Lecture 6 Flashcards
1
Q
Diabetes
A
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
2
Q
Symptoms - undiagnosed or poorly managed
A
- Type 1: Unusual weight loss
- Type 2: Tingling, pain, or numbness in the hands/feet * nerve problem
3
Q
Diagnosis - Hemoglobin A1C
A
- Average blood glucose level over the last 2-3 months
- Does not require fasting
- Once diagnosed: target A1C is less than 7%
- Normal: less than 5.7%
- Prediabetes: 5.7 - 6.5%
- Diabetes: greater than 6.5%
4
Q
Random Plasma Glucose Test
A
- Diabetes: greater than 200 mg/dL
- Performed without regard to timing
- Also called casual plasma glucose test
5
Q
Hypoglycemia
A
- low level of glucose
- can be no symptoms: Hypoglycemia unawareness
6
Q
Hyperglycemia
A
- High levels of glucose in the urine
- Excessive urinary frequency (polyuria)
- Excessive thirst (polydipsia)
- Fruity-smelling breath
7
Q
Insulin
A
- Facilitates the movement of glucose out of the bloodstream and into the liver
- Transport system to move the glucose molecule into skeletal muscle
- Promotes storage of protein and lipid
- Disturbances in insulin function affect storage
8
Q
Glucagon
A
- Hormonal antagonist to insulin
- Increases blood glucose to maintain normal levels and prevent hypoglycemia
- Rapid increase in glycogen breakdown in the liver
- prolonged increase in glucose production
9
Q
Control of insulin and glucagon release
A
- Tightly control between too much and not enough blood glucose
10
Q
Exogenous insulin
A
- used in both type 1 and type 2 diabetes
- Rapid acting: immediately before or after a meal
- subcutaneous injection
- Intermediate or long acting: can be daily
- Biphasic option
- IV in emergency situations
- Inhaled version
11
Q
Insulin pump
A
- a pump delivers insulin to the body through a thin, flexible tube called an infusion set
12
Q
Adverse effects of insulin therapy
A
- Hypoglycemia
- Symptoms worsen with lower blood sugar
- May lead to loss of consciousness, convulsions, and death
- Allergies and resistance: Pulmonary symptoms and skin reactions
13
Q
Glucose tablets are used for?
A
- hypoglycemia
14
Q
Immune based therapies
A
- imab/umad endings
- IV infusions or shots
- Body can build antibodies to them
- Serious side effects profiles
15
Q
TZIELD
A
- delay the onset of Stage 3 type 1 diabetes
- For adults and children 8 years of age and older who have Stage 2 type 1 diabetes
- for people who have tested positive for 2 or more type 1 diabetes - related autoantibodies, have abnormal blood sugar levels, do not have type 2 diabetes
16
Q
Drugs that stimulate insulin secretion and supply
A
- Sulfonylureas
- Meglitinides
- Incretion based therapies: GLP -1 receptor agonists, DPP - 4 inhibitors
17
Q
Insulin sensitizers
A
- Biguanides: Metformin
- Thiazolidinediones
18
Q
Other agents used in type 2 diabetes
A
- Alpha-glucosidase inhibitors
- Amylin analogs
- Bile acid sequestrants
19
Q
Sulfonylureas
A
- act directly on pancreatic beta cells and stimulate the release of insulin
- inhibits glucose production in the liver
- Best in early stages of the disease
20
Q
Meglitinides
A
- Directly increase the release of insulin from pancreatic beta cells
21
Q
Incretion based therapies - GLP - 1 receptor agonists
A
- sensitize pancreatic beta cells
- greater amount of insulin released when there is a rise in blood glucose
22
Q
Incretion based therapies - DPP - 4 inhibitors
A
- prolong the effects of endogenous incretions
- Increase the beneficial effects of these hormones on insulin release / glucose metabolism
23
Q
Metformin (glucophage)
A
- acts on the liver to inhibit glucose production
- increases the sensitivity of peripheral tissues to insulin
- Cornerstone of diabetes management
- Can cause GI problems
- Rare side effect: lactic acidosis ( confusion, lethargy, shallow/rapid breathing, tachycardia)
24
Q
Thiazolidinediones (glitazones)
A
- Decrease glucose production
- Increases the sensitivity of peripheral tissues to insulin
- take several months to take maximum effect
- More side effects: hepatotoxicity, lactic acidosis, edema, weight gain, fractures
- Rosiglitazone ( Avandia)
- Pioglitazone (Actos)
25
Alpha-glucosidase inhibitors
- inhibit enzymes that break down sugars in the GI tract
- delays glucose absorption
26
Amylin analogs
- Suppress glucagon secretion
- Delay gastric emptying
- Increase satiety
27
Bile acid sequestracts
- binds to bile and glucose in the GI tract
- limits glucose absorption
28
Non-pharmacological diabetes interventions
- Weight loss
- Diet strategies
- Exercise
- Tissue transplants
- Gene therapy
- Supplementation
29
What can exercise do?
- creates an insulin-like effect and change blood glucose levels
30
Ideal blood glucose level
- between 70 to 180 mg/dL
31
Exercise contraindicated over
- 240 mg/dL
32
What structure senses levels of TSH (thyroid stimulating hormone) in the bloodstream?
- Hypothalamus
* Pituitary gland releases TSH
33
Thyroid
- T3, T4, & Calcitonin levels
34
Parathyroid
- Calcium regulation
35
Treatment of hyperthyroidism
- Drug that attenuates the synthesis and effects of thyroid hormone
- Antithyroid drugs: inhibit thyroid hormone synthesis
- Iodide: inhibits steps involved in thyroid hormone synthesis
- Radioactive iodine: selectively destroys thyroid tissues
- Beta blockers: treats cardiovascular side effects
36
Treatment of hypothyroidism
- Thyroid hormone replacement
- T4 Levothyroxine (Synthroid)
- T3
- Combinations of T3 and T4 (Armour thyroid)
37
Parathyroid
- Calcium regulation
- can be affected by autoimmune disease
- Hypercalcemia: constipation, bone pain, kidney stones, fatigue, depression
38
Drugs that regulate bone mineral homeostasis
- Vitamin D: increases absorption of calcium and phosphate
- Biphosphonates
- Calcitonin: helpful adjunct to other treatments
- Estrogen therapy: Increases bone mineral content & reduces fracture risk in postmenopausal people
39
Biphosphonates
- Primary treatment for osteoporosis
- Alendronate ( Fosamax), Pamidronate ( Aredia)
- Absorb calcium crystals in the bone and reduce bone resorption by inhibiting osteoclast activity
- Increases bone mineral density
- reduces risk of fractures
- Some increased risk of osteonecrosis of the jaw
40
If calcium levels too high
- Thyroid releases CALCITONIN
- Increase calcium deposition in bones
- Decrease calcium uptake in intestines
- Decrease calcium reabsorption from urine
41
If calcium levels too low
- Parathyroid releases PTH
- Increases calcium release from bones
- Increase calcium uptake in intestines
- Increase calcium reabsorption from urine
