Endocrine Meds: diabetes Flashcards
Explain how insulin resistance can be detected
When the insulin resistance happens, the serum insulin level becomes elevated.
But cells can’t use insulin to absorb glucose, so blood sugar rises and rises.
***high plasma glucose will damage your microvascular circulation
Identify the duct that connects the liver, gallbladder, and pancreas
Common bile duct
Recall the exocrine function of the pancreas
Secretion of pancreatic juices (digestive enzymes & bicarbonate) into common bile duct
**Review
CCK –> acinar cells –> enzymes
secretin –> duct cells –> bicarbonate
List the digestive enzymes produced by the pancreas for digestion
Pancreatic lipase (tri –> mono & 2 FA)
Pancreatic amylase
Recall the endocrine function of the pancreas
Secrete hormones right into the BLOODSTREAM
** islets of Langerhans: alpha cells and beta cells
Recall the endocrine hormones produced by the pancreas
Glucagon
Insulin
Differentiate between type 1 and type 2 diabetes
Type 1 has NO INSULINE –> insulin replacement is necessary (no oral medications, only sub Q)
Type 2 has insulin resistance
Discuss the differences in the monitoring and management of type 1 versus type 2 diabetes
Type 1: always requires frequent blood sugar monitoring and insulin titration
Type 2: patients start off by taking oral meds + when panaceas tire out, they start insulin therapy
Treatment depends on the progression of disease
Name the biggest risk for diabetic patients who receives insulin therapy
Hypoglycemia
Brain & rest of the body loses the source of fuel!
List the signs and symptoms of hypoglycemia
CNS: headache, confusion, seizures, coma
Cardiovascular: palpitations (due to increased SNS activity)
GI: nausea
Others: sweating and tremor
What would happen if a patient is on beta blocker & receives too much insulin?
You will not see a fast heart rate. When plasma glucose is <50, the patient may show confusion and neuro changes
–> remind them to watch their blood sugar closely!!!
Determine how to treat mild-to-moderate hypoglycemia
Give carbohydrate-rich food if patient is able to swallow
Determine how to treat severe hypoglycemia
Administer IV glucose (hospital)
Give subQ glucagon (at home, facilitate glycogen breakdown in the liver, may take 20 min to kick in)
List 3 factors/drugs that exacerbate hypoglycemia
- Beta blockers (BB blocks SNS response, inhibits hepatic glu production)
- Sulfonylureas & meglitinides (anti-diabetic meds that insulin release from pancreas)
- alcohol (consumption stimulates insulin release)
What 3 factors/drugs will put a patient on the risk of elevated sugar
- Thiazide diuretics
- Glucocorticoids
- Sympathomimetics (epinephrine, norepinephrine, etc.)
Identify 2 major routes for anti-diabetic medications
- oral drugs
- non-insulin injectable drugs
**Overview: list the first 4 groups oral anti-diabetic medications
- Biguanides: metformin
- 2nd-gen sulfonylureas: glipizide, glyburide
- Meglitinides (Glinides): nateglinide, repaglinide
- Thiazolidinediones (Glitazones): pioglitazone, rosiglitazone
**Overview: list the next 3 groups of oral antidiabetic medications
- Alpha-Glucosidase inhibitors: acarbose, miglitol
- DPP-4 inhibitors (Gliptins): Linagliptin, saxagliptin
- Dopamine agonist: bromocriptine
Describe the mechanism of action of metformin (guanides)
Increase glucose uptake by muscles & decrease glucose production by liver
–> lower blood sugar!
prescribed as the first step of treatment
lifestyle modifications + metformin
Two common side effects of metformin
- GI distress
- rare metabolic acidosis
List 3 drugs that can cause lactic acidosis with metformin
- cimetidine (other H2 antagonists are fine!)
- alcohol
- iodine based radiocontrast dye (discontinue metformin 1-2 days before the test)
–> combined with metformin, it knocks down kidney and causes metabolic acidosis!
Identify 3 early signs of lactic acidosis
- unusual drowsiness
- hyperventilation (breathing faster to breath CO2 out)
- myalgia
Describe the mechanism of action of the 2nd gen sulfonylureas
Sulfonylureas increase insulin release from the pancreas
List 2 examples of the 2nd-generation sulfonylureas
glipizide
glyburide
