes Type 2 Diabetes

Often diagnosed in childhood Usually diagnosed in over 30 year olds

Not associated with excess body weight Often associated with excess body weight
Often associated with higher than normal Often associated with high blood pressure
ketone levels at diagnosis and/or cholesterol levels at diagnosis
Treated with insulin injections or Is usually treated initially without
insulin pump medication or with tablets
Cannot be controlled without taking Sometimes possible to come off diabetes
insulin medication
SIGNS AND SYMPTOMS

BMI within a healthy range (19–24.9)
At onset - Appearance over several weeks:
Increased thirst and urination,
increased hunger, blurry vision,
tirednessand fatigue, numbness or
tingling in hands and feet sores or wounds
that take a long time to heal, unexplained
weight loss
Risk of:
cardiovascular disease, including a risk
of heart attack and stroke, kidney
disease and kidney failure,eye problems
BMI above the healthy range (25 or over)
At onset - Development over several years
of:
increased thirst and urination,increased
hunger,blurry vision,tiredness and
fatigue,numbness or tingling in hands or
feet sores or wounds that take a long time
to heal unexplained weight loss
Risk of:
cardiovascular disease, including a risk
of heart attack and stroke, kidney disease
and kidney failure,eye problems and
 Type 1 Diabetes
and vision loss, nerve damage, problems
with wound healing,ketoacidosis
Type 2 Diabetes
vision loss,nerve damage problems with
wound healing,which can lead to gangrene
and the need for an amputation
ketoacidosis

 Development:
Type 1 diabetes is an autoimmune disease, which means it results from the immune
system mistakenly attacking parts of the body. In the case of type 1 diabetes, the
immune system incorrectly targets insulin-producing beta cells in the pancreas.
Nobody knows why this occurs, or how to stop it. The immune systems of people with
type 1 diabetes continue to attack beta cells until the pancreas is incapable of
producing insulin. People with type 1 diabetes need to inject themselves with insulin
to compensate for the death of their beta cells. Everyone with type 1 diabetes is
insulin-dependent. While Type 2 diabetes is different. The autoimmune systems of
people with type 2 diabetes don't attack beta cells. Instead, type 2 diabetes is
characterized by the body losing its ability to respond to insulin. This is known
as insulin resistance. The body compensates for the ineffectiveness of its insulin
by producing more, but it can't always produce enough. Over time, the strain placed
on the beta cells by this level of insulin production can destroy them, diminishing
insulin production.

 Type 2 diabetes and insulin injections:

People with type 2 diabetes may need to take insulin injections, usually for one
of two main reasons:
- Low sensitivity to insulin: The more excess body weight we carry, the less sensitive
we are to insulin. Being insensitive to insulin means insulin doesn't reduce blood
glucose levels as much as it should. People with low insulin sensitivity often
need to be injected with insulin to avoid hyperglycemia.
- Beta cell failure: If you develop insulin resistance, you need more of it to keep
your blood glucose levels stable. More insulin production means more work for the
pancreas. Over time, the beta cells can become burnt out by the constant
strain, and stop producing insulin altogether. Eventually, you can get to a similar
situation as someone with type 1 diabetes, in which your body is incapable of
producing the amount of insulin you need to keep blood glucose levels under
control. Insulin injections are necessary in these situations

