Diabetes mellitus Flashcards
exocrine cells involves synthesis and release of what?
digestive enzymes and sodium bicarbonate
what does the exocrine cells play an essential role in what?
digestion and absorption of food in small intestine
endocrine cells involves synthesis and release of what?
hormones
which cells are produced from acini cells?
exocrine
which cells are produced from islets of langerhans
endocrine
what does the endocrine cells play an essential role in what?
blood glucose levels
Insulin comes from which cells
beta
glucagon comes from which cells
alpha
somatostatin comes from which cells
delta
glycogenesis
glucose is stored in liver as glycogen
lipogenesis
glycogen coverts to glucose which converts to fatty acids which is stored as triglycerides in fat cells
what happens between meals?
liver releases glucose to maintain blood glucose within normal limits
glycogenolysis
glycogen broken down to release glucose
gluconeogenesis
synthesis of glucose from amino acids, glycerol and lactic acid
which type of diabetic goes into DKA?
type I
which type of diabetic has islet cell Ab
type I
AlC should be greater than or equal to what to diagnose Diabetes? fasting BG?
6.5/ >126mg/dl
A normal A1C should be? fasting BG should be?
below 5.7/ <100mg/dl
prediabetic A1C? fasting BG?
5.7-6.4/100-125mg/dl
when are all pregnant women screened for diabetes regaurdless of risk with an OGTT?
24-28 weeks
primary goal of diabetes treatment?
prevent long term complications
preferred treatment for severe hypoglycemia
IV glucose or Glucagon
macrovascular damage
heart disease HTN, stroke
microvascular damage
retinopathy, neuropathy, erectile dysfunction
what drug is important to prescribe for a diabetic who has HTN?
ACE inhibitor (lisinopril) or ARB (losartan)
treatment principles for diabetic management step 1
initiate lifestyle changes, start metformin
treatment principles for diabetic management step 2
add 2nd drug to metformin, continue lifestyle changes
treatment principles for diabetic management step 3
add 3rd drug to metformin and the other drug
treatment principles for diabetic management step 4
add insulin to to 3 other drugs,
A1C treatment goal
<7%
preprandial
before a meal
Preprandial plasma glucose treatment goal?
80-130 mg/dl
peak postprandial plasma glucose treatment goal?
<180
BP treatment goal for risk CVD and non risk CVD
Risk = 130/80
non risk= <140/90
LDL, triglycerides and HDL treatment goals
LDL <100
triglycerides <150
HDL >50
when is tight glycemic control inappropriate?
long standing type 2 advanced microvascular or macrovascular damage comorid conditions hx severe hypoglycemia limited life expectancy
which drugs help with nephropathy
ACE1 or ARB
which drugs help with neuropathy?
tricylic antidepressants, gabapentin
which drugs help with patients at high risk for hypoglycemia
metformin or pioglitazone
which drugs help with postprandial hyperglycemia
alpha-glucosidase inhibitor, Byetta
How does insulin effect K?
it increases K uptake into cells
how does insulin effect adipose tissue?
helps to breakdown fat
how does insulin effect muscle?
increases glycogen and protein synthesis
how does insulin effect liver?
increases storage of glucose as glycogen
inhibits glycogenolysis, glucomeogensis, ketogenesis
insulin analog example
Glargine (lantus)
Rapid acting insulin
Lispro (Humalog), aspart (Novolog), glulisin (Apidra)
how fast is rapid acting insulin and when does it peak, How long does it last
10-30 minutes, peaks 1 hour, lasts 3-6 hours
Short acting insulin
Regular (Humulin) Novolin R
When is short acting insulin given, peak? duration?
given 30-45 minutes, peaks at 1-5 hours and lasts about 6-10 hours
Intermediate-acting insulin
NPH
how fast is intermediate-acting insulin, peak? and duration?
1-2 hours, peaks 6-14 hours and lasts 16-24 hours
Long acting insulin, peak? duration?
Glargine (Lantus) and Detemir (Levemir) no peak, lasts 12-24 hours
ultra long acting insulin? peak? duration?
Degludec (Tresiba), no peak, lasts 42 hours
NPH can only be mixed with which type of insulin?
short acting (Regular (Humulin) Novolin R)
when mixing NPH which is drawn up first?
short acting (Regular (Humulin) Novolin R)
which type of insulin can cause bronchospasm in patients since you can give it via oral inhalation
short acting (Regular (Humulin) Novolin R)
short acting (Regular (Humulin) Novolin R) route
subq, IV infusion, IM, oral inhalation
how much does 15gm CHO raise BG?
50gm/dl
1 unit bolus of insulin lowers glucose by how much?
20-60mg/dl
metformin is which type of oral hypoglycemic?
Biguanides
Biguanides
metformin
most common side effects of Biguanides (metformin)
GI upset, B12 deficiency
when are Biguanides (metformin) given to a non diabetic?
Polycystic ovary syndrome (PCOS), to increase changes of pregnancy, prevention of type 2
which antidiabetics increase insulin secretion?
sulfonyureas, incretins, meglitinides
which antidiabetics increase glucose uptake and utilization?
Thiazolidinediones and Beguanides
In order for Biguanides to work, what is needed?
they need to be making insulin for this to work
Meglitinides (glinides)
Repaglinide (Prandin), Nateglinide (Starlix)
which type of oral hypoglycemics are Repaglinide (Prandin), Nateglinide (Starlix)
Meglitinides (“glinides”)
Thiazolidinediones (glitazones)
Rosi”glitazone” (Avandia)
which type of oral hypoglycemics are Rosi”glitazone” (Avandia)
Thiazolidinediones (glitazones)
Function of Biguanides (metformin)
prevents liver from making glucose
decreases intestinal absorption of glucose
increases insulin sensitivity to the tissues
lowers cholesterol
does NOT stimulate insulin secretion
oral hypoglycemic for patients with secondary beta cellfailure
metformin
Should you take Biguanides (metformin) with food?
no
warnings precautions with Biguanides (metformin)
impaired hepatic function, decreased B12 absorption, elderly
Sulfonylureas start with?
“Gli”
which oral meds are bad for pregnancy?
sulfonylureas, thiazolidinediones (really nothing except for metform)
bladder ca is a side effects of which med?
Thiazolidinediones
