10-Diabetes Lec

Question 1

Type 1 diabetes characteristics

Answer 1

• insulin dependant

Question 2

Are type one diabetes onset of symptoms sudden or acute?

Answer 2

Sudden

Question 3

Type one diabetes typically effects how many people and what age?

Answer 3

around 10% and childhood and teen years

Question 4

Is type one diabetes normally associated with family history?

Answer 4

uncommon

Question 5

Symptoms of type one diabetes

Answer 5

• polyuria
• polydypsia
• polyphagia

Question 6

T2DM characteristics

Answer 6

-not insulin dependant

Question 7

Are symptoms of DM2 more acute or sudden?

Answer 7

little more benign and not as obvious

Question 8

What is a characteristic normally noticed with T2DM?

Answer 8

sudden decline in eye sight

Question 9

What age group is normally affected by T2DM?

Answer 9

over 40 years

Question 10

Is T2DM associated with family history?

Answer 10

yes

Question 11

Are symptoms normally evident in T2DM?

Answer 11

may or may not have symptoms

Question 12

Insulin inside of the body is known as?

Answer 12

Endogenous

Question 13

Insulin outside of body?

Answer 13

exogenous

Question 14

Bolus insulin

Answer 14

• multiple daily injections mimics what your body would normally do
• When we eat = burst of endogenous insulin

Question 15

Basal Insulin

Answer 15

• covers you throughout the day

- even when we are not eating

Question 16

Best practices include:

Answer 16

● Multiple daily injections (MDI);

● Continuous Subcutaneous Insulin Infusions (CSII)

Question 17

Smart loop system

Answer 17

• pump that gives you insulin and captures interstitial fluid and glucose levels in accurate time
• More people are moving towards pumps b/c it reduces the risk of hypoglycemia (BIGGEST medical emergency for people with diabetes)

Question 18

What type of insulin is great for kids?

Answer 18

● FAST insulins is great for kids
○ Watch what they ate
○ Depending on what they ate - injects afterwards and it works fast

Question 19

Why are insulin regiments different?

Answer 19

• diff for each person

- depends on lifestyle , age etc

Question 20

T1DM

Answer 20

autoimmune disease assault on pancreas

Question 21

T2DM

Answer 21

• not as simple as eating too much and not being active

- lots of other organs involved

Question 22

Are most drugs for T2 oral or injectable?

Answer 22

oral

- we can use other drugs besides insulin injectables that help manage blood sugars

Question 23

Best Practice?

Answer 23

combination therapy

Question 24

Function, side effects of biguanide?

Answer 24

Function- targets liver and enhances insulin sensitivity in liver and peripheral tissues by activation of AMP activated protein kinase

• SE:: GI concerns, B12 deficiency, not RX if renal insufficiencies or hepatic failure.
• Hypo: Negligible risk as monotherapy

Question 25

Function, side effects of Glucagon like Peptide-1 (GLP-1)

Answer 25

- Action: activates incretin pathway by utilizing DPP-4 resistant analogue to GLP-1. - Hypo: Negligible risk as monotherapy - SE: Nausea & Vomitting, pancreatitis, parafollicular cell hyperplasia, not Rx for family hx of medullary thyroid cancer/multiple endocrine neoplasia syndrome. - This is injectable, and you can do it once a day

Question 26

Suffix for Glucagon like Peptide-1 (GLP-1)

Answer 26

IDE

Question 27

Function, side effects of Sodium Glucose Co-Transporter-2 Inhibitor (SGLT-2)

Answer 27

● Action: Inhibits renal glucose reabsorption. ● Blood come into kidneys for filtration and excrete glucose into urine ● Hypo: Negligible risk as monotherapy ● SE: polyuria, increased genital and UTI ● Older aging frail women are at most risks

Question 28

Suffix for Sodium Glucose Co-Transporter-2 Inhibitor (SGLT-2)

Answer 28

● End of these names are “-flozin”

Question 29

Effects and action of Dipeptidyl Peptidase-4 Inhibitor (DPP-4)

Answer 29

● Action: Amplifies incretin pathway activation by inhibition of enzymatic breakdown of GLP-1 and GIP. which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels. ● Normally once a day dosing ● Hypo: Negligible risk as monotherapy ● SE: pancreatitis?

Question 30

Suffix for Dipeptidyl Peptidase-4 Inhibitor (DPP-4)

Answer 30

● These names end in “-gliptin”

Question 31

Side Effects and action of insulin

Answer 31

- Best for lowering glucose levels - most potent - Biggest risk is hypoglycemia - Action: activates insulin receptors to regulate metabolism of carbohydrate, fat and protein. - Hypo: Significant, highest with short and intermediate acting insulin. - SE: potential weight gain

Question 32

Effects and Action | Thiazolidinediones (TZD)

Answer 32

-Drugs that came out as the “wonder drug” seemed to do it all - A lot of people were dying on this class of drug ● Action: enhances insulin sensitivity in peripheral tissues and liver by activation of peroxisome proliferator-activated receptor-gamma receptors ● Weight gain, edema, congestive heart failure ○ Biggest problem = prescribed to the wrong people ○ Anyone with a heart problem should NOT be prescribed this medication ● Hypo: Negligible risk as monotherapy ● SE: weight gain, edema, CHF (heart failure), macular edema, fractures, MI, CA increase (possible).

Question 33

anyone with heart problems should not be prescribed what drug class of medications?

Answer 33

Thiazolidinediones (TZD)

Question 34

Side effects and action of Alpha Glucosidase Inhibitor (AGI)

Answer 34

● Action: Inhibits pancreatic alpha-amylase and intestinal alpha-glucosidase. ● Let’s carbs pass through the intestines ● Hypo: Negligible as monotherapy. ● SE: GI side effects.

Question 35

Suffix for Thiazolidinediones (TZD)

Answer 35

ends in Zone

Question 36

Side effects of Insulin Secretagogues - Sulfonylureas & Meglitinides

Answer 36

● Pushes the pancreas to make more insulin or helps it along ● A lot of elder people are on this medication ○ Really cheap and easy dosing ○ Removed off of these drugs b/c there are far better options out there ● Action: activates sulfonylurea receptor on beta-cell to stimulate endogenous insulin secretion. ● Hypo: Moderate to significant. ● SE: weight gain, caution with renal/hepatic issues and elderly; elderly older adults (cheap medication so more people and government use it)

Question 37

Side effects and action of anti obesity agent

Answer 37

* Action: inhibits lipase * Hypo: None * Se: GI side effects; more diarrhea with high carb meal * People taking need to be on multivitamin as they are not absorbing some nutrients

Question 38

Agent characteristics

Answer 38

``` ● BG lowering efficacy and durability ● Risk of inducing hypoglycemia ● Effect on weight ● Contraindications and/or side effects ● Cost/coverage ● Other…cardioprotection? ```

Question 39

Patient characteristics

Answer 39

``` ● Degree of hyperglycemia ● Risk of hypoglycemia ● Overweight or obese ● Comorbidities (renal, hepatic issues) ● Preferences (medication adherence) ● Access to treatment ```