Diabetic Pharmacology Flashcards
Function of pancreatic hormones - Insulin
Lowers blood sugar by facilitating glucose entry into cells and promoting storage as glycogen.
Function of pancreatic hormones - Glucagon
Raises blood sugar by promoting glycogen breakdown and glucose production in the liver.
Function of pancreatic hormones - Somatostatin
Regulates GI absorption and motility, may inhibit insulin and glucagon release.
Function of pancreatic hormones - Ghrelin
Inhibits insulin release, regulates GI function, lipid metabolism, CV function, growth hormone release.
Alpha (A) cells
Produce glucagon.
Beta (B) cells
Produce insulin.
Delta (D) cells
Produce somatostatin.
F cells
Produce pancreatic polypeptide.
Epsilon (E) cells
Produce ghrelin.
Role of insulin in carbohydrate metabolism
Facilitates movement of glucose into cells for storage or usage, increases glycogen synthesis, inhibits glycogen breakdown.
Role of insulin in protein and lipid metabolism
Promotes storage of proteins and lipids, stimulates protein synthesis and synthesis of fatty acids and triglycerides.
Cellular mechanism of insulin
Binds to receptors on target cells, initiates biochemical changes, promotes glucose diffusion into cells.
Glucagon as hormonal antagonist of insulin
Increases blood sugar levels to prevent hypoglycemia, promotes glycogen breakdown and glucose production.
Role of glucagon in glycogenolysis and gluconeogenesis
Rapidly increases glycogen breakdown, prolongs hepatic glucose production to sustain blood glucose levels.
Mechanism of action of glucagon
Binds to receptors on hepatic cells, activates enzymes to increase glycogenolysis and gluconeogenesis.
Blood glucose levels and hormone release
Normal fasting blood glucose: 70-110 mg/dL. Insulin is released when blood glucose increases, glucagon is released when it decreases.
Hyperglycemia and hypoglycemia
Hyperglycemia: elevated blood sugar causing neural and vascular damage. Hypoglycemia: low blood sugar with severe complications.
Diabetes Mellitus - Causes
Insufficient insulin secretion or decreased peripheral effects of insulin.
Diabetes Mellitus - Types
Type 1: 5-10% of cases, destruction of B cells, no insulin production. Type 2: 90-95% of cases, B cell dysfunction, decreased insulin sensitivity.
Diabetes Mellitus - Effects and complications
Chronic hyperglycemia, dehydration, electrolyte imbalance, ketoacidosis, vascular and neural damage, retinopathy, renal failure, poor wound healing, neuropathy.
Type 1 Diabetes - Characteristics
Unable to synthesize insulin, typically develops in childhood but can occur at any age.
Type 2 Diabetes - Characteristics
Combination of B cell dysfunction and decreased insulin sensitivity, associated with poor diet, obesity, lack of exercise.
Treatment of Type 1 Diabetes
Requires exogenous insulin administration to replace normal pancreatic production.
Treatment of Type 2 Diabetes
May include insulin along with other agents, depends on the severity and cause of the condition.
Rapid-acting insulin
Administered once/day or immediately before/after a meal for quick effect.
Intermediate/Long-acting insulin
Provides prolonged effects for sustained insulin levels throughout the day or night.
Combination insulins
Combine rapid and intermediate forms, minimizing the number of injections needed.
Insulin pen/subcutaneous injection
Patients are trained in safety and injection management, common sites include abdomen, thighs, buttocks.
Insulin pumps
Deliver a continuous infusion of insulin, manually activated at meal-times for additional dosing.
Insulin sliding scale
Amount of insulin varies based on blood glucose levels, requires regular glucose monitoring.
Adverse effects of insulin therapy - Hypoglycemia
Quick drop in blood glucose levels, symptoms include headache, fatigue, hunger, tachycardia, sweating, anxiety, confusion.
Adverse effects of insulin therapy - Insulin allergy
Rare but can include pulmonary symptoms or skin reactions.
Primary agents in Type 2 Diabetes - Sulfonylureas
Stimulate insulin release from B cells, primary adverse effect is hypoglycemia.
Primary agents in Type 2 Diabetes - Meglitinides
Directly increase insulin release from B cells, examples: Repaglinide (Prandin), Nateglinide (Starlix).
Primary agents in Type 2 Diabetes - Incretin-based therapies
Regulate insulin secretion and effects, examples: GLP-1 receptor agonists (Exenatide, Liraglutide), DPP-4 inhibitors (Lingagliptin, Saxagliptin, Sitaliptin).
Insulin sensitizers - Metformin
Reduces glucose production in the liver, increases tissue sensitivity to insulin, primary oral antidiabetic agent.
Insulin sensitizers - Thiazolidinediones
Similar to metformin, act on liver to inhibit glucose production and increase insulin sensitivity, examples: Rosiglitazone (Avandia), Pioglitazone (Actos).
Nonpharmacologic interventions - Dietary management
Focus on healthy body weight, reduce tissues requiring insulin, educate on carbohydrate management.
Nonpharmacologic interventions - Exercise
Aerobic exercise increases tissue sensitivity to insulin and can reduce blood glucose levels for up to 72 hours.
Nonpharmacologic interventions - Tissue transplants and gene therapy
Transplantation of pancreatic B cells into the pancreas for Type 1 DM patients.
Rehabilitation considerations - Hypoglycemia
Monitor for signs of hypoglycemia, educate patients on the importance of not skipping meals and monitoring blood glucose levels before therapy.
Rehabilitation considerations - Complications of diabetes
Monitor for balance and fall issues due to neuropathies, weakness and fatigue due to renal failure, and increased risk for amputations due to poor wound healing.
Rehabilitation considerations - Pharmacological management
Ensure patients have taken their medications, educate on disease progress, and reinforce the importance of non-pharmacological management.
Which organ is primarily involved in the management of blood sugar levels through the release of insulin and glucagon?
- Thyroid
- Pituitary
- Adrenal
- Pancreas
- Pancreas
How does insulin primarily work to lower blood glucose levels?
- Reduces glucose absorption from GI tract
- Reduces appetite to reduce glucose absorption
- Reduces reabsorption of glucose in the kidneys
- Facilitates entry of glucose into peripheral tissues
- Facilitates entry of glucose into peripheral tissues
What is the range for normal, fasting blood glucose?
- 200-220
- 50-70
- 70-110
- 120-140
- 70-110
Which form of diabetes is categorized as the bodies inability to synthesize the needed amounts of insulin?
- Type I Diabetes Mellitus (T1DM)
- Type 2 Diabetes Mellitus (T2DM)
- Type I Diabetes Mellitus (T1DM)
What do you think is the primary problem associated with insulin therapy?
- Insulin Allergy
- Pulmonary Failure
- Hypoglycemia
- Drowsiness
- Hypoglycemia
Which of the following medications discussed is the primary oral medication used to treat Type 2 Diabetes?
- Sitagliptin (Januvia)
- Metformin (Glucophage)
- Pramlintide (Symlin)
- Glipizide (Glucotrol)
- Metformin (Glucophage)
Which cells in the pancreas are responsible for the production of insulin? These are commonly damaged leading to diabetes.
- A-cells
- F-cells
- E-cells
- B-cells
- B-cells
