Diabetes Flashcards
How can B blockers cause a functional interaction of hypoglycemia
The bradycardic effects of beta blockers can mask the fast pounding heart beat that is a key sign of hypoglycemia
remember, many pts are treated with both beta blockers and diabetes (also when eye drops given ie timolol which is a beta blocker)
Types of Insulin
Long Duration
Insulin Glargine
Low solubility at low pH
Peakless basal level of insulin lasting more than 20 hrs w/o hypoglycemia
What are the glucose suppressors?
They are Biguanides
ie Metformin
stops the liver from making excess sugar
doesnt cause hypoglycemia
What are the insulin secratogogues and what are they used for?
These are the sulfonylureas and Meglitinides
for type II
help pancreas make extra insulin, but reduces serum glucagon so there is hypoglycemia
What are the sulfonylyreas? SEs? Contras?
oral diabetic drug
GLIPIZIDE GLYBURIDE, GLIMEPIRIDE
SEs: Weight gain, hypoglyc
Contras: Sulfa allergy, prego, liver/kidney issues
What are meglitinides? SEs? Contras?
These secratogogues that incr inslin secretion
REPAGLINIDE, NATEGLINIDE
short acting, lower postprandial glucose. but only works when glucose is present. if absent or low, drug doesnt work as well
SEs: weight gain,
Contras: liver/kidney issues preggos
GLP-1 is a hormone released in response to food ingested. (glucagon like peptide) This is a type of INCRETIN. What is an analog of of GLP?
Exenatide.
Used to improve glycemic control but if used with sulfonylurea, get hypoglycemia BUT NOT IF USED WITH METFORMIN
can sometimes acute fatal pancreatitis
What are the Dipeptidyl Peptidase Inhibitors and what do they do?
Sitagliptin
Inhibits the peptidase that rapidly breaks down GLP-1
less likely to cause hypoglycemia so helps to control blood sugar
What are starch blockers (alpha glucosidase inhibitors) and what do they do?
they slow the digestion of starches
What is a Alpha glucosidase inhibitor?
Acarbose, Miglitol
oligosacch analogs
bind to intestinal disacchs, delays carb absorption
take with the first bite of each meal
PREVENT TYPE 2 DIABETICS IN PREDIABETICS
does interfere with metformin tho
hypoglycemia if used with sulfonylureas
What is amylin?
Second hormone secreted by Beta cells (pancreas)
Lowers post prandial glucose and glucagon release, slows gastric emptying and reduces appetite
Amylin Analogs?
Pramlintide
fast absorption, brief duration
for type 1 and 2
causes GI and hypoglycemia
What are the insulin sensitizers and what do they do?
These are Thiazolidinediones
helps body cells use insulin better
activate PPARgamma which regulate genes for metabolism, development, tumorigenesis
Induce P450, so reduce levels of cyclosporine, oral contraceptives
Pioglitazone is a thiazolidinedione with major side effects. what are they and what are the contras?
Can cause or worsen CHF
Contras: CHF, severe HF, BLADDER CANCER!!!
What are the SEs of ROSIGLITAZONE (Avandia)
Heart risks. now has black box warning about making CHF worse, also risk of HF and MI
