Exam 2 Study Guide Diabetes

Question 1

What is Diabetes?

Answer 1

Relative or absolute deficiency of insulin causing glucose intolerance.

Fasting sugar >126 mg/dL
75gm glucose tolerance test: >200mg/dL after 2 hours
hb1Ac >6.5%

Question 2

What are diabetes statistics?

Answer 2

8-9% of US population
73000 die per year
about 50% undiagnosed
14% of population is prediabetic

Question 3

What are the functions of insulin?

Answer 3

Promote glucose and amino acids through membrane of all muscle cells, fibroblasts, FAT cells.

*anabolic hormone

Question 4

Insulin doesn’t affect glucose reuptake in…

Answer 4

neurons
kidney
RBC’s

Question 5

insulin and C-peptide are secreted from B cells in pancreas in response to …

Answer 5

Glucose

Question 6

Consequences of Diabetes….

Answer 6

• Increased lipolysis = blood ketosis and increase triglycerides
• Increased glycogenolysis and gluconeogenesis
• anabolic effect (Muscle wasting)

Question 7

Type 1 diabetes is found in

Answer 7

in young patients who lose islet beta cells

Question 8

Characteristics of Type 1 Diabetes…

Answer 8

No insulin
loss of beta cells from autoimmunity (virus)
Ketoacidosis

Question 9

Characteristics of Type 2 Diabetes

Answer 9

Insulin resistant
Excessive Visceral fat
Older (starting to see more younger)
minimal ketoacidosis but high glucose
Indians, hispanics, and african-americans = higher risk

Question 10

Type II diabetes is also known as a …

Answer 10

Metabolic Syndrome (X)

(a group of risk factors that increase chance of heart disease, diabetes, and stroke

Question 11

What is the pathogenesis of Type II Diabetes?

Answer 11

Visceral fat
impaired glucose metabolism and insulin sensitivity
Hepatic inflammation and cirrhosis

Question 12

Major metabolic complications of Type II…

Answer 12

Very high glucose
Hyperosmolar consequences (Coma)
Brain Swelling

Question 13

What is Gestational Diabetes?

Answer 13

diabetes in pregnant women due to dress of pregnancy

3-10%

Question 14

Consequences of Gestational Diabetes…

Answer 14

• insufficient placental function
• abnormally large babies w/ excessive insulin secretion and early hypoglycemia causing malformations.
• can become Type II later in life

Question 15

What are the 4 oral problems of diabetics?

Answer 15

Gingivitis and Periodontitis
Poor wound healing
Abnormal infections (Candidiasis)
Xerostomia

*make sure patients avoid hypoglycemia.

Question 16

What treatment is used for Type 1 and advanced Type II?

Answer 16

Insulin replacement therapy

try to replicate natural insulin patterns

Question 17

What is the most common dose of Insulin?

Answer 17

U-100

Question 18

Insulin can be obtained by which 2 ways?

Answer 18

Genetically modified e-coli. (Humulin)

or cow and pigs for special cases

Question 19

What are the different types of insulin?

Answer 19

Rapid acting
Short acting
NPH (natural protein hagedorn)
Insulin Glargine
Insulin determir

Question 20

What is characteristic of Rapid acting insulin?

Answer 20

• Rapid onset, early peak onset, 4 hour duration

- Taken immediately before a meal

Question 21

What is an example of Rapid acting insulin?

Answer 21

Lispro (Humalog)

Question 22

What is characteristic of Short acting insulin?

Answer 22

• Crystalline zinc helps to delay onset and lengthen duration
• 30 min onset, peaks 2-3 hours, lasts 5-8 hours

Question 23

What is characteristic of NPH insulin?

Answer 23

• immediate acting
• delayed absorption and onset (linked peptide protamine)
• Onset 2-5 hours
• Duration 4-12 hours
• often mixed with other insulins for immediate and sustained needs

Question 24

What is characteristic of glargine insulin?

Answer 24

Long acting sustained insulin

good background insulin

Question 25

What is characteristic of determir insulin?

Answer 25

Long acting

Background insulin

Question 26

What are the two means of insulin delivery?

Answer 26

S.c. Injection

Continuous S.c. infusion (pump)

Question 27

Side effects of Insulin…

Answer 27

-Hypoglycemia
  Tachycardia
  Perspiration
  Tremors
  Hunger
  Confusion
  Seizures
  Coma

-Local irritation and subdermal atrophy

Question 28

What are hypoglycemic drugs for Type II DM?

Answer 28

Insulin Secretagogues
Biguanides
DPP 4 Inhibitor/Stigaliptin

Question 29

How do insulin secretagogues work?

Answer 29

Increase the release of insulin from beta cells

Question 30

What are examples of insulin secretagogues?

Answer 30

Sulfonylureas

• Tolbutamide (Orinase)
• glipizide
• glitinides (Prandin)

Question 31

What are side effects of insulin secretagogues?

Answer 31

hypoglycemia and weight gain

bind to plasma proteins and can be dislodged by other drugs binding at the same sites

Question 32

How do Biguanides work?

Answer 32

not fully understood; decreases glucose production in the liver and increases efficiency of insulin binding.

Question 33

What are examples of Biguanides?

Answer 33

Mefromin-Glucophage

Question 34

Benefits of Metformin…

Answer 34

Insulin sparing (no hypoglycemia)
May prevent CVS effects of type II DM

Question 35

Side effect of Biguanides…

Answer 35

Gi irritation

Question 36

How do DPP-4 inhibitors work?

Answer 36

Slows the inactivation of incretin hormones which in turn, through glucose-dependent insulin tropic polypeptide (GIP) and glucagon like peptide-1, stimulates insulin synthesis and release.

*Increases storage of glucose and reduces glucagon activity leading to reduced hepatic glucose production and release.

Question 37

What is and example of a DPP-4 Inhibitor?

Answer 37

sitagliptin (Januvia)

Question 38

What does Acabose do to treat T II DM?

Answer 38

• slows digestion and absorption of starch, disaccharides from small intestines
• may help prevent Type II DM

*GI irritation (Bloating)

Question 39

What do Thiazolidinediones such as rosiglitazone do to treat Type II DM?

Answer 39

Reduces insulin resistance (especially fat and muscle cells)

Question 40

How does glucagon treat Type II DM?

Answer 40

It increases gluconeogenesis.

*produced in alpha cells of pancreas