DM II Flashcards
What is a common finding in patients with DM II (Pathophysiology)?
Insulin Resistance develops causing hyperglycemia in the body.
Insulin Resistance can be
Genetically Determined or
Acquired based on Environmental Factors
Insulin Resistance has an effect on
Muscle
Liver
Adipose Tissue
Pancreas
DM II can cause
Microvascular Complications (Retinopathy, Nephropathy, Neuropathy) Macrovascular Complications (CVD)
See DM I Notes
When treating DM II, what should you consider with patients?
Level of patient’s interest of involvement!
Shared decision making is important because lifestyle of the patient, and patient control is an important thing to consider.
Three common drugs for DM II
- Metformin
- Sulfonylurea
- TZDs
Body makes how many units of insulin every 24 hours?
25 units
How do you diagnose DM II?
Oral Glucose Tolerance Test (OGTT)
Initial Treatment for DM II
Monotherapy: Metformin
2 Drug therapy: Add sulfonylureas, insulin, GLP-1 receptor agonist
Common Insulin given
NPH
Levamir
Lantis
What is the #1 goal of treatment for DM II
Getting Glucose levels NORMAL
The higher the glucose in the blood, the ______ Metformin will work
More
Metformin has multiple beneficial effects, such as:
Decreasing blood glucose Decreasing Insulin Resistance Lowering Triglycerides Lowering Cholesterol Improves Fibrinolyric Defects Vasculature is benefited
Contraindications for Metformin usage?
When Creatinine is Greater than 1.4/1.5 (Female/Male)
This indicated Renal Failure, Heart Failure or Liver Failure
Phenoformin
Similar Drug to Metformin
Why isn’t phenoformin not more commonly used?
Issues with Mitochondria causing a decrease in ATP production
Benefit of sulfonylurea
CHEAP
Effects of Sulfonylurea:
Hypoglycemia
Weight Gain
Doesn’t last very long
Sulfonylurea is commonly used in conjunction with what medication for effective DM II treatment?
Metformin (based off the lecture)
What is the primary function of TZD (Thaiazolidinediones)?
Improves Fat Metabolism
Why does TZD work for DM II
Increased metabolism of fat will cause glucose to go down because fat makes the body insulin resistant, and fat can get into the muscles and liver.
Benefits of TZD?
Reduced rate of MI and stroke. Reduces NASH (fatty liver)
When is TZD most commonly used?
Prediabetics to prevent DM onset
Side Effects of TZD
Weight Gain
Water Retention in CHF
Bone loss in females
Bladder Cancer in Males
What is the GLP-1 Receptor?
Receptor on the B-cells in the Pancreas
Causes the Beta Cells to make more Insulin (via boost of cAMP)
When does GLP-1 Receptor not work?
When the blood sugars are low.
Won’t activate Beta Cells to make more insulin, so you won’t go into hypoglycemic effects.
GLP-1 Receptor Medications are commonly used in conjunction with
Metformin (but also used with long-acting insulin)
GLP-1 Receptor Meds are limiting because
Expensive
Side Effects of GLP-1 Receptor Meds
Nausea
Pancreatitis
C-Cell Hyperplasia
GLP-1 Receptor Drugs
Exenatide (Byetta)
Januvia
Liraglutide
What does Exenatide (Byetta) do?
Stimulated GLP-1 and Deactivates the degradation of proteins
What does Januvia do?
Inhibits the degradation enzyme of GLP-1
