Q5 DM Flashcards
Alpha cells secrete ____
Beta cells ____
Delta cells _____
PP cells _____
Glucagon
Insulin
Somatostatin
Pancreatic polypeptide (PP)
In an insulin resistant person, a ____ amount of insulin is needed to push glucose into cells.
Larger than usual
C-peptide in type I DM?
C-Peptide in type II DM?
Not present in T1
Present in normal or high amounts in T2
Secreted by delta cells, inhibits release of insulin and glucagon?
Stored and secreted with insulin, delays gastric emptying, regulates food intake?
Somatostatin
Amylin
T/F: Incretins are released from cells in the pancreas
Degraded by?
False. They are released in the GUT. Examples:
GIP, GLP1.
DPP-4
Normal A1C =
Prediabetic A1C
DM A1C
<5.7
5.7-6.4
>=6.5
goals for diabetics:
A1C, FBG, and 2h PPBG?
A1C <7
FBG 80-130
2h PPBG <180
Why do diabetics with high blood sugar get DKA?
without enough insulin to get glucose into the cells, the cells think they are starving so the body starts to break down fats for energy, but the ketones overwhelm.
All DM patients should lose _____
5% of body weight
T1DM basal and bolus dosing: calculate?
Calculate the total daily dose (TDD) = 0.4-0.5u/kg/day.
Usual TDD = 0.4-1u/kg/day.
Give 40-50% of TDD as basal insulin and the remaining 50-60% as bolus insulin.
Which insulins have no peak?
Long acting glargine, and degludec.
Most common SEs of insulin:
CI?
Weight gain, peripheral edema, hypoglycemia, hypoK, local injection site reactions.
Monitor for HypoK with concomitant loop diuretic use.
Metformin is a Biguanide. 1st line in DM. MOA? SE? CI? BBW?
Decrease hepatic glucose production, decrease intestinal absorption of glucose and increase sensitivity to insulin.
SE: d/n, upset stomach, vit b12 deficiency.
CI - eGFR <30, DKA, chronic metabolic acidosis.
BBW: Lactic acidosis.
Contrast procedures, HF, impaired kidney fxn can increase risk for ________ when taking metformin.
Lactic acidosis
Sulfonylureas - Glipizide, Glimepiride, Glyburide.
MOA, SE, CI
Used to be 2nd line but not anymore (does not preserve Bcell fxn)
Stimulate insulin release from pancreas
SE: Hypoglycemia, weight gain
CI: T1DM, DKA, sulfa allergies.
GLP1 Agonists:
Dulaglutid (Trulicity)
Exenatide (Byetta, Bydureon)
Liraglutide
Semaglutide
Lixisenatide
DPP4 Inhibitors:
Sitagliptin (Januvia)
Linagliptin (Tradjenta)
Saxagliptin (onglyza)
Alogliptin (Nesina)
SGLT2 Inhibitors:
Empagliflozin(Jardiance)
Dapagliflozin
Ganagliflozin
Ertugliflozin
SGLT2 Inhibitor MOA, SE, CI
Inhibit sodium-glucose cotransporter protein 2.
Decrease reabsorption of glucose in the kidneys
SE: Hypotention, TUI, genital mycotic infection (nec fasciitis), increased urination, dehydration
CI: severe renal impairment, ESKD or dialysis.
STAY HYDRATED. Cardiovascular and renal protection
Meglitinide: MOA, SE, CI
MOA: Stimulate insulin release from the pancreas (T2 DM not T1)
SE: Hypoglycemia, weight gain
CI DKA, T1DM, not in combo with NPH insulin.
Repalinide, Nateglinide.
Which DM drugs have the most A1C lowering effects?
Metformin>sulfonylurea>TZD>GLP1agonists.
New DM med that has cardiac and renal benefits?
Finerenone
_____ can be added to insulin regimen to T1DM patients to decrease fluctuations in BG levels.
Injected amylin
