Endocrine Flashcards
How to treat DMI
Low sugar diet, insulin replacement
How to treat DM II
Weight loss, then metformin, then other agents
How to treat gestational diabetes
Diet modifications, exercise, insulin. NOT metformin
Three short acting insulins
Insulin aspart, insulin glulisine, insulin lispro
Bind insulin receptor (tyrosine kinase). Increase glucose stored as glycogen, increase synthesis of glycogen in muscle, protein synthesis and K intake.
Increases triglyceride storage in fat cells.
Short acting insulin
Given IV for DM I II and gestational. Can also be given for hyperkalemia. Causes hypoglycemia and weight gain.
Intermediate acting insulin
NPH
Long acting insulin
Glargine and detemir. Glargine is more stable
Metformin
A biguanide that increases glycolysis and decreases gluconeogenesis. Increases peripheral glucose uptake in states of insulin insensitivity.
Can be used in patients without islet function.
Metformin side effects
GI upset. Does not cause hypoglycemia. Can cause some weight loss
Most important side effect is lactic acidosis because it blocks the breakdown of lactate in liver. DO NOT USE in renal patients.
When not to use metformin
In renal patients
Sulfonylureas
and Mechanism
First generation: Tolbutamide, chlorpromamide
Second generation: Glyburide, Glimepiride, Glipizide
Close the ATP dependent K channel to depolarize the cell . Leads to Ca influx and release of insulin.
Requires some islet function so can’t use for DM1.
Sulfonylureas side effects
Risk of hypoglycemia increases with renal failure.
Disulfiram like reaction with tolbutamide/chlorpromamide.
Glitazones
Pioglitazone, rosiglitazone. Increase insulin sensitivity by binding to PPAR gamma.
Pioglitasone, rosiglitazone side effects
Hepatotoxicity, bone loss, heart failure.
Alpha glucosidase inhibitors
Acarbose, miglitol. Prevent breakdown of disaccharides. Side effects are basically like lactose intolerance.
