Hormones and Diabetes (Chapter 14) Flashcards
what are the two thyroid hormones ?
T3 triiodothyronine
T4 thyroxine
what effect do thyroid hormones have on basal metabolic rate ?
increase it
what effect do thyroid hormones have on protein synthesis and catabolism ?
increase both
what are the main symptoms of hyperthyroidism?
excitability, sweating, weight loss, nervousness, tremor
what are the main symptoms of hypothyroidism?
somnolence, muscular sluggishness, slow HR, increased weight
depressed growth of hair- hyper or hypothyroidism?
hypo
decreased blood volume and CO- hyper or hypothyroidism?
hypo
what are 4 reasons hyper or hypo-thyroidism may occur ?
autoimmunity
cancer
diet
bad genetics
how can autoimmunity cause hypothyroidism?
destruction of thyroid gland
how can autoimmunity cause hyperthyroidism?
errant stimulation of thyroid receptors (Grave’s disease)
how can cancer lead to hyperthyroidism?
tumor of thyroid gland
how can diet cause hypothyroidism
lack of iodine
what are goiters? in what disease do they occur ? what do they result in
large protrusions in neck, can occur from hyper or hypothyroidism. result in higher level of TSH activity
what kind of drugs treat hypothyroidism?
T3 and T4 drugs taken orally
usually T4 drug taken
what is the most popular drug given to treat hypothyroidism?
levothyroxine (T4)
how long does it take for a hypothyroidism drug to take effect
6-8 weeks
what kind of substances will decrease T4 absorption?
calcium, aluminum antacids
how drugs will enhance destruction of T3, T4 hormones ?
those that induce cytochrome p450
what are adverse effects of drugs against hypothyroidism?
similar to hyperthyroidism symptoms (nervousness, tachycardia, weight loss)
what are the 2 treatments for hyperthyroidism
destruction of thyroid gland by thyroidectomy or radioactive iodine (may become hypothyroid and need T4)
inhibit thyroid hormone synthesis with thioamide drug
what is the main goal of birth control ?
inhibit ovulation and fertilization
what are the two types of oral birth control?
combined oral contraceptive pill (estrogen and progestogen) OR progestogen-only.
what ingredient in high dosage is in the morning after pill ?
progestin
what are major adverse effects of birth control? (6)
breast fullness fluid retention depression headache nausea vomiting
who is contraindicated for birth control? (5)
people at risk of thrombosis estrogen-dependent cancer liver disease pregnancy heavy smokers over 35
what condition is common in menopause ?
estrogen deficiency
what is estrogen therapy for ?
estrogen deficiency in menopause
what are the adverse effects of estrogen therapy ?
although smaller doses than in birth control, same adverse effects
what drugs can stimulate estrogen receptors?
selective estrogen-receptor modulators can be agonists of antagonists of estrogen
used to treat various estrogen-related diseases
what are androgens ?
anabolic steroids with masculinizing effects
where are androgens produced ?
in testes or in ovaries
what are three examples of androgens from testes ?
testosterone, DHT, DHEA
what are 4 uses of androgens ?
therapeutic uses:
- males with hypogonadism
- osteoporosis
- endometriosis
non-therapeutic:
-cheating in sports
which androgen is an anti-ager that may increase performance
DHEA
what are adverse effects of androgens ?
heart disease, mood disorders, etc
what drug treats gigantism and acromegaly ?
somatomedin drug
what is a somatomedin drug ?
a formulation of a hormone that suppresses growth hormone
what are adverse effects of using growth hormone in the face ?
protrusion of jawbone and forehead
what are adverse effects of using growth hormone in the extremities ?
joint pain, carpal tunnel syndrome, continued growth of soft tissues
what drug do athletes use even though there is no adequate research showing that it can provide benefits ?
human growth hormone
gestational diabetes leads to which kind of diabetes ?
type II
what is the age of onset of type I diabetes ?
usually in 20s
which type of diabetes is insulin-dependent ?
type I
what proportion of the diabetes patients do type I patients represent ?
10%
what proportion of the diabetes patients do type II patients represent ?
