Pharm Test 4 Flashcards
Beta cells produce
insulin, proinsulin, C peptide and amylin
what is amylin?
something that suppresses production of glucagon which is the opposite of insulin
what do alpha cells release?
glucagon
what do delta cells release?
somatostatin
what is an insulin secretagog?
glucose, something that makes the body secrete insulin
what are the 2 major types of secretory tissues that are in the pancreas?
exocrine gland-digestive enzymes
endocrine gland- alpha, beta, delta cells
where are the alpha beta and delta cells?
in the islets of langerhans
insulin receptors are what kind of receptor?
tyrosine kinase
what does insulin binding to insulin receptors do?
translocates glucose transporters to the cell wall
we always have a ____ level of insulin
constitutive
describe homeostasis processes when bg rises.
bg rises
insulin is released from beta cells
liver stores some as glycogen
bc insulin came out and was bound to insulin receptors now glucose transporters are moved to the cell wall
this pulls glucose into the cell
glucagon causes breakdown of _______ in the liver to _______ bg
glycogen
raise
type 1 diabetics are
insulin dependent- autoimmune thing where the body doesn’t produce insulin
type 2 diabetics are ________ on insulin
non-dependent
type 4 diabetes happens during
pregnancy. Pregnancy hormones block insulin receptors.
type 3 diabetes is from
pancreatitis, drug therapy, illness, etc.
cardinal symptoms of diabetes
polydipsia
polyphagia
polyuria
Describe the sorbitol pathway, and why it leads to peripheral neuropathy and blindness.
Sorbitol and fructose increase intracellular osmotic pressure (attracts water leading to cell injury)
More glucose means more sorbitol, Sorbitol can not leave the cell, excess sorbitol in cell, more water rushes in, cells burst
2 types of diabetes tests:
fasting BG
glucose tolerance test
Describe the structure of insulin
long string of amino acids
Broken down into beta and alpha chain held together by disulfide linkages
They are in the active form when they are together
The proform has a C peptide. Only the body makes c peptide.
what is leptin?
something that makes you feel full
what are the types of glucose transporters?
glut 1,2,4
4 main types of insulin preparations :
rapid acting
short acting
intermediate acting
long acting
what are the rapid acting insulins?
Lispro, aspart, glulisine
what are the short acting insulins?
Novolin, humulin
what are the intermediate acting insulins?
Neutral protamine Hagedorn (NPH)
what are the long acting insulins?
Glargine, detemir
what does the tight control of bg look like?
Basal + bolus (calculated)
Long acting once per day, rapid acting before meals
what does the conventional control of bg look like?
70/30 premixes
illness makes your ____ go up so you need more insulin
bg
1 unit of Rapid acting insulin disposes ____ of carbohydrates
12-15g
If lunch intake has 60 carbs how many units of rapid acting insulin should you give?
4 units.
60/15=4
1 unit of rapid acting drops the bg by
50mg/dl
if bg is 200 you should give how many units of rapid acting insulin?
2 units
200/50=100
symptoms of hypoglycemia
Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating
treatment for hypoglycemia
Glucose / simple sugars: 3-4 glucose tablets, ½ can of soda
Glucagon injection
1 mg IM, IV, SQ - may repeat in 20 minutes if needed
Inhibits insulin release, raises BG levels
how does glucagon work?
inhibits insulin release from beta cells in the liver
8 classes of oral antidiabetic drugs
biguanines
insulin secretagogues
thiazolidinediones
alpha-glucosidase inhibitors
bile acid sequestrant
amylin analogs
gliflozin
incretin based therapies
BIT A BAGI
what is first line therapy oral antidiabetic?
biguanide
how does biguanide work?
drug example?
Slows down gluconeogenesis (glucose production in liver)
metformin
MOA of insulin secretagogue?
makes us produce more insulin via binding to K+ channels
MOA of Thiazolidinediones (TZDs
Increase insulin signal transduction
Increased effect of Glut 4 going to cell surface
MOA of Alpha-glucosidase inhibitors
Blocks digestion of complex carbohydrates
- smelly farts
MOA of Bile acid sequestrant
Big gloop that goes through intestine and blocks glucose from being absorbed so take with food
MOA of amylin analogs
suppresses glucagon release
MOA of gliflozin
targets SGLT2 transporters. blocks glucose uptake in the PCT
more glucose going out in urine, also works as an osmotic diuretic (good for BP reduction)
side effects of gliflozins
Dehydration
Necrosis of genital region
High glucose in urine → bacteria in genital region fed a steady diet of glucose bc they are peeing out glucose, especially bad with bedridden patients
pts with dm have a LDL goal of
<100
Diagram a treatment algorithm for patients with Type II diabetes.
Combination therapy
Biguanide
Biguanide + Insulin OR Biguanide + Secretagogue
Biguanide + 2-3 other classes
Intensive Insulin Therapy
