diabetic drugs Flashcards
The Pancreas
• Can be found just “tucked in”
the angle formed by the gastric pylorus and the proximal duodenum
The Pancreas
• You’ve already learned it has two functions:
1) Exocrine (various digestive enzymes)
2) Endocrine
The Endocrine Pancreas
Produces insulin (signalling a “fed” state), glucagon (signalling a “hungry” state), gastrin, somatostatin, and many others. releases into blood stream
Beta cells
secrete insulin which causes BG to decrease (after all, you’re in the fed state and need to stash that
energy)
alpha cells
secrete glucagon which causes BG to
delta cells
secrete somatostatin which regulates a LOT of things (and gets
very, very complicated!)
The Exocrine Pancreas
Releases bicarb (why?) reverses bicarb so digestive zymogens can work and digestive zymogens to break down fats and proteins • All goes awry with pancreatitis
) Diabetes insipidus
Critter doesn’t produce or kidneys don’t respond toVasopressin (Antidiuretic Hormone/ADH)
diabetes mellitus type 1
Insulin-Dependent DM (IDDM)”
DM type 2
Non-Insulin-Dependent DM (NIDDM) Broadly, Type 1 DM is an absolute insulin deficiency and Type 2 DM is a relative deficiency of insulin
DM type 3
Other
• Due to side effects of drugs, toxins, viral infections, genetic predispositions, etc. Variable in course & treatment
DM type 4
Gestational
• Women may develop extreme insulin resistance during their third trimesters of pregnancy (same time they might be prone to blowing out mitral valves, eh?) as a result of hormonal changes
Type 1 DM
• These critters must receive insulin or suffer from the four “classic” symptoms of hyperglycemia:
Polyphagia -Polydipsia -Polyuria -Polyweightloss(?)
Type II DM
• These critters produce variable
amounts of insulin and exhibit insulin resistance.
»These critters typically require increasing doses of insulin and combination therapy with other antihyperglycemics
uncontrolled Type 4 DM can lead to
xtremely large babies, dystocia, and neonatal hypoglycemia
why are plasma insulin levels are not an accurate measure of insulin production
nsulin is removed from circulation so rapidly (3-5 minute half-life). c protein measurement better guide
C-Protein
NOT to be confused with Protein C or C- reactive protein!
• A 31 amino acid peptide used to differentiate Type 1 DM from Type 2 DM
Half-life of C-Protein is
~30 minutes
– Therefore ~5X as much in the blood stream as insulin
insulin is produced by
β-cells in the pancreas in response (generally) to glucose (the archetypical “fed state”)
Insulin’s main effect target tissues are
liver, fat, and muscle
• Insulin exhibits anabolic effects on these target tissues
Insulin is increasingly being used by perfusionists for
hyperkalemia therapy (what’s this? what’s “normalkalemia?), often in conjunction with glucose to “drive” potassium intracellularly
hat else can you do to lower potassium levels?
?
…perfusionists have started to seek much “finer” control of glucose levels on bypass, so
insulin drip and anti-hyperglycemic protocols have become much more common.
Rapid onset/short-acting insulin
Regular insulin (Humulin R, Novolin R) -Insulin aspart (Novolog) -Insulin glulisine (Apidra) -Insulin lispro (Humalog). Given IV or subcutaneously (SQ)
