3 - Diabetes Flashcards
What are the diagnostic parameters for a diagnosis of DMII?
Fasting glucose > 126
Casual plasma > 200 AND s/s of diabetes
Hgb A1C of 6.5 or higher
In regards to meals, when should lispro be taken?
When should regular insulin be taken?
Lispro: immediately before or after meals
Regular: 30-60 min before meals
Which non-insulin diabetes medication is used in pregnant women?
Metformin is the ONLY ONE
What is the MOA of metformin?
Inhibits glucose production in the liver
Sensitizes tissues to insulin
Is hypoglycemia a concern with metformin?
NO
It does not actively lower blood glucose levels
Metformin carries a black box warning for:
metabolic acidosis with accumulation
Patients with renal failure are particularly at risk
Why has metformin historically been held pre-operatively?
Fear of hypoglycemia and lactic acidosis
Should you continue metformin if a patient is admitted to the hospital?
No. Patients are going to undergo significant changes in medications, hemodynamics, and nephrotoxic drugs/events
Its not worth the risk inpatient
If a patient with Type 1 diabetes has hypertension, what would be the first line drug?
ACE-I, or an ARB if unable to tolerate
Helps reduce the risk of CV incidents and nephropathy, even without HTN
What are C-peptides, and how are they useful in diabetes management?
When the body produces insulin, the last step is cleaving the C peptide, converting proinsulin to insulin
Measuring C peptides allows us to analyze how much insulin is being made endogenously
Activation of ______ adrenergic receptors promotes insulin release
Activation of __________ adrenergic receptors inhibits insulin release
Beta 2 promotes
Alpha 2 inhibits
Activation of ______ adrenergic receptors promotes insulin release
Activation of __________ adrenergic receptors inhibits insulin release
Beta 2 promotes
Alpha 2 inhibits
If the goal of beta 2 activation is to provide the body with glucose, why would it trigger insulin secretion?
Beta 2 activation also triggers glycogenolysis and increased glucose production, so the effect of the insulin isn’t meant to decrease blood glucose levels. It’s meant to facilitate movement of that released glucose into cells
Insulin has two anabolic effects:
- stimulates cellular uptake of glucose, AAs, nucleotides, and potassium
- promotes synthesis of complex organic molecules
Insulin deficiency causes a _______ state
catabolic
Describe the catabolic effects of insulin deficiency:
Glycogen is converted into glucose (hyperglycemia)
Proteins are broken down into AAs (muscle wasting)
Fats are converted to glycerol and free fatty acids (hyperlipidemia)
Only one long acting insulin is appropriate for mixing with short acting insulins:
NPH
Why do we always draw clear to cloudy?
Because accidentally contaminating rapid insulin with long acting could be catastrophic, whereas the reverse would a small amount of rapid insulin in NPH is unlikely to cause damage
BIGUANIDES
MOA & DRUG LIST
- Inhibits glucose production in the liver
- Reduces glucose absorption in the gut (slight)
- Sensitizes insulin receptors in fat tissues and skeletal muscles increasing glucose uptake in response to insulin
METFORMIN
What are the most common side effects of Metformin?
N/V/D
Decreased absorption of Vit B12, which may lead to worsened peripheral neuropathy
Metformin carries a black box warning for:
Severe metabolic acidosis
What are the therapeutic uses of Metformin?
- Glycemic control
- Prevention of DM2 in overweight persons
- Gestational Diabetes
- PCOS
Which oral agent is usually initiated at diagnosis of Type II DM, before lifestyle changes are attempted?
Metformin
Which classes of oral noninsulin drugs act by increasing insulin release from Beta cells?
The insulin secretagogues:
Sulfonylureas and Glinides
