Diabetes Flashcards
What is Type 1 Diabetes?
Destruction of beta cells in the pancreas - NO INSULIN PRODUCED. More common in kids > adults
(autoimmune response)
What is Type 2 Diabetes?
Body becomes resistant to insulin. There is insulin but it is ineffective.
(Insulin Resistant – Body does not respond to the increased amount of insulin. Overtime, beta cell will stop functioning because of increased demand and lack of supply resulting in the individual being dependent on insulin.)
What is one of the Hallmarks of T2DM?
Dysregulation of insulin-signaling pathways
another mentioned is elevating fasting plasma glucose concentrations
How does T2DM work in regards to hepatic glucose production?
- Liver produces glucose during a fasting state
- After eating, insulin is released and is supposed to signal the liver (via beta cells) to stop making glucose.
- In cases of T2DM, the liver is insulin-resistant and produces glucose –> LEADS TO HYPERGLYCEMIA
- Livers of patients with T2DM are also glucose-resistant
Best treatment strategy for T2DM
Glucose control!
Controlling BP is 2nd.
What’s the deal with HbA1c (Glycosylated Hemoglobin)?
A biomarker of average glucose control over long-term.
Concentrations of BhA1c in blood is directly realted to blood glucose concentrations over the lifecycle of the RBC (60-120 days)
Reflects overall efficacy of diet, exercise, Rx on glycemic control
Should you use HbA1c to alter insulin doses?
No, HbA1c does not reflect day-to-day changes
What is hyperinsulinemia?
Normal amounts of insulin are ineffective at lowering plasma glucose concentrations
This is a symptom of Insulin resistance / metabolic syndrome / “pre-diabetes” (may occur in high stress, trauma, immunosuppression, and pregnancy)
How is metabolic syndrome defined? (see chart in PPT; not loading on this website)
Waist > 102 men (>80 women)
HDL 150
Fasting glucose > 100
BP > 130/85
Depending on governing body, waist + 2 (or any 3) are criteria for diagnosis
What is first line therapy for pre-diabetes?
Weight loss
What causes death in T2DM?
Usually cardiovascular disease
How many new cases of end-stage renal disease are attributed to diabetes?
Over 40%
What % of those with diabetes have nervous system damage?
60-70%
Is Diabeteic Peripheral Neuropathy asymptomatic?
Yes, is up to 50% of cases
What is the leading cause of hospital admissions for people with diabetes in developing countries?
Foot ulcer
What are glycemic goals for those with T2DM?
Fasting blood glucose 80-130 mg/dL and HbA1c
What % of patients benefit from physical activity and a monitored diet? And why?
100%
Glucose uptake is done through a insulin-independent pathway
Should diabetics focus on aerobic exercise or resistance training?
Both! Both have better benefits than either alone.
150 mins of aerobic activity and 2-3 days/week of resistance training.
Who needs Insulin Therapy?
Every Type 1 and Advanced Type 2
Balance basal and post-prandial (Snickers) requirements
- Produced by recombiant DNA technology
- -Amino acid modifications yield different PK properties
Cannot be taken in GI tract (it is a polypeptide)
Absoprtion and duration of action all affected by injection site, blood flow, temp, and physical activity
What different Insulin Rx are available?
Rapid and short-acting (most flexibility, least hypoglycemia; administered with/near meals; often combined with longer acting products)
Intermediate acting
Long acting
Mix insulin preparations
Continuous sc insulin infusion
What’s so cool about Continuous sc insulin infusion?
Pump technology helps mimics physiological insulin release
-Careful monitoring needed but provides insulin therapy for motivated patients.
Lifestyle change:
- Must monitor more often
- Costly
- Higher life expectancy
What is the most common adverse event of insulin rx?
Hypoglycemia - diabetics often do not adequately produce counter-regulatory hormones to aid in prevention of hypoglycemia
What is first line therapy for T2DM in regards to medication?
