E1. Drugs acting on glucose metabolism Flashcards
Look at slides 3 – 10 review of glucose metabolism.
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What cells are involved in the making of insulin? A. Alpha cells B. Beta cells C. F cells D. Delta cells
B. Beta cells
What cells are involved in the making of glucagon? A. Alpha cells B. Beta cells C. F cells D. Delta cells
A. Alpha cells
What cells are responsible for somatostatin? A. Alpha cells B. Beta cells C. F cells D. Delta cells
D. Delta cells
What cells are responsible for pancreatic polypeptide? A. Alpha cells B. Beta cells C. F cells D. Delta cells
C. F cells
What can cause the stimulation of insulin secretion?
– Rise in blood glucose concentration – G.I. hormones: – – gastric, CCK, secretin, gastric inhibitory polypeptide, glucagon – amino acids and fatty acids in the GIT – vagal stimulation (M receptors) – – catcholamines (beta-2 receptors)
Whatcauses the inhibition of insulin secretion?
– decrease in blood glucose concentration
– somatostatin
– catecholamines (a2 or I3 receptors)
What happens if you have too much insulin?
Too little insulin?
Too much: hypoglycemia
too little: hyperglycemia
What are the differentials for hypoglycemia? (5 main, 4 of which have subs)
- artifact
- Unable to make glucose
– liver failure/cirrhosis
– Portosystemic shunt
– severe malnutrition (neonates/toy breeds)
– hyperadrenocorticism (pituitary/GH deficiency)
– glycogen storage diseases - Excessive consumption
– sepsis
– extreme exertion - Exogenous hypoglycemic agents
– insulin overdose
– overdose of other hypoglycemic agents (e.g.. glipizide) - Endogenous hypoglycemic agents
– xylitol toxicity (dogs)
– insulin secreting islet cells neoplasia (insulinoma)
– extrapancreatic neoplasia
– islet cell hyperplasia
What are the two main therapeutic considerations for hypoglycemia? (Gen.)
Not involving insulin, and involving insulin.
*Look at slide 13 for subcategories
What are the three main pharmacologic therapy for hypoglycemia?
– Replacement
– diet
–Anti-hypoglycemic agents
*look at slide 14 subcategories
Is glucagon commonly used to treat hypoglycemia? What’s the initial dilution you should start off with?
Not commonly used. Initial dose should be 50 ng/kg followed by 10 – 15 ng/kg/minute.
*adjust based on blood glucose measurement
What is the proper dose if using dextrose for an acute case or maintenance?
Acute: 1 mL/kg of 50% dextrose diluted (1:4)
maintenance:
- 2.5-5% dextrose IV
- Adjust based on blood glucose levels
*don’t want to use greater than 5% dextrose because greater than that will cause phlebitis.
What are some considerations you should take into account when using dextrose to treat hypoglycemia? (2)
– Hyperosmolality/irritation
– rising glucose stimulates insulin secretion
You use dietary management to treat acute and chronic hypoglycemia?
Acute: Karo syrup/corn syrup (mostly used outside of clinic, as good as dextrose in an emergency situation)
chronic: – frequent, small meals – complex carbs (symbol carbs may stimulate insulin secretion) – easily digestible – moderate fat and protein
How can use pharmacologic therapy to treat hypoglycemia?
What is the goal of this therapy?
– glucocorticoids
– Diazoxide
– Streptozotocin
– somatostatin
Goal is to eliminate/minimize clinical signs associated with hypoglycemia (this may not be maintaining a “normal” blood glucose!)
What is the DOC/ reached for first drug to treat hypoglycemia?
Glucocorticoids (prednisone, prednisolone)
What do glucocorticoids do to the gluconeogenesis, glucose uptake (in tissue), and glucagon secretion?
Increase gluconeogenesis, decreased glucose uptake into tissue, stimulate glucagon secretion
What is the bioavailability of glucocorticoids is taken orally?
Good oral bioavailability
Where does prednisone and prednisolone need to go to be activated? (Organ)
The liver/hepatic metabolism is required
What dose should you start off with when using prednisone or prednisolone?S
.5 mg/kg/day, increase as needed
What are the side effects of using prednisone or prednisolone?
Generally mild at low doses (PU/PD, panting) and get progressively more severe as this is increased (immunosuppression, etc.).
What are the drugs that can be used to treat hypoglycemia?
Diazoxide, somatostatin, octreotide (somatostatin analog), streptozotocin
How do you give Diazoxide?
When should you give this?
What are its side effects?
– Oral
– when glucocorticoids and diet longer work
– side effects:
paper celebration, anorexia/vomiting/diarrhea, less commonly (tachycardia, hematologic changes, diabetes, fluid retention)
look at slide 19 and 20 for more information. Slide 20 gives the mode of action.
