Antidiabetics Flashcards
A protein secreted from the beta cells of the pancreas and is necessary for carbohydrate metabolism and plays an important role in protein and fat metabolism
Insulin
Synthetic preparations that stimulate insulin release or otherwise alter the metabolic response to hyperglycemia
Oral hypoglycemic drugs (oral antidiabetic drugs)
A chronic disease that results from deficient glucose metabolism
Diabetes mellitus
Increased urine output
Polyuria
Increased thirst
Polydipsia
Increased hunger
Polyphagia
Diabetes that results from genetic factors and requires insulin administration
Type I Diabetes
Diabetes that results from genetic factors and obesity and does not always require insulin administration
Type 2 Diabetes
Tissue atrophy or hypertrophy
Lipodystrophy
Results from administering too much insulin
Hypoglycemic reaction (insulin shock)
Results when there is an inadequate amount of insulin in the body. Sugar cannot be metabolized, resulting in fat catabolism.
Ketoacidosis (DKA)
What does Hemoglobin A1C tell us?
What a person’s blood sugar has been running over the last 3 months.
Explain the ranges for HgA1C.
<5% = no diabetes
5.7 - 6.45 = prediabetes
>6.5% = diabetes
Desired level for diabetics = <7%
Where does insulin have the greatest absorption?
Abdomen
Why do insulin injection sites need to be rotated?
Repeated injections in the same spot can cause lipoatrophy and lypohypertrophy. Both can interfere with insulin absorption.
When should rapid acting insulin be given?
Within 5-15 minutes of a meal.
What is the only type of insulin that can be given IV?
Short-acting regular insulin, Humulin R, and Novolin R
What type of insulin is isophane NPH, Novolin N, and Humulin N?
Intermediate-acting
What type of insulin is glargine (Lantus)?
Long-acting
What is the peak of glargine?
It doesn’t have one.
True or False: All insulin pens must be refrigerated right after opening.
False
fridge for 3 month and room temp 1 months
Why do we use combination insulins?
They have short and intermediate effects. Avoids the necessity for 2 separate shots.
What drugs can cause an increase in blood glucose?
Thiazides, glucocorticoids, estrogen, and thyroid drugs.
What drugs can cause a decrease in blood glucose?
TCAs, MAOIs, aspirin, oral anticoagulants
What types of insulin do we use for sliding scales?
Rapid or short acting
Why do we use insulin pumps?
They allow for tighter glucose control and less hypoglycemic reactions.
What are symptoms of hypoglycemia?
Nervousness, tremors, lack of coordination, cold/clammy skin, headache, confusion
Explain the Somogyi effect.
Occurs in the predawn hours (2-4am). The patient ahs a rapid decrease in blood glucose. This stimulates hormonal release to increase blood glucose. Management consists of monitoring the blood glucose between 2 and 4 and decreasing HS insulin.
Explain the Dawn phenomenon.
The patient has hyperglycemia upon awaking. Symptoms include headache, night sweats, and nightmares. Treatment includes increasing the HS insulin dose.
When combining insulins in one syringe, in which order should they be drawn up?
Clear to cloudy
Regular to intermediate
True or False: Long-acting insulins can be combined with other insulins in the same syringe.
False
True or False: It is important for diabetics to eat a snack before exercise.
True
Tolbutamide, Tolazamide and Chlorpropamide are examples of which type of med?
1st generation sulfonylureas
Glipizide, glyburide, and glimepiride are examples of which type of med?
2nd generation sulfonylureas
Sulfonylureas work by:
Stimulating the pancreatic beta cells to secrete more insulin. 2nd generations also decrease glucose production by the liver.
True or False: 2nd generation sulfonylureas have a longer duration and fewer side effects than 1st generation.
True
Metformin is what type of antidiabetic drug?
Non-sulfonylurea/Biguanide
How does metformin work?
It decreases the hepatic production of glucose from stored glycogen.
What are the most common side effects of Metformin?
Nausea, diarrhea, bitter/metallic taste
Acarbose and Miglitol are what type of med?
Alpha-glucosidase inhibitor
How do alpha-glucosidase inhibitors work?
They inhibit alpha-glucosidase (a digestive enzyme) in the small intestine that is responsible for the release of glucose from complex carbs in the diet.
Pioglitazone and rosiglitazone are what type of med?
Thiazolidinediones
Repaglinide and netaglinide are what type of med?
meglitinides
True or False: Meglitinides work in a manner similar to sulfonylureas.
True
Sitagliptin and saxagliptin are what type of med?
Incretin modifiers
According to the book, what are the criteria for use of antidiabetic drugs?
Onset of diabetes mellitus at age 40 or older.
Diagnosis of diabetes for less than 5 year.
Normal weight or overweight for age.
Fasting blood glucose 200 mg/dL or less.
Less than 40 units of insulin required per day.
Normal renal and hepatic function.
How does glucagon work?
It increases blood glucose by stimulating glycogenolysis.
When do we use glucagon?
When a patient has hypoglycemia and they are unable to eat or drink.
How does diazoxide work?
It increases blood sugar by inhibiting insulin release from the beta cells. They also stimulate release of epinephrine from adrenal medulla, which stimulates glycogenolysis.
