Endo Pharm (2) Diabetes Flashcards by Retha Dawes

define Diabetes Mellitus

Chronic hyperglycemia caused by relative or absolute deficiency of insulin

OR… caused by a deficiency of insulin action = “insulin resistance”

How well did you know this?

Not at all

Perfectly

Type of diabetes that is an autoimmune disorder.

DM1
Rapid Beta Islet cell destruction

Trigger may be virus or toxin
Mumps, coxsackie B4 virus

How well did you know this?

Not at all

Perfectly

Type of diabetes that has a genetric predisposition and obesity

DM II

Gradual loss of beta islet cells (couple decades)

How well did you know this?

Not at all

Perfectly

Age for DM I onset

< 25

How well did you know this?

Not at all

Perfectly

Age for D II onset

> 25

How well did you know this?

Not at all

Perfectly

Complications of DM

Death from Ketoacidosis
CVD
and Opathies

How well did you know this?

Not at all

Perfectly

what are the 3 opathies of DM

Neuropathy
Nephropathy
Retinopathy

How well did you know this?

Not at all

Perfectly

Cells in the pancreas that produce insulin

Islets of Langerhans

How well did you know this?

Not at all

Perfectly

What do the Islets of Langerhans produce?

INSULIN
GLUCAGONE
Somatostain
Islet Amyloid
Polypeptide
Pancreatic Polypeptide

How well did you know this?

Not at all

Perfectly

Insulin Actions

Inhibits Catabolic (breakdown) actions
Inhibits glycogen breakdown
Inhibits aminoacids &amp; fatty acid breakdown into ketones

Anabolic Actions
Promotes glycogen production & storage
Promotes triglyceride synthesis

Effects on Muscle:
Promotes protein synthesis
Facilitates Glucose transport & Glycogen storage

Effects on Adipose Tissue:
Increased Triglyceride storage
Most efficient energy storage form

How well did you know this?

Not at all

Perfectly

Glucagon

EFFECTS ARE OPPOSITE OF INSULIN

Therefore, reducing glucagon secretion can be a diabetes treatment goal.

How well did you know this?

Not at all

Perfectly

Ketoacidosis

A serious diabetes complication where the body produces excess blood acids (ketones).

How well did you know this?

Not at all

Perfectly

Treatment goals of DM

Avoid Ketoacidosis, avoid hyperglycemia > 300

Reduce Long Term Complications

Reduce Hypoglycemic episodes

Prevent diabetes

How well did you know this?

Not at all

Perfectly

DM treatment strategies

Provide exogenous insulin
Make the most of endogenous insulin: reduce resistance (diet and meds)
Stimulate secretion of endogenous insulin
Reduce Glucagon secretion
Reduce glucose absorption from the GI tract
Increase urinary excretion of glucose

How well did you know this?

Not at all

Perfectly

Hypoglycemia

Adverse effect of insulin

symptoms:
reduced cognition
Sympathetic system response
tremors, anxiety, tachycardia, mydriasis

In severe cases: Coma, seizure, brain damage, death

How well did you know this?

Not at all

Perfectly

Amylin Analog

used with as an adjust with insulin to increase satiety.

How well did you know this?

Not at all

Perfectly

How do you increase insulin (med)

sulfonyluria

How well did you know this?

Not at all

Perfectly

Avoid use of sulfonylurias in this

hepatic and renal disease

drug interaction of 1st gen sulfonylurias

sulfa, warfarin increase effect

avoid use of 2nd generation sulfonylureas in?

Elderly and those with CVD
Glipizide
Glyburide
Glimepiride

Caution for all sulfonylureas

CONTRAINDICATED IN PATIENTS WITH HEPATIC IMPAIRMENT OR RENAL INSUFFICIENCY

meglitinies

increase insulin secretions (sulfonyureas also stimulate insulin)

some overlap with Sulfonylurea receptor

reduce insulin resistance how?

Weight loss
Biguanides: Metformin (glucophage)

Thiazolidinediones (Glitazones)
Rosiglitazone
Pioglitazone

Biguanide

Metformin (Glucophage)

Biguanide mode of action

reduce gluoconeogenesis (breakdown of glycogen) reduced insulin resistance

Biguanides side effects

May facilitate weight loss GI SIDE EFFECTS PREDOMINATE Nausea diarrhea bloating

Biguanides contraindications

Liver Disease Chronic Heart Disease Chronic Renal Disease

What vitamin can Biguanide effect?

B12

Biguanide caution

LACTIC ACIDOSIS POSSIBLE ESPECIALLY IN COPD, CHRONIC RENAL OR HEPATIC DISEASE

Thiazolidinediones: "Glitazones"

Enhanced tissue sensitivity to insulin Mode of action includes gene regulation slow onset of action Improves Lipid Profiles Monotherapy or in combination with: Sulfonylureas and Metformin

Glitazone warnings

ROSIGLITAZONE WITH 1.43 TIMES GEATER RESK FOR MYOCARDIAL INFARCTION THAN PLACEBO OR METFORMIN but... recent study of pioglitazone shows no MI risk but perhaps increase risk of CHF Fracture rate increased in women on rosiglitazone

Incretins

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism.

Incretin Mimetics

Glucagon-Like Peptide-1 secreted like the "L cells" of the intestine decreases glucagon secretion Increases insulin secretion responsible for "incretin effect" May increase pancreatic beta cell mass

GLP=1

reduces glucagon secretion

enzyme that metabolizes GLP-1

DPP-4

Use GLP-1 analog as adjunct to:

MAY FACILITATE WEIGHT LOSS

GLP-1 legal issues

Lawsuit underway claiming increased risk of: Pancreatitis Pancreatic Cancer

FDA Warning: DPP-IV inhibitors

SEVERE and DISABLING JOINT PAIN

Alpha-Glucosidase Inhibitors

Reduce Starch ad Disaccharide Absorption by competitive inhibition Take before meals

Side effects of Alpha-Glucosidase Inhibitors

GI Symptoms: Flatulence diarrhea bloating/abd pain

Gliflozins

enhance glucose secretion in urine

Gliflozin side effects

UTI's | vaginitis

FDA warnings gliflozin

INCREASED RISK OF KETACIDOSIS INCREASED RISK OF LIMB AMPUTATIONS but... they significantly reduce CV disease risks