90%
what is the age of onset of type II diabetes ?
usually 40s
which cells release insulin ?
the beta-islet cells of pancreas
what is the normal response to high blood glucose ?
high blood glucose
this is sensed by the beta cells in islets of Langerhans in pancreas
insulin is released and interacts with insulin receptors on tissues
insulin receptors cause glucose transporters to become active and glucose is uptaken into the tissue
what is the only tissue that glucose is not transported into with the help of insulin ?
brain
what is the effect of insulin on glycogen storage ?
insulin will cause the formation of glycogen in the liver
what is the effect of insulin on fat ?
insulin will increase fat storage
what is the fancy word for post-meal ?
post-prandial
insulin helps to maintain blood glucose at what fasting and post-meal level ?
fasting: <100mg/dL
post meal: <120mg/dL
what is the main thing insulin does in the blood ?
it gets rid of everything: glucose gets uptaken, amino acids get uptaken, and FFA get stored into fat
what is the pathophysiology of type I diabetes ?
the beta islets of the pancreas get damaged and destroyed by an autoimmune disease, and insulin is not produced at sufficient levels.
what explains the high level of peeing, as well as weight loss and hunger as a symptom in type I diabetes ?
the blood glucose rises and it cannot be used by tissues or stored as glycogen or fat because there is not enough insulin to facilitate that. therefore, it acts as a diuretic: the kidney starts excreting it in the urine. This causes a loss in calories meaning that the person loses weight and becomes hungry more often.
what explains diabetic ketosis ?
since the tissues can’t use glucose appropriately, they start using fat instead, which leads to an increase in ketoacids.
also, low insulin means the brain tricks itself into thinking there is low glucose. because of this, there is more gluconeogenesis and FFA are released to make ketoacids for the brain to utilize. this increases the blood glucose and contributes to ketosis, increasing the acidity of blood, and acetone is produced which produces a weird fruity smell.
what is the pathophysiology of type II diabetes, by stages?
insulin receptors do not work properly. islet cells may be working just fine.
the pancreas makes extra insulin because insulin isn’w working. this leads to insulin resistance in the tissues.
the disease develops, and over time the pancreas gets burnt out because it’s producing too much insulin, and stops working, therefore resembling type I diabetes.
at this point insulin injections are needed.
what type of diabetes does ketoacidosis happen in ?
only type I
what type of diabetes often goes undiagnosed for years ?
type II
what are the 4 hormones involved in diabetes ?
insulin
incretin
glucagon
amylin
what do incretins do ?
modulate insulin release, increase insulin release after eating, before blood glucose levels get elevated
what does glucagon do ?
its effect is opposite to insulin, and it works to raise blood glucose levels
what does amylin do ?
slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels.
what are cardiovascular long term implications of diabetes ?
hypertension, heart disease, stroke
what are musculoskeletal long term implications of diabetes ?
diminished sensation in hands and feet
amputation
foot infections
what are face long term implications of diabetes ?
retinopathy periodontal disease (gums)
what are the two causes of type I diabetes ?
environmental and genetic
what are the four causes of type II diabetes ?
genetic
obesity
sedentary lifestyle
old age
what are the four diagnostic tests for diabetes ?
glycosylated hemoglobin : HbA1c <7% is goal, indicative of plasma glucose concentration
fasting plasma glucose levels
two hour plasma glucose levels (after ingesting glucose)
symptoms of hyperglycemia
what are the three poly symptoms of uncontrolled diabetes ?
polyuria
polyphagia (increased appetite)
polydipsia (increased thirst)
what are the main non drug control of type II diabetes ?
diet and exercise
what is the dietary strategy for control of type II diabetes ?
control protein intake
lower saturated fat intake
reduce carbs, cholesterol
leave vitamins and minerals
why is exercise important in diabetes type II ?
improves glucose uptake by muscles and reduces risk of cardiovascular complications
what are the excluding factors for exercise in diabetes ?
neuropathy or retinopathy
can diabetics participate in sports ?
yes if they have good glycemic control
what is the rapid/short acting treatment for type I diabetes
intravenous injection of insulin, used for postprandial glycemic control, but injected before the meal
what kind of dose is the rapid/short acting treatment for type I ?
a “bolus” loading dose
what is the intermediate acting/long acting treatment for type I diabetes ?
subcutaneous injection
after meal
what kind of dose is the intermediate/long acting treatment for type I ?
maintenance dose
what is the major adverse effect of insulin injection ?
hypoglycemia
what is hypoglycemia in diabetes treatment due to usually ?
a calculation error or an unplanned change in diet and exercise
what 2 drugs can affect blood glucose and lead to hypoglycemia ?
beta blockers and alcohol which decrease glucose release from liver
what 3 drugs can cause hyperglycemia ?
corticosteroids, nasal decongestants, beta-agonists
what drugs are used for type II diabetes (general)
orally administered+ insulin sometimes
what do sulfonylureas do ?