Reference:
Diabetes.co.uk. (n.d.). Differences Between Type 1 and Type 2. Retrieved April
23, 2019, from
https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html
Nichols, H. (2019, March 25). Diabetes: The differences between types 1 and 2.
Retrieved April 23, 2019, from https://www.medicalnewstoday.com/articles/7504.php
3. Discuss the physiology of insulin. Include different analogues of human insulin.
Insulin is synthesized in the beta cells of pancreas in the form of preproinsulin
which is the ultimate precursor and gene for the same is located on chromosome 11
close to that for insulin like growth factor-2 (IGF-2).
 Within a minute after synthesis it is discharged into cisternal space of rough
endoplasmic reticulum where it is cleaved into proinsulin by proteolytic enzymes.
Proinsulin with a C (connecting) chain linking A and B chains is then transported
by microvesicles to the Golgi apparatus.
Proinsulin is released in vesicles.
Conversion of proinsulin to insulin continues in maturing granules through the
action of prohormone convertase 2 and 3 and carboxy peptidase H. Maturing granules
are translocated with the help of microtubules and microfilaments.
Insulin is secreted from the beta cells in response to various stimuli like glucose,
arginine, sulphonylureas though physiologically glucose is the major determinant.
Various neural, endocrine and pharmacological agents can also exert stimulatory
effect.
Glucose is taken up by beta cells through GLUT-2 receptors. After entering the
beta cell, glucose is oxidized by glucokinase, which acts as a glucose sensor. Glucose
concentration below 90 mg/dl do not cause any insulin release. At such substimulatory
glucose concentrations, K+ efflux through open KATP channels keeps the ß cell membrane
at a negative potential at which voltage-gated Ca2+ channels are closed.
As there is increase in plasma glucose, glucose uptake and metabolism by the ß
cell is enhanced. Rise in ATP concentration result in closure of KATP channels,
leading to a membrane depolarization, opening of voltage-gated Ca2+ channels, Ca2+
infl ux, a rise in intracellular calciumconcentration, and ultimately exocytosis
of insulin granules. Structurally, the pancreatic KATP channel consists of two
unrelated subunits: a sulfonylurea receptor (the SUR1 isoform) and a potassium
channel subunit that forms the central ion-conducting pathway. The mature KATP
channel exists as an octamer of potassium channel subunit and sulfonylurea receptor
subunits in a 4:4 stoichiometry. A sub unit specific site specific to pancreatic
KATP channel, confers glimepiride an advantage over the other sulfonylurea
secretagogues. Sulfonylurea, and non-sulphonylurea drugs act as insulin
secretogogues by closing KATP channels bypassing the ß cell metabolism. Diazoxide
is a K channel opener and inhibits insulin secretion,independent of blood glucose
levels.
 Analogues of human insulin
a.Insulin preparations: Porcine insulin has been withdrawn from the market globally
and bovine is expected to be extinct very soon. Human insulin is available in the
short acting i.e. regular and intermediate acting i.e. Neutral Protamine Hagedorn
(NPH) forms. Insulin analogues which are synthetically modifi ed with some changes
in the amino acid sequence are also available. Rapid acting insulin analogues Lispro
(Eli Lilly) and Aspart (Novo Nordisk) are already in the market while glulisine
(Sanofi -Aventis) is to be launched shortly. Glargine (Sanofi -Aventis) and Detemir
(Novo Nordisk) are the long acting analogues available. Ultralente is now withdrawn.
b.Regular insulin: Regular insulin is available as a clear solution at neutral pH.
0.4% of zinc is added to allow the insulin molecules to self associate into hexamers.
For the prevention of growth of micro-organisms phenol or m-cresol is added. Regular
insulin has its onset of action within 15-30 min after subcutaneous injection, maximum
activity peaks at 120-150 min while the action lasts for 6-8 hours. In order match
the peaks of glucose and insulin, subcutaneous injection is advised to be taken 30-40
min prior to meals
c.NPH or isophane insulin: Isophane insulin is known as NPH insulin as it was developed
in Denmark at the Hagedorn Laboratory in 1940s. In order to prolong the action of
insulin, a positively charged protein, protamine is added in a molar ratio of 1:6
to regular insulin. It binds with the negatively charged insulin at neutral pH.
Neutral ph value is achieved by use of phosphate buffer. Zn and m-cresol are also
added. NPH insulin is slowly absorbed from subcutaneous tissue with peak at 5-7 hours
and the action lasts for 12-15 hours. This insulin is most commonly used at bedtime
to control fasting blood sugar.
d.Lente insulin: If zinc is added in excess amount (10 times that added in NPH),
at neutral pH and if acetate is used as a buffer instead of phosphate, it forms
insoluble insulin-zinc complexes. This property is exploited for the production of
lente insulins. The action profi le of these preparations depends upon the physical
conditions of insulin. Semilente is amorphous and has biphasic absorption kinetics
with short duration of action. Ultralente is long acting crystalline suspension.
These insulins cannot be mixed with regular insulin due to their zinc content and
are not very popular.
e.Premixed formulations: Regular and NPH insulin are available in a premixed
formulation with 30:70, 50:50, 25:75 proportions. These preparations are very popular
as there is no mixing involved. Patients of type 2 diabetes on split mix regime may
be shifted to premixed preparation if they are on approximately similar proportion.
g.Rapid acting Analogues: Regular insulin when injected is in hexamer form, which
slowly releases into monomers and is responsible for delay in the action. Analogues
are synthesized by modifying the amino acid sequence so as to keep insulin molecule
in monomeric form which has rapid onset of action and peak resembling physiology.
After subcutaneous injection the action starts at 30 min, peaks at 60-90 min and
is over by 4 hours. This action profi le is very effi cient in controlling postprandial
glycemic excursions without any risk of delayed hypoglycemia.
h.Long acting analogues:Long acting analogues are designed in an attempt to obtain
a steady basal insulin level without any peak unlike NPH, which has a risk of late
night hypoglycemia. In insulin glargine, the amino acids sequence is altered so as
to change isoelectric pH of insulin to 7.4 from 5.4. It is clear and soluble at an
acidic pH. After injection in subcutaneous space it gets precipitated and is released
slowly, making its action last for even more than 24 hours. Most of the patients
require a single dose for basal cover. Insulin detemer has a long action by virtue
of a fatty acid chain attached to it.
i.Premixed Analogue preparations: Insulin glargine cannot be mixed with any other
insulin by virtue of its acidic pH and high Zn content i.e. 30 ug/ml. Premixed
preparations are available with protamine insulin. In these preparations the
protamine-insulin part has to be formulated with the same insulin analogue like lispro
or aspart. These preparations are available in 25:75, 30:70, 50:50 proportions.
Reference: Joshi, S. (2007, July). Insulin History, Biochemistry, Physiology and
Pharmacology. Retrieved April 23, 2019, from
http://japi.org/july2007/suppliment/19.pdf