Module 15 Diabetes Flashcards
1
Q
Diabetes Symptoms
A
- Polyuria, increased urination
- Polydipsia, increased thrust
- Polyphagia, increased hunger
- Weight loss
2
Q
Insulin
A
- Peptide hormone
- Beta cells of pancreas islets
- Respond to increase in glucose levels
- Causes glucose uptake
- Muscle, liver, fat cells
- Results in glucose synthesis (storage)
3
Q
Glucose in Muscle Cells
A
- Used as energy
- Promotes protein synthesis
4
Q
Glucose in Fat Cells
A
- Synthesis of fatty acids
- Triglyceride synthesis
5
Q
Type I Diabetes
A
- Diagnosed in children/adolescents
- Autoimmune reaction
- Immune cells destroy insulin beta cells
- Too little/no insulin production
6
Q
Type II Diabetes
A
- Body resistant to insulin
- Decreased insulin synthesis
- Obesity/overweight influence
- Most common type
7
Q
Gestational Diabetes
A
- Begins midway through pregnancy
- Diet/exercise used to moderate
- Larger babies
- Born with hypoglycemia
- Blood sugar returns to normal after birth
8
Q
Diabetic Retinopathy
A
- Common cause of blindness
- Hyperglycemia causes retinal capillary damage
- Control blood sugar to minimize risk
9
Q
Diabetic Nephropathy
A
- Proteinuria (protein in urine)
- Decreased glomerular filtration
- Increased BP
- Main cause of death in type I patients
- ACE inhibitors/ARBs for prevention
10
Q
Cardiovascular Disease (CVD)
A
- Heart attack/stroke
- Main cause of death in type II patients
- Early development of atherosclerosis
- Hyperglycemia & lipid metabolism combo
- Stains reduce risk
11
Q
Foot Ulcers
A
- Main cause of hospitalization for diabetes patients
- 50% of lower limb amputations
- Regular foot exams
12
Q
Fasting Plasma Glucose Test
A
- Fast for 8 hours prior
- Blood sample taken to measure blood glucose
- Preferred testing method
13
Q
Oral Glucose Tolerence Test (OGTT)
A
- Used when other tests unable to diagnosis
- Oral dose 75g of glucose administered
- Plasma glucose measured 2 hrs after
14
Q
Casual Blood Glucose Test
A
- Blood drawn regardless of last meal time
- Exhibiting polyuria, polydipsia, weight loss
- Followed up with fasting test
15
Q
Diet Goals for Type I
A
- Maintain weight
- Meals 4-5 hrs apart
16
Q
Exercise Goals for Type I
A
- Increases response to insulin & glucose tolerance
- Encourage exercise
- Strenuous exercise may cause hypoglycemia
17
Q
Insulin Admin for Type I
A
- Required for survival
- Measure blood glucose 3+ times/day
18
Q
Diet Goals for Type II
A
- Caloric restriction
- Normalize insulin release
- Decrease insulin resistance
- Losing weight (majority of patients obese)
19
Q
Exercise Goals for Type II
A
- Encourage physical activity
- Stimulates glucose uptake
20
Q
Glycosylated Hemoglobin
A
- Index of average levels of past months
- Verify response to therapy
- Maintain <7% HbA1C total hemoglobin
- Prolong glucose exposure forms glycosylated derivatives (HbA1C)
21
Q
Metabolic Actions of Insulin
A
- Cellular uptake of glucose in liver, muscle, fat
- Formation of glycogen & triglycerides
- Decreased hepatic gluconeogenesis
- Cellular uptake of amino acids
- Increased protein synthesis
22
Q
Insulin Discovery
A
- Discovered by Fredrick Banting
- Prior to discovery patients died in 2-3 years
- Anabolic
- Promote energy storage & conservation
23
Q
Insulin Deficiency
A
- Catabolic
- Breakdown of complex molecules
- Raise blood glucose
24
Q
Catabolic Effects
A
- Glycogenolysis (glycogen to glucose)
- Gluconeogenesis (new synthesis)
- Decreased glucose use
25
Q
Short Duration Rapid Acting Insulin Classes
A
- Insulin lispro
- Insulin aspart
- Insulin glulisine
26
Q
Short Duration Rapid Acting Insulin Usage
A
- Administered in association with meals
- Control postprandial glucose rise (after eating)
