lecture 9 Flashcards
what are some of the signs of diabetes?
frequent urination, increased thirst, hunger and tiredness
complications of diabetes?
stroke, heart attack, kidney disease, eye disease, and nerve damage
3 things used to diagnose diabetes?
fasting plasma glucose test, oral glucose tolerance test and measurement of glycated hemoglobin test
explain type 1 diabeties
beta cells produce no insulin. insulin dependent
explain diabetes 2
don’t produce enough insulin, insulin resistant. related to obesity
Lisper, aspart, and glulisine have what type of time action?
fast acting
detemir and glargine have what type of time action?
slow (basal)
two functions of insulin?
allow glucose to come into the cell and to inhibit glucose production from pyruvate in the liver
what is glitazone?
insulin sensitizer
what is metformin?
insulin sensitizer
what is a good drug for combination therapy with other drugs?
metformin
metformin acts upon what?
AMPK
NAME 4 THINGS METFORMIN DOES DEALING WITH LIPID METABOLISM?
decrease Acetyl coa carboxylase, increase FA transport to mitochondria, increase FA oxidation, decrease lipolysis
name 4 things metformin does to glucose metabolism?
increase glut 4, increase ate production, increase glycogen synthesis and decrease gluconeogenesis
contraindications for metformin?
type 1 dm, renal failure, liver failure, congestive heart failure
side effects of metformin?
GI cramping, okay with food. lactic acidosis risk
pioflitazone and rosiglitazone (TZD) are what?
sensitizers
pioglitazone good for people what what?
renal insufficiency
problem when pioglitazone?
delayed action: onset 3 weeks, full effect 10-12 wks
side effects of pioglitazone
weight gain, liver function abnormalities ( ALT), fluid retention, anemia and fractures of long bones in women.
rosiglitazone may cause what? and should be avoided for patients with what?
angina, or MI. ischemic heart diseases
contraindications for pioglitazone?
type 1 DM, prego, liver disease, anyone younger than 18.
sulfonyllureas and glinides are what
insulin secreters
glucagon like peptide incretins are what
secretors
glimepiride, glipizide, glyburide are all what
sulfonylureas
disadvantages to sulfonylureas
hypoglycemia, weight gain, secondary failure due to gradual loss of beta cels common
contraindications to sulf
type 1 dm, allergy, hyperemia in older its, cautious for woman
name some of the effects of incretin?
secreted from GI, decrease appetite, decrease gastric emptying, increases insulin release
DPP-4 inhibitors are what
secretors
DPP-4 enzymes usually do what?
decrease GLP-1 enzymes which normally would increase glucose
Sitaglipin (Januvia®), Saxagliptin (Onglyza®), Linagliptin (Tradjenta®) Alogliptin (Nesina®) are what
DPP inhibitors
DPP-4 inhibitors used in mono therapy for what
diet and exercise
DPP-4 inhibitors used in combination therapy with what?
metformin, TZD, SU or SU +met and now insulin
DPP4 inhibitor should NOT be used for what 2 things?
type 1DM, and for treatment of diabetes ketoacidoses
side effects of Gpp4 inhibitor?
few side effects- but GI adverse reactions
eventide is what
GLP1 analog
adverse effects of exentide
nausea and vommiting, not recommended for renal failure. hypoglycemia only with SU
alpha glucosidase inhibitors do what?
limit glucose influx from gut. competitive inhibition of hydrolytic enzymes in git, delay and prolong glucose absorption.
acarbose and miglitol (Precose® and Glyset®) are what
alpha glucosidase inhibitors
side effects of alpha glucosidase inhibitors?
diarrhea and flatulence
Canagliflozin and Dapagliflozin are what?
SGLT-2 inhibitors
SGLT-2 inhibitors DO WHAT
decrease renal threshold for urinary excretion of glucose, diuretic effect, lower blood pressure, contribute to weight loss, risk of bladder infections
what decreases glucose production?
glitazones
what decreases glucose absorption?
acarbose (alpha glucosidase inhibitors)
what increases insulin production?
SU, GLP1, and DPP4 inhibitors
what increase peripheral glucose utilization?
glitazones
what increase glucose excretion
SGLT2 inhibitors= canagliflozin
4 steps of type 2 diabetes treatment?
diet and exercise, mono therapy, combination oral agents, and insulin
mono therapy is treated with what
metformin and life style
combination agents treated with what
metformin + SU, TZD GLP1 analogies or DPP4 inhibitots
insulin stage treated with what
insulin and everything from combination stage
