Diabetes

Question 1

what requires glucose absolutely - they can not burn fat for energy

Answer 1

RBC
neurons
renal medula

Question 2

hyperglycemia level mg/dl

Answer 2

> 126mg/dl

Question 3

HbA1c in diabetics goal

Answer 3

primary goal <6%

Question 4

main cause of death in DM

Answer 4

Cardia Vascular disease

Kidney Failure

Question 5

where is insulin coming from and what does it do

Answer 5

pancreatic beta-cells
stimulates GLUT in muscles and fat
inhibits glycogenolysis in liver
inhibits gluconeogenesis in liver

Question 6

what is insulins counter

Answer 6

glucagon
pancreatic alpha-cells
stimulate liver gluconeogenesis

Question 7

mechanism of insulin release

Answer 7

glucose enters beta-cell
increased oxidation i.e ATP rise
increased ATP opens K-channel to close
efflux of K stopped so cell now depolarizes
depolarization opens Ca channels
Ca influx causes insulin release from secretory granules

Question 8

insulin pathway to GLUT

Answer 8

insulin binds extracellular alpha-unit on tyrosine receptor
intracellular beta-unit autophoshorylates
IRS autophoshorylates and activates several kinases that causes up regulation of GLUT to membrane

Question 9

when do you give a patient insulin and ADR

Answer 9

DM1
DM2
severe hyperKalemia
stress induced (cortisol) hyperglycemia

ADR:
hypoglycemia - (hunger, sweat, weak, drowsy, warm, dizzy, blurred vision, seizure, coma)
»> give oral glucose, IV glucose or glucagon

lipoatrophy, lipohyperthrophy at injection site

Question 10

aspart

Answer 10

ultra shorrt acting insulin

IV
insulin pumps

Question 11

lispro

Answer 11

ultra short acting insulin
rapid onset
short duration of action

IV
insulin pumps

Question 12

regular

Answer 12

short acting
rapid onset

IV

Question 13

NPH

Answer 13

intermediate acting

cannot be used IV

Question 14

glarcine

Answer 14

peakless
very long acting
slow onset

Question 15

detemir

Answer 15

peakless
very long acting
slow onset

Question 16

group insulin types by duration

Answer 16

aspart, lispro (ulta-short)

regular (short)

NPH (intermediate)

glargine, detemir (long)

Question 17

what is the aim of Rx Tx in DM2

Answer 17

diet, exercise
increase insulin release from pancreatic beta-cells
increase peripheral insulin receptor sensitivity
decrease hepatic glucose production
inhibit alpha-glucoside hydrolase in gut
inhibit alpha-amylase in gut
administer insulin

Question 18

DM2 Rx common side effects

Answer 18

hypoglycemia

weight gain

Question 19

name 2 insulin secretagogues

Answer 19

glyburide

repaglinide

Question 20

glyburide

sulfonylurea

Answer 20

blocks K-ATP channel in beta cells = depolarization

ADR:
hypoglycemia
weight gain
sulfa allergies
liver toxic
disulfram reaction

Question 21

repaglinide

Answer 21

causes K-ATP channel to close

ADR:
hypoglycemia
weight gain

Question 22

Rx that inhibit sugar absorption

Answer 22

acarbose

blocks alpha-glucoside hydrolase in gut
blocks alpha-amylase in gut

duration is only 4-5 hours

ADR:
liver toxicity
GI discomfort
Osmotic diarrhea

Question 23

name insulin sensitizers

Answer 23

pioglitazone
rosiglitazone
metformin

Question 24

pioglitazone

rosiglitazone

Answer 24

activates PPAr nuclear receptors
increases GLUT-4 in muscle and adipose

increased fat synthesis and storage
decreased hepatic glucose production

ADR:
weight gain !!!
increased blood cholesterol
fluid retention - heart issue
MI (rosiglitazone)
hepatoxic
anemia

Question 25

metformin

Answer 25

sensitizes insulin receptors in adipose, liver, muscle

ADR:
lactic acidosis (increased anion gap)
GI discomfort
alteration of taste
megaloblastic anemia