Metformin (Biguanide) - oral insulin sensitizer
- Requires insulin but does not impact secretion –> less risk of hypoglycemia vs secretagogues
- Monotherapy or combo Rx
How does Metformin work?
Decreased HGO (liver glucose production) via decreased gluconeogenesis
- Slows absorption in GI tract and enhances uptake in the peripheries.
- Combats high fat and cholesterol.
- Decreases appetite and leads to weight loss.
What drug promotes IN secretion from beta cells?
Sulfonylureas (K-ATP channel modulators)
What type of drug is a insulin sensitizer?
Thiazolidinediones
Can cause weight gain and liver toxicity. Lots of complications. Some are banned. Metformin is superior
Which drugs prevent post-prandial (Snickers) rise in blood glucose?
Alpha-Glucosidase inhibitors (Miglitol and Acarbose). Both taken at the beginning of meal time to reduce dietary glucose absorption
What medicine comes from Gila Monster and what does it do?
Exenatide - increased insulin secretion
50% homologous with to GLP-1 w/ much monger half-life
What are the newest drugs for T2DM?
SGTL2 Inhibitors
- Canaglifozin (Invokana)
- Dapaglifozin (Farxiga)
Blocks the reabsorption of glucose by the kidney by blocking SGLT2 (which normally transports insulin)
EFFECTS ARE INDEPENDENT OF INSULIN!
-Glucose eliminated in urine. May cause weight loss, UTI, and bladder cancer
How to treat obesity?
Use holistic approach
What drugs were banned for obesity?
Fenfluramine (CVD), Sibutramine (MI), Rimonabant (suicide)
How does Orilstat work?
Prevents breakdown and absorption of lipids (~30%) to reduce overall caloric intake. Adverse GI side effects may further reduce caloric intake even more - administered with meals
Side effects: poop stains if eat too much fat
New drugs to treat obesity?
Lorcaserin (Belviq), Qsymia (Phentermine - anphetamine) (Topiramate - anti-convulsant)
Newest obesity drug?
Contrave (combo of Bupropion [antidepressant] and Naltrexone [addiction killer])
When was the first guidelines for kids/teens with T2DM published?
2013 by the American Pediatric Association
Are mood spectrum disorders associated with serious endocrine/metabolic co-morbidities?
Yes.
What is one of the top-selling drugs world-wide, used in treatment of psychoses: drug induced disease?
Atypical Antipsychotic Medications (treat schizo, bipolar, and pyschosis)
Horrible side effects:
- reduced life expectancy
- Weight gain and metabolic syndrome
- Bone loss
- Sudden death in dementia patients
- Being prescribed more often to children!?
Effect of diabetes on life expectancy?
- Type 1 on average has decreased life expectancy by 20 years
- Type II on average has decreased life expectancy 30-50% vs. non diabetics
What do diabetics die of?
- Acute Complications (hypoglycemia, ketoacidosis, non-ketotic hyperosmolar coma)
- Chronic Complications (CVD, glucose toxicity, diabetic retinopathy, idabetic nephropathy, diabetic neuropathy, skin disorders, neonatal diabetes)
According to Rijo, what is the gold standard biomarker for glucose control?
HbA1c (glycosylated Hemoglobin)
What is tight glucose control?
Goal is to maintain glucose within normal range, achieved via dietary change, medications, and insulin.
- Tight Glucose Control levels
- Maintaining Blood glucose between 80 and 130 mg/dl and HbA1c
5 most common meds for T2DM according to Rijo? (but 6 are listed)
Metformin Sulfonylureas Thiazolisinediones Alpha-Glucosidase Inhibitors DPPIV Inhibitors SGLT2 Inhibitors
Risk factors for PAD
i. Cigarette Smoking
ii. Diabetes Mellitus
iii. Hypertension
iv. Dyslipidemia
v. C-Reactive protein
vi. Insulin resistance
vii. Chronic kidney disease
