Diabetes: week 1 Flashcards
what happens during glycogenesis
glucose turning into glycogen (by insulin)
what kind of acid base issue does ketogenesis cause?
metabolic acidosis
which hormone stimulates glycogen breakdown into glucose
glucagon
what are the 4 hormones that increase blood glucose
- epinephrine
- cortisol
- growth hormone
- glucagon
what hormones decrease blood glucose (2)
- GLP-1
- insulin
what is the main difference between type 1 and type 2 DM
- type one is when the pancreas fails to produce insulin due to loss of beta cells
- type 2 is when the tissue cells become resistant to insulin (this can be due to decreased sensitivity of target cells or decreased glucose production in the liver)
what is the primary goal of treatment for DM
manage symptoms of hyperglycemia
what are the 5 symptoms of acute hyperglycemia
- polyuria
- poydipsia
- weight gain
- lethargy
- blurred vision
what are the 7 major complications of chronic hyperglycemia
- eye disease
- renal failure
- diabetic foot (ulcers)
- stroke
- heart damage
- nerve disease
- arteriosclerosis
how does chronic diabetes affect the eye
high blood glucose and high blood pressure can damage eye blood vessels, causing retinopathy, cataracts, and glaucoma
how does chronic hyperglycemia affect the kidneys
high blood pressure damages small blood vessels and excess blood glucose overworks the kidneys, causing nephropathy
which issue with the heart is common which high blood pressure and insulin resistance
coronary heart disease
what is coronary heart disease?
Coronary heart disease is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries
what does insulin do to amino acids and proteins
holds on to amino acids and increases protein synthesis
where does insulin act on when the body consumes amino acids and proteins
the muscle
how does insulin act on lipids
increases triglyceride synthesis
decreases the release of FFA and glycerol
decreases oxidation of FFA to ketoacids
what are the 3 major adverse effects of insulin
- hypoglycemia
- hypokalaemia
- lipodystrophy (injection practices)
which type of insulin can be administered intravenously
Regular Insulin
what factors would determine which type of insulin you use? ```
the onset, peak and duration
which type(s) of insulin have short duration and are rapid acting
- insulin lispro
- insulin Aspart
which type(s) of insulin is short duration and short acting
regular insulin
which insulin will have intermediate duration
NPH
which type(s) of insulin will have long duration
insulin glargine (Lantus), and insulin detimir
which insulin(s) have ultra long duration
insulin Dregludec
what is humilin 50/50
combination insulin
what are the bolus insulins
insulin lispro, insulin aspart, insulin glulisine and regular insulin
what are the basal insulins
NPH insulin, insulin glargine and insulin detemir
what are the 5 main categories/types of insulin’s
- short duration, rapid acting
- short duration, short acting
- intermediate duration
- long duration
- ultra long duration
what are the 2 insulin sensitisers
- metformin (biguinide)
- Rosiglitazone (TZDs)
what are the 2 incretin agents
- GLP-1 receptor agonists (Liraglutide)
- DPP-4 inhibitors (Sitagliptin)
what are the 2 insulin secretagogues
- sulfonylureas (gliclazide)
- meglitinides(repaglinide)
what are the 2 glucose wasters
- SGLT 2 inhibitors
- alpha glucosidase inhibitors
how does metformin work to lower blood glucose and improve glucose tolerance
- it inhibits glucose production in the liver
- it sensitises insulin receptors in target tissues
can the insulin sensitizers be used to treat T1DM?
no, there needs to be insulin present
which type of drug is Liaglutide
a GLP-1 receptor agonist
what does GLP-1 do
it regulates hormones after eating to cause:
- increase in insulin
- decrease in glucagon
- slows gastric emptying
- decrease in appetite
which anti-hyperglycemic medications are also considered non-insulin injectables
The incretin agents (GLP-1 receptor agents and DPP-4 inhibitors)
what do DPP-4 inhibitors do
- basically inhibits DPP-4 which allows GLP-1 to do its thing
which drug may cause hypoglycemia if taken with DPP-4 inhibitors
sulfonylurea
what type of drug is Sitagliptin
DPP-4 inhibitor
what are meglitinides and what do they do
they stimulate the release of insulin from the pancreas (same category as gliclazide/sulfonylureas but shorter acting)
what do alpha glucosidase inhibitors do (MOA)
delays the absorption of dietary carbs, reducing the spike in blood glucose after a meal
what is alpha glucosidase and what does it do
- alpha glucosidase is an enzyme located in the intestine that normally breaks down carbs for absorption (alpha glucosidase inhibitors inhibits this enzyme which slows the digestion of carbohydrates)
how do you treat hypoglycemias in a patient who is taking alpha glucosidase inhibitors
don’t give sucrose, give glucose tabs (becasue sucrose needs to be broken down and the whole point of the drug is that it doesnt break down glucose)
what is the MOA for SLGT2 inhibitors
they basically inhibit SGLT-2 in the kidney, reducing reabsorption of glucose
- they also increase urinary glucose excretion
Combination insulin usually consists of which 2 types of insulin?
30% regular insulin and 70% NPH insulin
what is the main benefit for sliding scale insulin
you can titrate to address blood sugar at that moment, prescribers will set units and rates so you just do it
what are the three adverse effects of insulin
hypoglycemias
hypokalemia
lipoduistrophy
which short duration rapid acting insulin should be given just after meals
insulin aspart
what is the peak onset for insulin lispro
30 mins to 2.5 hours
what is the peak of insulin aspart
1-3 hours
what is the peak of NPH insulin
6-14 hours
what is the peak of R insulin
1-5 hours
what is the cloudy insulin
NPH
out of biguanides and TZDs, which acts more on increasing insulin sensitivity (primarily)
TZDs are primarily going to work on insulin sensitivity, as well as inhibit glucose production in the liver
whats the difference between glycogenesis and glucogenolysis
glycogenesis is glucose to glycogen, and glycogenolysis is vice versa
whats the difference between meglitinides and sulfonurea?
meglitinides are shorter acting
