Diabetes Meds Flashcards
Where is insulin secreted from and in what amount?
- synthesized and stored bound to zinc in granules in the B-islet cells of the pancreas
- 60 units/day (25% total content)
- continuously released + additional increases following carbohydrate ingestion
Describe how high blood glucose stimulates insulin release:
- glucose enters B-cell via GLUT-2 transporter
- converted to ATP via oxidation
- closes ATP-sensitive K+ channel causing depolarization
- Ca2+ enters cell
- insulin is secreted
GLP-1 stands for…
glucagon-like peptide-1
GIP stands for…
glucose-dependent insulinotropic peptide
DPP-4 stands for…
dipeptidyl peptidase
Describe the incretin effect:
GLP-1 and GIP are released from specialized neuroendocrine cells of the small bowel –> stimulate insulin release
What is the function of DPP-4?
rapidly inactivates GLP-1 and GIP
How is the incretin response affected by type 2 DM?
type 2 DM blunts the incretin response and GIP becomes ineffective in stimulating insulin release
List the 4 hormones that increase serum glucose:
1) cortisol
2) catecholamines
3) glucagon
4) growth hormone
List the 4 peptides that stimulate insulin release:
1) glucagon-like peptide-1 (GLP-1)
2) glucose-dependent insulinotropic peptide (GIP)
3) pituitary adenylate cyclase-activating polypeptide (PACAP)
4) vasoactive intestinal peptide (VIP)
Action of insulin on muscle:
- anabolic hormone enhancing protein synthesis and decreasing protein breakdown
- glucose transport into muscle using GLUT-4 transporter
- glycogen synthesis and storage
Action of insulin on fat:
- increases fatty acid and triglyceride uptake into adipose tissues (lowers plasma FA levels)
- increased glucose transport into fat cells using GLUT-4 transporter
- inhibits fat breakdown
- increased clearance of ketone bodies
Which 3 types of tissues do not require insulin for transportation of glucose?
- brain
- liver
- kidney
Action of insulin on liver:
- increased synthesis of glycogen in liver
- inhibited gluconeogenesis, glycogenolysis, and ketogenesis
- excess glucose converted to FFA
- synthesis of FFA and glycerol into triglycerides for fat storage
- increased protein synthesis from amino acids
Action of insulin on electrolytes:
- increases K+ uptake into cells
- increase renal Na+ retention
Action of insulin on brain:
- stimulates memory
- controls appetite
Action of insulin on cardiovascular system:
vasodilatory properties
Summary of insulin effects on the body:
- increase glucose update
- increase glycolysis
- increase protein synthesis
- increase lipogenesis
- decrease gluconeogenesis
- decrease lipolysis
- decrease proteolysis
Diabetes diagnosis A1C, fasting BG test, and GTT:
A1C = 6.5%+
FBG = 126 mg/dL+
GTT = 200 mg/dL+
Prediabetes diagnosis A1C, FBGT, and GTT:
- A1C = 5.7-6.4%
- FBG = 100-125 mg/dL
- GTT = 140-199 mg/dL
Normal A1C, FBGT, and GTT:
- A1C = <5.7%
- FBG = <99 mg/dL
- GTT = <140 mg/dL
Lifestyle r/f type 2 DM:
- high carbohydrate intake
- metabolic syndrome
- inactivity
- obesity
- HTN
- high cholesterol
What is a HgA1C?
- glycosylated hemoglobin
- amount of glucose combined with Hgb is directly proportion to the total amount of sugar in the body
- useful tool in measuring long-term glucose control d/t life span of rbc = 8-12 weeks
- goal is <6.5%
Diabetic complications:
- Alzheimer’s dz
- nerve damage
- eye damage
- hearing impairment
- dental problems
- cardio/cerebro/vascular dz
- kidney damage
- extremity damage
- skin conditions r/t poor wound healing
Hierarchy of DMII treatment:
- diet & lifestyle mgmt
- monotherapy with PO agent
- combination therapy with PO agents
- insulin/injection therapy alone or combo
What was the first type of oral diabetic agent?
sulfonylureas (1955)
5 types of glucose lowering medications:
1) secretagogues (increase endogenous insulin release)
2) insulin sensitizers (reduce insulin resistance)
3) dopamine agonist (increase early morning dopamine levels)
4) agents that reduce glucose absorption
5) agents that inhibit glucagon secretion
Sulfonylurea candidates…
- must have 30% normal B-cell function
- cannot be overweight
- may have an intolerance to Metformin
Most commonly prescribed diabetes medications:
1 biguanides (Metformin)
#2 insulin analogs
#3 sulfolnylureas
