diabetes Flashcards
what percent of diabetes are type 1 and majority are diagnosed before 20 yo?
5%
insulin dependent diabetes
type 1
diabetics who are overweight, non white and diagnosed after 40
type 2 diabetes
what percent of people with type 2 diabetes are undiagnosed
25%
Therapy is aimed at keeping A1-C below ____?
7
blood pressure below ______; and LDL cholesterol below _____
140/180 AND 100
does arcus ever go away?
no there for life
whats the lowest a1c level?
6
whats the highest a1c level?
10
2 diabetic drug classes
oral hypoglycemics
insulin
4 oral therapy drug classes
- Biguanides
• Sulfonylureas
• Thiazolinediones / Glitazones
• DPP-4 Inhibitors
fuel for brain
only glucose
why is hypoglycemia dangerous?
life threatening –> due to loss of sugar for brain
when metformin is combined with dpp4 inhibitor what do we see?
neutral weight loss
MODY
maturity onset diabetes of the young; MONOGENIC (unlike the others); autosomal dominant disorder (only requires one gene to be affected)
polygenic and influenced by environment
type 1 and type 2 diabetes
INDICATION
DM-II, Polycystic Ovary Syndrome (PCOS)
DOSING [500-1000mg]
1 tab bid
metformin indication
reason why metformin is used for polycystic ovary syndrome
similar manifestations to diabetes
what organ fails towards end of diabetes
renal
CLINICAL PHARMACOLOGY
Oral Hypoglycemic, Infertility
Mechanism of Action
Biguanide-based; activates AMP-activated protein kinase (AMPK) which in turn suppresses hepatic gluconeogenesis & intestinal glucose absorption; increases insulin sensitivity
metformin moa
biguanides are found in diabetic drugs and what else?
preservative for cls
lactic acidosis from metformin –> mechanism
lactic acidosis from metformin –> if m. is in fight and flight –> under hypoxia it produces lactic acid –> liver must spew out more glucose for m. –> but liver refuses to uptake lactate –> therefore no stimulus to produce glucose
why do beta blockers mask hypoglycemia?
heart slows down –> they dont feel hyperglycemic
blood sugar levels rapidly decrease, if decreased too far brain needs sugar and they could shut down –> diabetic coma
metfomin plus what drug makes a pt suffer from hypoglycemic crisis?
cyclosporine
sympathetic ns role for beta 2 receptor on hepatic
glycogenolysis; gluconeogenesis
developed as an extension with work done on sulfomide antibiotics
sulfonylureas
2nd Generation (succeed 1st gen) • Glipizide [Glucotrol®] • Glibenclamide / Glyburide [Micronase®, Diabeta®] 1st Generation • Tolbutamide [Orinase®] • Chlorpropamide [Diabinese®] (discontinued in usa)
types of sulfonylureas
INDICATION
DM-II
DOSING [5, 10 mg]
2.5 – 20 mg PO qd - bid
glipzide
CLINICAL PHARMACOLOGY
Oral Hypoglycemic
Mechanism of Action
Stimulates pancreatic islet beta cell insulin release
Actions involve binding to an ATP-dependent K+ channel: blocked efflux leads to depolarization, Ca++ release and insulin vesicle effusion
glipzide moa
INDICATION
DM-2
DOSING [15/30/45mg]
1 tab qd
pioglitazone
2 types of glitazones
- Pioglitazone [Actos®]
* Rosiglitazone [Avandia®]
CLINICAL PHARMACOLOGY
Hypoglycemic/Anti-Diabetic
Mechanism of Action
A thiazolidinedione (aka glitazone) insulin sensitizer selectively stimulates nuclear receptor PPAR which increases insulin sensitivity in liver, skeletal muscle and adipose tissue
pioglitazone moa
regluates amount of glucose released
liver