increase insulin release from pancreas
what are sulfonylureas called ?
insulin secretagogues
what do glinides/meglitinides do ?
stimulate pancreas to release insulin
which type II oral drug has a shorter effect ?
glinides/meglitinides
what do biguanides do ?
reduce release of glucose from liver
what is an undesirable effect of biguanides ?
lactic acidosis
when does drug therapy commence in type II diabetes ?
after a person eats healthy for 3 months and blood glucose still unhealthy
what does the lab test for A1C show ?
avg glucose levels for past three months
what does a blood glucose monitor show ?
current glucose levels
what is the goal of treating type II diabetes ?
bringing A1C to 7% in 6-12 months
what should be blood glucose goals before meals and 2 hours after for 7% A1C in 6-12 months ?
before: 4-7 mmol/L
after: 5-10 mmol/L
what should be blood glucose goals before meals and 2 hours after for 6% A1C in 6-12 months ?
before: 4-6 mmol/L
after: 5-8 mmol/L
what are the advantages of biguanides ?
they don’t cause weight gain or hypoglycemia
what is an example of a biguanide ?
metaformin
what is an example of an insulin sensitizer ?
rosiglitazone
what do insulin sensitizers do ?
make tissue more able to use glucose
if blood glucose is very high, which two drugs will be combined and to what effect ?
insulin sensitizers with metamorfin (biguanide)
which will make tissue more able to use glucose and help liver decrease glucose production
do insulin sensitizers cause hypoglycemia ?
no
what are the two kind of insulin secretagogues ?
sulfonylureas and non-sulfonylureas
what drugs can cause hypoglycemia ?
alpha-glucosidase inhibitors
what is an example of an alpha-glucosidase inhibitor ?
prandase
what do alpha-glucosidase inhibitors do ?
prevent digestion of carbohydrates that are usually broken down into simple sugars that can increase blood sugar
what do anti obesity drugs help with in type II diabetes ?
decrease absorption of fat in intestine
what is an example of an anti-obesity drug ?
xenical
what is insulin used for in type I and type II
type I: insulin dependent for life
type II: used as needed, and in combination with pills
what is the goal of insulin regimen ?
to mimic insulin secretion in people without diabetes
what are some suggestions an AT may have for a diabetic (5)
write down medicines in schedule write down problems with therapy to discuss later medic alert bracelet exercise with friend take care of feet and have foot exams
what is crucial for good glycemic control in type I diabetes ?
insulin preparations
what are the 4 categories of insulin preparations ?
rapid, short acting, intermediate acting, and long acting
what are the properties of rapid acting insulin preparations ?
fastest onset and shortest duration of action
what are the properties of long acting insulin preparations ?
slowest onset and longest duration of action
what is the color, onset, peak, and duration of rapid acting insulin ?
clear
onset: 10-15 minutes
peak: 60-90 minutes
duration 4-5 hours
what is the color, onset, peak, and duration of short acting insulin ?
clear
onset: 0.5-1 hr
peak: 2-4
duration: 5-8
what is the color, onset, peak, and duration of intermediate acting insulin ?
cloudy
onset: 1-3 hrs
peak: 5-8
duration: up to 18
what is the color, onset, peak, and duration of long acting insulin ?
clear
onset: 90 min
peak: none/flat
duration: 24 hrs
why can’t insulin be given orally ?
because it is a polypeptide, so it would just get broken down into aminoacids in the stomach
what is basal or bolus insulin ?
bolus= for rapid-acting and short-acting insulin
A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used.
basal= for intermediate acting and long-acting insulin
The role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting.
what is premixed insulin?
a single vial that contains a fixed ratio of insulins with a combination of basal or bolus insulins
when is rapid-acting insulin taken ?
right before eating or to lower high blood glucose
what are two examples of rapid acting insulin ?
humalog (insulin lispro)
novorapid (insulin aspart)
when is short acting insulin taken ?
30 minutes before eating or to lower high blood glucose
what are two examples of short acting insulin ?
humulin
novolin
when is intermediate acting insulin taken ?
bedtime, or twice a day
give two examples of intermediate acting insulin ?
humulin
novolin
when is long acting insulin taken ?
once or twice a day
two examples of long acting insulin ?
lantus (insulin glargine)
levemir (insulin detemir)
3 examples of premixed insulin ingredients ?
humalog, humulin (more short acting) with novolin (intermediate acting) in different ratios
