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2060 Pharmacology > Module 15 Diabetes > Flashcards

Module 15 Diabetes Flashcards

1
Q

Diabetes Symptoms

A
  • Polyuria, increased urination
  • Polydipsia, increased thrust
  • Polyphagia, increased hunger
  • Weight loss
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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)
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3
Q

Glucose in Muscle Cells

A
  • Used as energy
  • Promotes protein synthesis
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4
Q

Glucose in Fat Cells

A
  • Synthesis of fatty acids
  • Triglyceride synthesis
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5
Q

Type I Diabetes

A
  • Diagnosed in children/adolescents
  • Autoimmune reaction
  • Immune cells destroy insulin beta cells
  • Too little/no insulin production
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6
Q

Type II Diabetes

A
  • Body resistant to insulin
  • Decreased insulin synthesis
  • Obesity/overweight influence
  • Most common type
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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
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8
Q

Diabetic Retinopathy

A
  • Common cause of blindness
  • Hyperglycemia causes retinal capillary damage
  • Control blood sugar to minimize risk
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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
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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
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11
Q

Foot Ulcers

A
  • Main cause of hospitalization for diabetes patients
  • 50% of lower limb amputations
  • Regular foot exams
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12
Q

Fasting Plasma Glucose Test

A
  • Fast for 8 hours prior
  • Blood sample taken to measure blood glucose
  • Preferred testing method
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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
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14
Q

Casual Blood Glucose Test

A
  • Blood drawn regardless of last meal time
  • Exhibiting polyuria, polydipsia, weight loss
  • Followed up with fasting test
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15
Q

Diet Goals for Type I

A
  • Maintain weight
  • Meals 4-5 hrs apart
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16
Q

Exercise Goals for Type I

A
  • Increases response to insulin & glucose tolerance
  • Encourage exercise
  • Strenuous exercise may cause hypoglycemia
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17
Q

Insulin Admin for Type I

A
  • Required for survival
  • Measure blood glucose 3+ times/day
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18
Q

Diet Goals for Type II

A
  • Caloric restriction
  • Normalize insulin release
  • Decrease insulin resistance
  • Losing weight (majority of patients obese)
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19
Q

Exercise Goals for Type II

A
  • Encourage physical activity
  • Stimulates glucose uptake
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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)
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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

2060 Pharmacology (18 decks)

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