10-Diabetes Lec Flashcards
Type 1 diabetes characteristics
- insulin dependant
Are type one diabetes onset of symptoms sudden or acute?
Sudden
Type one diabetes typically effects how many people and what age?
around 10% and childhood and teen years
Is type one diabetes normally associated with family history?
uncommon
Symptoms of type one diabetes
- polyuria
- polydypsia
- polyphagia
T2DM characteristics
-not insulin dependant
Are symptoms of DM2 more acute or sudden?
little more benign and not as obvious
What is a characteristic normally noticed with T2DM?
sudden decline in eye sight
What age group is normally affected by T2DM?
over 40 years
Is T2DM associated with family history?
yes
Are symptoms normally evident in T2DM?
may or may not have symptoms
Insulin inside of the body is known as?
Endogenous
Insulin outside of body?
exogenous
Bolus insulin
- multiple daily injections mimics what your body would normally do
- When we eat = burst of endogenous insulin
Basal Insulin
- covers you throughout the day
- even when we are not eating
Best practices include:
● Multiple daily injections (MDI);
● Continuous Subcutaneous Insulin Infusions (CSII)
Smart loop system
- 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)
What type of insulin is great for kids?
● FAST insulins is great for kids
○ Watch what they ate
○ Depending on what they ate - injects afterwards and it works fast
Why are insulin regiments different?
- diff for each person
- depends on lifestyle , age etc
T1DM
autoimmune disease assault on pancreas
T2DM
- not as simple as eating too much and not being active
- lots of other organs involved
Are most drugs for T2 oral or injectable?
oral
- we can use other drugs besides insulin injectables that help manage blood sugars
Best Practice?
combination therapy
Function, side effects of biguanide?
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
Function, side effects of Glucagon like Peptide-1 (GLP-1)
- 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
Suffix for Glucagon like Peptide-1 (GLP-1)
IDE
Function, side effects of Sodium Glucose Co-Transporter-2 Inhibitor (SGLT-2)
● 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
Suffix for Sodium Glucose Co-Transporter-2 Inhibitor (SGLT-2)
● End of these names are “-flozin”
Effects and action of Dipeptidyl Peptidase-4 Inhibitor (DPP-4)
● 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?
Suffix for Dipeptidyl Peptidase-4 Inhibitor (DPP-4)
● These names end in “-gliptin”
Side Effects and action of insulin
- 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
Effects and Action
Thiazolidinediones (TZD)
-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).
anyone with heart problems should not be prescribed what drug class of medications?
Thiazolidinediones (TZD)
Side effects and action of Alpha Glucosidase Inhibitor (AGI)
● Action: Inhibits pancreatic alpha-amylase and intestinal alpha-glucosidase.
● Let’s carbs pass through the intestines
● Hypo: Negligible as monotherapy.
● SE: GI side effects.
Suffix for Thiazolidinediones (TZD)
ends in Zone
Side effects of Insulin Secretagogues - Sulfonylureas & Meglitinides
● 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)
Side effects and action of anti obesity agent
- 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
Agent characteristics
● BG lowering efficacy and durability ● Risk of inducing hypoglycemia ● Effect on weight ● Contraindications and/or side effects ● Cost/coverage ● Other…cardioprotection?
Patient characteristics
● Degree of hyperglycemia ● Risk of hypoglycemia ● Overweight or obese ● Comorbidities (renal, hepatic issues) ● Preferences (medication adherence) ● Access to treatment
