Insulin and Oral Hypoglycemic Agents Flashcards
Key cell types of endocrine pancreas and secretions
alpha cell - glucagon
beta cell - insulin and amylin
What type of hormone is insulin?
peptide hormone - ORAL ADMINISTRATION NOT POSSIBLE
binds on the surface of cells
Regulation of insulin release
+ - glucose, amino acids, incretins, Epi/Beta-2, Vagus stimulation
(-) –> NE/Alpha-2)
ATP builds up, activates Potassium channel which leads to depolarization and ACTIVATION OF CALCIUM CHANNEL
CALCIUM IS ULTIMATELY WHAT CAUSES INSULIN RELASE
Which glucose transporter is regulated by insulin?
where are these transporters located?
GLUT-4
muscle and adipose tissue
Metabolic processes associated with lack of insulin
glycogeneolysis
glycolysis
ketogenesis
Type I Diabetes Symptoms (name some)
Polyuria/nocturnal enuresis thirst blurred vision weight loss/polyphagia weakness/dizziness parasthesias loss of consciousness
Type II Diabetes Symptoms (name some)
Asypmtomatic initially Infection Neuropathy Obesity and Metabolic Syndrome Classic severe insulin deficiency signs
Normal Fasting Glucose
Diabetes
100 or Less, up to 140ish with a meal
Greater than 126, 110 to 125 is pre-diabetes
Most common route of admin of insulin
SCI
others are IV and IM
Rapid acting insulin
what is the effect of the amino acid substitution?
duration of action?
Insulin lispro
INsulin aspart
INsuline glulisine
Inhaled insulin
substitution to PREVENT COMPLEX FORMATION
3 to 5 hours
Short acting insulin
duration of action?
Regular insulin
4 to 12 hours
Intermediate acting insulin
duration of action
NPH
10 to 20 hours
Long acting insulin
duration of action?
Glargine
Detemir
12 to 20 and 22 to 24 hrs respectively
What type of insulin is better for meals? What is better for basal levels of insulin?
Short acting for meals
Long acting for basal level maintenance
Adverse effects of insulin
hypoglycemia hypersensitivity resistance lipohypertrophy lipoatrophy
Treatment for hypoglycemia
glucose or glucagon
Biguanides (1)
MOA
Adverse
Metformin
DECREASES HEPATIC GLUCOSE OUTPUT, increases peripheral glucose utilization
GI disturbances, B12 deficiency
Sulfonylureas (3)
MOA
Adverse
Glimepiride, Glipizide, Glyburide
inhibition of ATP-sensitive potassium channel on B cell - resulting in INSULIN RELEASE
weight gain, hypoglycemia
Meglitinides (2)
MOA
Adverse
Repaglinide, Nateglinide
inhibition of ATP-sensitive potassium channel on B cell - resulting in INSULIN RELEASE
weight gain, hypoglycemia
Glucosidase inhibitors (2)
MOA
ADverse
contraindications
Acarbose, Miglitol
INHIBIT BRUSH BORDER GLUCOSIDASE and subsequent absorption of glucose
abd pain, diarrhea, flatulence
contraindicated in GI diease
Thiazolidinediones (TZD’s) (2)
MOA
ADverse
Pioglitazone, Rosiglitazone
decrease peripheral resistance by ACTIVATING PPAR-GAMMA AND INCREASING GLUT-4 RECEPTOR LEVELS
peripheral edema, weight gain, hepatotoxicity, fractures, hypoglycemia, CV
Amylinomimetic (1), admin? target organ?
MOA
Adverse
Pramlintide, must be injected, LIVER
inhibits glucagon release, inhibits gastric emptying, anoretic
nausea, vomiting, anorexia, hypoglycemia, delayed drug absorption
Incretins (2) - organ target?
MOA
major adverse effect
Exenatide, Liraglutide - target PANCREAS
potentiate insulin secretion
inhibit glucagon release
inhibit gastric emptying
anoretic
N,V, D, hypoglycemia, ACUTE PANCREATITIS
DPP Inhibitors (3)
MOA
ADVERSE (3)
Sitagliptin, Saxagliptin, Linagliptin - oral admin
inhibit INCRETIN DEGRADATION
ACUTE PANCREATITIS, HEMORRHAGIC OR NECROTIZING PANCREATITIS
