Diabetes Flashcards
Insulin effects
Glucose – the most potent stimulant of insulin secretion
-
sympathetic activation of adrenergic B2 receptors also induces insulin secretion
(“Beta 2 tuba”)
-insulin increase hepatic glycogen stores
(“Full liver candy jar”)
- increased glycogenesis
- decreased glycogenolysis
-insulin increases glycogen storage and protein synthesis in muscle
(“Glycogen glazed ham”)
-increases triglyceride storage in adipocytes
(“Full fatty donut jar”)
-insulin decreases serum K+
(“Old lady Eating banana candy”)
- increased Na+/K+ ATPaase in skeletal muscle drives K+ into the cells
Names Insulin Analogs Therapy
Rapid onset , Short acting (“Girls And Lads”)
(Insulin) Glulisine
- *Aspart**
- *Lispro**
Intermediate acting (“Rest Now”)
- *Regular** Insulin
- *NPH** Insulin
Long Acting (“Don’t Go”)
Insulin Detemir
Glargine
Rapid acting , Short duration insulin Properties
(“Girls And Lads”)
Glulisine
Aspart
Lispro
- insulin glusine, aspart, and lispro control the postprandial glucose spike
- have rapid onset and short duration of action, mimicking post prandial response.
(“Tall immediate peak on “girls and Lads”)
(“Birds nibbling the peak”)
-these do not polymerize into hexamers so they are absorbed rapidly
Intermediate acting insulin therapy Properties
(“Rest Now”)
- *Regular** insulin
- *NPH** insulin
-regular and NPH insulin have a delayed onset and intermediate duration of action (NPH is more delayed) this is due to the formation of dimers and hexamers, taking time to breakdown
(“Delayed peak on the house”)
-Regular insulin is only one to be administered IV
(“Ivy under R”)
- IV regular insulin is useful in the management of DKA (watch K+ levels)
(“Ivy next to Candy Cane Key”) - IV regular insulin is useful in the management of hyperkalemia (administer with glucose!)
(“Ivy next to eaten banana”)
Long Acting Insulin Therapy
(“Don’t Go”)
Insulin Detemir
Insulin Glargine
-provide a steady background level of insulin-glargine has no peak (“Roof on hat is long and flat”)
General Side Effect of Insulin Therapy
-insulin therapy can cause hypoglycemia
(presents with tachycardia, palpitations, sweating, nausea)
(“Falling candy”)
what should be administered in case of severe insulin induced hypoglycemia
-Gluca-gone for when your glucose is gone!
other than Insulin Analoges , What other drugs can treat Diabetes ?
Sulfonylureas
- 1st Generation-“amide”
(“Mother swan in a maid outfit”)
→ Chlorpropamide
→ Tolbutamide
- 2nd Generation-“ride”
(“Goslings riding on the mother swan’s back”)
→ Glyburide
→ Glimepiride
→ Glipizide
Meglitinides
- *Repa**glinide
- *Nate**glinide
GLP1- Agonists-“tide”
Exenatide
Liraglutide
DDP4 inhibitors-“gliptin”
Sitagliptin
Saxagliptin
Linagliptin
Sulfonylureas/Meglitinides MOA
-bind ATP-dependent K+ channels on beta cells leading to depolarization of beta cells calcium influx release of endogenous insulin
(“Sulfa swan lake behind closed banana gate”)
(“Father goose gliding into the beta cell”)
Sulfonylureas Properties
-Sulfa Drugs
1st Generation-“amide”
- *Chlorprop**amide
- *Tolbut**amide
- long duration of action -rarely used
2nd Generation - “ride”
- *Glybu**ride
- *Glimepi**ride
- smaller dosing, long duration of action
Glipizide
- has the shortest duration of action (less risk of hypoglycemia)
Meglitinides Properties
(“Father goose gliding into the scene”)
Repaglinide
Nateglinide
-Meglitinides (glinides) are NOT sulfa drugs-can be used in patients with an allergy to sulfa
(“Father goose cannot lay eggs”)
Sulfonylureas / Meglitinides Side Effects
- sulfonurease/meglitinides can cause hypoglycemia
- sulfonureas/meglitinides can cause weight gain
- 1st generation sulfonureas (cloropropramide) cause a disulfiram like reaction with ingestion of alcohol
Sulfonylureas/Meglitinides are used for…
-sulfonylureas and Meglitinides are oral agents
used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“fat old lady raising 2 fingers”)
GLP1 Agonists MOA
(“TIDE” detergent”)
- *Exena**tide
- *Liraglu**tide
Activate GLP 1 receptor
- increase insulin secretion/increase satiety
- decrease Glucagon /decrease gastric emptying
(“Langerhansel “Gulp” activated when looking at Hag”)
DPP4 inhibitors MOA
(“4 DRIPPNG laundry items hanging”)
- *Sita**gliptin
- *Saxa**gliptin
- *Lina**gliptin
inhibit DPP4 enzyme thus increase GLP-1 activity
(“Laundering old hag letting out endogenous gulps”)
- Dipeptidyl peptidase (DPP4) is an enzyme that usually inactivates GLP-1
GLP1 agonists / DPP4 inhibitors Properties
-GLP-1 and DPP-4 inhibitors are oral agents used in the treatment of TYPE 2 diabetes requiring functional beta cells for endogenous insulin release
(“2 fingers hag”)
-GLP-1 agonists and DPP-4 inhibitors increase endogenous insulin release and C-Peptide levels
(“C-Wrapper”)
-GLP-1 agonists and DDP-4 inhibitors decrease glucagon secretion this aids in lowering serum glucose levels
(“Falling empty glucagon packets”)
-GLP-1 and DDP-4 inhibitors decrease gastric emptying leading to increase satiety and delayed glucose absorption
(“Sealed gastric container”)
-GLP-1 agonists and DPP-4 inhibitors do NOT cause hypoglycemia
(“Green candies NOT falling off the tree”)
GLP-1 agonists Side Effects
-GLP-1 agonists (exenatide) can cause pancreatitis, seek immediate medical care
(“Creepy detergent lady Squeezing pancreas sponge”)
DPP4 inhibitors Side Effects
(“DRIPPNG laundry items hanging”)
-DPP-4 inhibitors (gliptins) can increase risk for upper respiratory infections and nasopharyngitis
(“Clothespin clipping nose of 4 shirt lady “)