- Subcutaneous route of admin
- Clear solution
27
Q
Short Duration Slow Acting Insulin
A
- Unmodified human insulin
- Subcutaneous admin prior to meal
- Control postprandial glucose rise
- Forms small aggregates to slow absorption
- Clear solution
28
Q
Intermediate Duration Insulin Classes
A
- Neutral protamine hormone (NPH)
- Insulin detemir
29
Q
Intermediate Duration Insulin Usage
A
- Delayed onset
- Subcutaneous injected 1/2 times daily
- Control blood glucose between meals
30
Q
NPH Insulin
A
- Conjugated protein (large)
- Less soluble due to protamine
- Decreases absorption
- Cloudy suspension
31
Q
Insulin Detemir
A
- Molecules bind to each other
- Delays absorption
- Clear solution
32
Q
Long Acting Insulin
A
- Insulin glargine
- Subcutaneous injection 1 per day at bedtime
- Low solubility at pH
- Forms microprecipitates, slowly dissolve
- Clear solution
33
Q
Mixing Insulins
A
- Short acting with longer duration
- Single syringe
34
Q
Insulin Mixing Rules
A
- Only NPH mixes with short acting
- Short acting into syringe first
35
Q
Insulin Therapy Complications (Rapid Decrease)
A
- Hypoglycemia (<3 mmol/L)
- SYN activation
- Tachycardia
- Palpitations
- Sweating
- Nervousness
- Coma
- Convulsions
- Death
36
Q
Insulin Therapy Complications (Gradual Decrease)
A
- CNS symptoms
- Headache
- Confusion
- Drowsiness
- Fatigue
37
Q
Hypoglycemia Management
A
- Prevent irreversible brain damage
- Fast acting oral sugar (conscious)
- IV glucose (unconscious)
- Hormone glucagon on hand
38
Q
Glucagon
A
- Produced by pancreas
- Conversion of glycogen to glucose
- Hypoglycemia treatment
- Used on unconscious patients
39
Q
Oral Antidiabetic Drugs
A
- Type II treatment
- Biguanides
- Sulfonylureas
- Meglitinides
- Thiazolidinediones (glitazones)
- Alpha-glucosidase inhibitors
- Gliptins
40
Q
Biguanides
A
- Increases number & sensitivity of insulin receptors
- Decrease hepatic gluconeogenesis
- Reduces intestinal glucose absorption
- No risk of hypoglycemia
41
Q
Adverse Effects of Biguanides
A
- Nausea
- Decreased appetite
- Diarrhea
- Decreased absorption of vit B12 & folic acid
- Lactic acidosis (rare but 50% fatality)
42
Q
Sulfonylureas
A
- Stimulate insulin release form pancreas
- Inhibit glycogenolysis
- 1st & 2nd generation
- 2nd gen more potent, less drug interactions
43
Q
Adverse Effects of Sulfonylureas
A
- Hypoglycemia
- Pancreatic burnout (prolonged use)
44
Q
Meglitinides
A
- Stimulate insulin release from pancreas
- Short half life
- Less likely to cause hypoglycemia
- Less likely to cause pancreatic burnout
- Effective treatment of postprandial rise
45
Q
Thiazolidinediones (Glitazones)
A
- Increase inulin sensitivity in target tissues
- Increase number of glucose transporters
- Decrease hepatic gluconeogenesis
- Activate PPARy receptor
- Activates carb metabolism regulation genes
- Increase HDL
- Decrease triglyceride levels
46
Q
Adverse Effects of Thiazolidinediones (Glitazones)
A
- Fluid retention (edema)
- Headache
- Myalgia
47
Q
Alpha-Glycosidase Inhibitors
A
- Delay carb absorption in intestine
- Block alpha-glucosidase enzyme (carb breakdown)
- Reduces postprandial rise
48
Q
Gliptins
A
- Inhibit dipeptidyl peptidase 4 enzyme (DPP-4)
- Breakdown of incretin hormones GLP-1 & GIP
- Increase insulin release
- Decrease glucagon release
49
Q
Adverse Effects of Alpha-Glycosidase Inhibitors
A
- Flatulence
- Cramps
- Abdominal distention
- Diarrhea
- Decreased iron absorption
50
Q
Incretin Mimetics
A
- Synthetic incretin analogs
- Mimic incretin hormone actions
- Increase insulin release
- Decrease glucagon release
- Subcutaneous admin
- Adjunctive with biguanides/sulfonylureas
51
Q
Adverse Effects of Incretin Mimetics
A
- Hypoglycemia
- Pancreatitis
51
Q
A
