Diabetes Flashcards
Regular insulin Regimen?
take 30 minutes before meal.
lasts 6-8 hours
peaks in 2
w/ intermediate
Split and mixed regimen?
regular or short acting insulin w/ intermediate before breakfast and dinner
Split and mixed with bedtime intermediate?
the second intermediate-acting insulin can be held until
bedtime (9pm)
this improves morning fasting reading control.
Regimen in multiple pre-meal injections and bedtime long acting?
what is it good for?
Bfast: short acting
lunch: short
din: short
bed: long (glargine) —can split for 5 daily injections
maintain blood glucose level
What is the only thing better than pre-meal injection and bedtime?
insulin pumps
if they on pump you don’t do regimen
Missing an insulin dose may cause
diabetic ketoacidosis
What are the actions of insulin?
Increase storage of glucose as glycogen increase glucose utilization stimulate transport of glucose to cells increase fat storage increase fat synthesis in liver increase protein synthesis
suppresses glucose production while fasting
Basal insulin.
about 50% of daily needs.
What is prandial insulin and what does it do?
mealtime insulin
limit hyperglycemia after meals
peaks 1 hr after injection 10-20% of daily dose.
Most pts should be insulin treated with
multiple daily prandial and a basal injection
or
continuous SubQ insulin fusion
You should match prandial dose to
carb intake
premeal blood glucose levels
anticipated activity.
normal ranges of glucose?
80-120
check 6-10x a day
before meal/2 hr peaks/ bedtime/ 2 am once a month
When insulin is too high, missed meal, strenuous exercise?
symptoms?
Hypoglycemia
headache/ fatigue/ hungry/ tachycardia/ sweat/anxiety/confused/ weak/fainting/ numb at fingers and mouth due to Epi release.
Tx of hypoglycemia
15-20 g of glucose. for someone w/ <70 mg/dL
recheck in 15
Risk factors for hypoglycemia:
old dec food intake long standing disease (many to notice)/ >10 years recent episode cog impairment infection alcohol/renal dysfx
How can risk of nocturnal hypoglycemia be minimized?
20% reduction in daily basal insulin dose
low glycemic index carb feeding after exercise.
Sxs of ketoacidosis?
thirsty nausea/vomit/ab pain SOB/weak Fruity-scented breath confusion hyperglycemia high ketones
hyperglycemia signs
weak/tired a lot of peeing increased thirst dec appetite blurry vision/fruit breath itchy/dry skin seizure coma
MOA of incretin mimetic?
glucagon like peptide.
given 2x a day.
helps preserve beta cell function in pancreas.
suppresses appetite/inhibit glucagon secretion
reduce gastric emptying
ADRs on incretin mimetic?
nausea, vomiting, diarrhea, risk of mild to moderate hypoglycemia when used with a sulfonylurea so reduce sulfonylurea dose
hormones that stimulate insulin secretion in response to meals?
2 types?
half-life?
incretin: in GI
glucagon insulinotropic peptide: K cells in duodenum.jeju
glucagon like peptide in L cells.
half life is 2 mins.
What is the Fx of incretin?
stimulus to insulin secretion when food is ingested
inhibit glucagon secretion
slow gastric emptying and reduce appetite.
MOA for sulfonylureas
type 2
long acting insulin secreatogues (inc secretion)
block ATP sensitive K+ Channels on b-cell plasma membrane, suppress glucagon
STIMULATE APETITE
cause weight gain
ADR of sulfonylureas
hypoglycemia (when u miss meal)
weight gain
bind to albumen
careful with old ppl with renal disease
not for preggo/lactating.
What to not for sulfonylureas?
they cause release of insulin so if u cant produce it, you shouldn’t take it.
take 30 min before, lasts 6-8 hrs.
Lispro?
short acting insulin 5 mins b4 meal, peak at 1 hr. lasts 3-5 hours
Glarine ?
Peakless insulin: lasts 24 hours.
replaces basal level insulin
acts like continuous pump.
NPH:
intermediate insulin
takes long to absorb but lasts long.
mix of insulin and crystalline zinc
If someone takes a mix dose of regular insulin and NPH, when is it most likely that a hypogly
before lunch: reg insulin may still be effective and NPH could also effect causing hypoglycemia
What does metformin do?
reduce gluconeogenesis in liver stimulate glycolysis improve glucose utilization reduce carb absorbtion increase fatty acid break down. reduce LDLs and triglycerides increase insulin binding weight loss NO HYPOGLYCEMIA
When do you use metformin?
first choice unless renal/hepatic issues.
for polycystic ovary syndrome can be used with sulfonylureas fitazones DPP-4 inhibitors insulin
ADRs for Metformin?
nausea/diarrhea/lactic acidosis
B12 deficiency
caution with renal/hepatic and people over 80
first line of Tx for T2betes.
Exercise considerations?
150 a week. -if glucose >250 mg before ex, check for ketone and take insulin and wait til they drop -if glucose less than 100, take carbs. -dont inject at exercise site -dont exercise at peak insulin. -
Best time for T1D to exercise?
After Breakfast
check glucose before bed man.
Regular training increases____
muscle capillary density
oxidative capacity
lipid metabolism
insulin signaling proteins.
Mod exercise type 1
glucose utilization
catecholamine response
Blood Glucose
MAx sprint?
Increase
increase
decrease
decrease
increase
increase
MOA of glitazones.
insulin sensitizer increase in muscle, liver,fat improving resistance.
improve fat and cholesterol levels
delay progression of diabetes
ADR of glitazones
fluid retention weight gain increase risk of Fx bladder cancer. maybe increase MI?
What are other areas glitazones work at?
islet cells of pancreas to enhance secretion of insulin over long term. prevent regression of beta cell Fx.
Info on glucagon?
secreted from islet alpha cells when there is hypoglycemia to produce glucose from liver.
INHIBIT INSULIN
activate via ANS nerves and adrenaline
What confirms Dx of diabetes?
Pre= FBG=100-126 A1c= 5.7-6.4
Diabetes
FBG > 126
A1c=>6.5
