Insulin and Hypoglycemic Agents Flashcards
which glucose transport does insulin mediated uptake of glucose?
what tissues is it located in?
GLUT4
muscle and adipose tissue
what stimulates gluconeogenesis:
AA, glycerol, lactate –> glucose
glucagon (+)
insulin (-)
what stimulates glyogenesis
insulin
glucose –> glycogen
what stimulates glycogenolysis
glucagon
what stimulates glycolysis
insulin
glucose –> pyruvate
random blood gluocse concentration of ___ can indicate DM
200 mg/dL or above
fasting plasma glucose of ___ can indicate DM
126 mg/dL
2 h plasma glucose of ___ can indicate DM
A1c >_ ____
200 mg/dL
6.5%
how does the kinetics of insulin have less of a preferential effect on hepatic metabolism
diffusion into peripheral tissues rather than portal circulation
therapeutic goal of insulin therapy
fasting blood glucose 90-120 mg/dL
what insulin therapy has rapid action and short acting
insulins lispro, aspart, glulisine
is human regular insulin and technosphere inhaled insulin long or short acting
short
which insulin therapy has intermediate duration
human NPH
what insulin therapy has long acting duration
insulin glargine, detemir, degludec
what can cause lipohypertrophy as a SE in insulin therapy
fat deposition at injection site
what can cause lipoatrophy as a SE in insulin therapy
fat loss at injection site
what insulin therapy is associated with weight gain, which with weight loss
Long acting = weight gain
inhaled = weight loss
(+) regulation of insulin release
glucose
AA
incretins (Glp1)
Epi/B2-adrenergic stimulation
vagus stimulation
(-) regulation of insulin release
NE/alpha2-adrenergic stim
amylin
most common complication with insulin therapy is hypoglycemia. What are sx produced by ANS?
tachycardia
sweating
tremors
nausea
hunger
most common complication with insulin therapy is hypoglycemia. What are neuroglycopenic sx?
irritability
confusion
seizure
coma
death
tx of hypoglycemia
glucose or glucagon
administration of glucagon for hypoglycemia?
injected - b/c peptide
1st line agent for DM tx
metformin
key points of metformin (biguanides)
- does not produce hypoglycemia
- not dependent on beta cell fxn
MOA of metformin
decrease hepatic glucose output**
increase peripheral glucose utilization
Adverse effects of metformin
Diarrhea
N&V
which generation of sulfonylureas and meglitinides are most often used?
2nd generation - glimepiride, glipizide, glyburide
sulfonylureas
MOA of sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)
inhibition of ATP-sensitive potassium channel of beta cell, resulting in insulin release
Adverse effects of sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)
weight gain
GI
hypoglycemia
what are the glucosidase inhibitors
acarbose
miglitol
who is acarbose and miglitol contraindicated for?
pts with GI disease
if someone has hypoglycemia while on a glucosidase inhibitor how should it be treated
with oral glucose
what should glucosidase inhibitors be taken with
a meal
what are the oral antidiabetic agents
Metformin
sulfonylureas and meglitinides (glimepiride, glipizide, glyburide; repaglinide, nateglinide)
glucosidase inhibitors (acarbose, miglitol)
thiazolidinediones (pioglitazone, rosigllitazone)
MOA of pioglitazone and rosiglitazone
decrease peripheral resistance by activating peroxisome proliferator-activated receptor-gama
effect on glucose metabolism, insulin signaling
Adverse effects of pioglitazone and rosiglitazone (thiazolidinediones)
Cardiovascular (MI)
how is amylinomeimetic - pramlintide adminsistered
injected (synthetic peptide)
MOA of pramlintide (amylinomimetic)
inhibit glucagon release
inhibit gastric emptying
anoretic effect
what agents are incretins
exenatide**
liraglutide
how are incretins administered
injected
MOA of incretins (exenatide, liraglutide)
- potentiate insulin secretion
- inhibits glucagon release
- inhibits gastric emptying
- anorectic effect
SE of incretins
Nausea
hypoglycemia
what drugs are the dipeptidyl peptidase inhibitors
- inhibit incretin degradation
sitagliptin**
saxagliptin
linagliptin
how are DPP inhibitors administers (“-gliptin”)
oral
SE of DPP inhibitors (“-gliptin”)
Nasopharyngitis
URI
HA
what are the sodium glucose transporter 2 (SGLT2) inhibitors?
- inhibit renal glucose reabosroption
- canagliflozin**
- dapagliflozin
- empagliflozin
think “FLO” for excretion
SE of SGLT2 inhibitors?
(“-flozin”)
UTI
Hypotension
Hypoglycemia
which drug discussed can be used for both type I and type II
pramlinitide
