Diabetes Podcast 1 and 2 Flashcards
Diabetes leads to abnormal
Protein metabolism
Lipid metab
Carb metab
Drug therapy goal
in protein breakdown
dyslipidemia
hyperGly, inc BG
dec BG to optimal level
normalize metabolic changes
Drug therapy mechanisms for hyperGly
inc ___ sec/mimic action
Suppress __ action
___ is tupicaly inc at early stages
poorly controlled diabetics lose ____ secreting cells of panc, making it diff to mount response to
Slow ____
Excrete
insulin
glucagon
glucagon
glucagon, hypogly
gastric emptying
glucose
Inc insulin in muscle/fat increases
in liver, dec
dec
promotes
ultimately
glucose uptake
glucose prod
gluconeogenesis
glucose storage as glycogen
dec BG
slow GE dec
normally, % of gluocse is reabsorbed
in DM, filtered load ___ reabsorptive capacity
post prandial hypergly
100
exceeds, glucose present in urine
T1DM has absolute req for
Beta cell fxn in T1/T2/T1.5
insulin
fast dec, slowest dec, middle
Diagnositc criteria for DM
Fasting plasma glucose >
A1C >
Random plasma glucose > ___ or 2hr oral glucose tolerance test >
Typical glycemic goal in diabetics
126 (normal <100)
6.5% (normal <5.6%)
200 (normal <140), >200
<7%
Glycosylated hemoglobin (A1C)
glucose and Hb can form
A1C is proportional to
lifespan of RBC/A1C
measuring HbA1C gives index of ___ of hyperglycemia
Estimated avg glucose
eAG=
covalent bond
circ glucose conc
120 days
severity over months
(A1C-2)X30
Goal of therapy for DM
reduce sx of
3 Ps + F
Avoid
Strive for
this reduces risk for
best reduction in comps occurs w
hypergly
Polyuria, polydipsia, polyphagia, Fatigue
hypoGly
normalglycemia, euglycemia
retinopathy, neuropathy, nephropathy
A1C less than 7%
Insulins
Duration and name
Rapid (3)
Short acting - identical to
Intermediate acting (1)
Long acting (2)
can be used for
insulin lispro/aspart/glulisine
Regular (human)
NPH (isophane insulin suspension)
insulin (glargine/detemir)
T1DM/T2DM
Insulin reduces blood glucose by
inc glucose uptake into
inc membrane ___ to enable transport
Suppresses ___ prod in liver
facilitates storage of glucose as
inhibits
Insulin is a ___ hormone
promotes storage of
in absence, storage is
muscle/adipose
glucose trans GLUT4
glucose
glycogen
gluconeogenesis
storage
all nutrients (AA, glucose, FA)
suboptiml/zero
AntiDM drugs
bind to sulfonylura receptor to inc insulin secretion
act on liver/muscle/adipose to lower glucose
reduce intestinal absorption of glucose
mimic or prolong actions of endo incretin hormones
reduce reabsorption of glucose in kidney
promote amylin sec
miscell
Sulfonylureas, meglitinides
metformin, thiazolidinediones
alpha glucosidase inhib
GLP1 receptor ag, DPP4 inhib
SGLT2 inhib
Pramlintide
Bromocriptine, Colesevelam
Sulfonylureas (2nd gen)
Glinides (Meglitinides)
Biguanides
Alpha glucosidase inhib
Prototype drugs, indications, mechanism
Glimepiride/Glyburide-T2DM- insulin secretagogue
Repaglinide/Nateglinide- T2- insulin secretagogue
Metformin- T2- dec HGP/glucagon
Acarbose-T1/T2- dec mealtime CHO absorp
Thiazolidinediones (TZDs/Glitazones)
GLP 1 receptor ag
DPP4 inhib
Amylin analog
SGLT inhib (Gliflozins)
Prototype, indication, mechanism
Pioglitazone/Rosiglitazone-T2-insulin sensitizers (inc gluc uptake, dec HGP)
Exenatide
Sitagliptin- both T2- both insulin secretagogues (inc 1st phase insulin release, dec glucagon, GE)
Pramlinitide-T1/T2-dec glucagon, GE
Canaglifozin-T2-inc renal excretion of gluc
