Pharm Final: Diabetic Patient

Question 1

DMI vs. DMII

Answer 1

DMI: Insulin Dependent

• Insulin
• Adjunctive Therapies

DMII: non-insulin Dependent

• Exogenous Insulin
• Anti-diabetic Drugs
• Adjunctive Therapies

Question 2

How is diabetes defined?

Answer 2

A hereogenous group of syndromes characterized by an elevation of blood glucose and metabolic perturbation caused by a relative or absolute insulin deficiency.

Question 3

Insulin
Function:
Mechanism of Action:
Therapeutic Use:

Answer 3

Insulin
Function: decrease blood glucose

Mechanism of Action: stimulates peripheral glucose uptake + inhibits hepatic glucose production

Therapeutic Use: Type I and II DM, Hyperkalemia, diabetic coma

Question 4

Hypoglycemia
Symptoms:
Non-Pharm Management:
PT Implications:

Answer 4

Hypoglycemia

BG

Question 5

Thiazolindinediones
Indications:
MOA:

Answer 5

Thiazolindinediones
Indications: As adjunct to diet and exercise for Type II diabetes

MOA: increase insulin sensitivity by affecting PPAR-y (peroxisome proliferators-activated receptor) at adipose tissue, skeletal muscle, and in the liver

-no risk of hypoglycemia
effective in highly insulin-resistant patients

Side Effects: weight gain and edema

Question 6

Meformin
Uses:
MOA:

Answer 6

Meformin
Uses: Preferred agent for Type 2 diabetes.

MOA: Decreases endogenous hepatic production of glucose

-Decreases plasma insulin
-No risk of hypoglycemia
Well-established history of effectiveness. Weight loss may occur. Convenient daily dosing. Many contraindications. Monitor renal function.

Question 7

Adjunct Therapy in addition to Medical Managment

Answer 7

• Energy balance, diet, exercise: low carb, low fat, calorie restricted diet
• Cardiovascular Disease/Hypertension: reduce BP

Question 8

Exercise and DM
Use:
PT Implications

Answer 8

-Exercise has an insulin-type effect, reducing BG

• Be aware of the signs of hypoglycemia (confusion, fatigue, sweating, nausea)
• Inquire about insulin regime, BS prior to session.
• Delay session start for snack or insulin treatment if needed.
• Have source of glucose on-hand in clinic
• Instruct patient about how exercise can alter BG
• -Adjust insulin by reducing dose 15-30%