S2L2 - Diabetes Flashcards
What does insulin do?
Regulates glucose storage
What does glucagon do?
Modulates glycogen stores for release
What does somatostatin do?
Inhibits secretory cells
What does gastrin do?
Stimulates gastric acid secretion
What is type III and IV diabetes?
Type III is induced by other causes like pancreatitis or drug therapy
Type IV is gestational
How is insulin formed?
From pro-insulin within beta cell golgi
What is formed in equal amounts with insulin?
C-peptide
What degrades insulin?
60% liver and 40% kidney but reversed in insulin treated patients
What stimulates insulin release?
Vagus nerve stimulation and blood glucose levels
What are the target tissues of insulin?
Liver, fat and muscle
What is the insulin effect on the liver?
Inhibits glycogenolysis, conversion of AAs to glucose and FAs and AAs to keto acids, promotes glucose storage as glycogen and increases TG synthesis
What is the insulin effect on muscle?
Increases AA and glucose transport and glycogen and protein synthesis
What is the insulin effect on adipose tissue?
Increases TG storage and glucose transport into cells
What are the routes of insulin administration and the formulations
Inhaled not well tolerated, SQ most often, IV in emergency
Rapid, short, intermediate and long
How is DKA managed?
saline hydration, regular insulin infusion every 2 hours, potassium serum level maintenance which can translate to hyponatremia
What is HHS?
Hyperosmolar hyperglycemic syndrome - elevated blood glucose level complication in T2D with similar symptoms to DKA, but management more focused on hydration
What are the symptoms and management of hypoglycemia? Why does it happen?
Tachycardia (fast HR), diaphoresis (sweating), tremor, nausea, confusion - treat with glucose or glucagon (oral or injectable) - complication of therapy
What are sulfonylureas and how do they work?
Insulin secretory agents that stimulate the pancreas - they close K channels depolarizing the cell and causing calcium influx to stimulate insulin release
Why are sulfonylureas not used anymore?
Can give hypoglycemia and increased drug activity because of liver and kidney dysfunction
What are the sulfonylurea drugs?
Glyburide, glipizide and glimepiride
What are the newer insulin secretory drugs?
Meglitinide class - repaglinide
D-Phenylalanine - nateglinide
Used in patients with sulfur allergy - similar MOA and benefits of sulfonylurea
What is metformin?
A biguanide - inhibits the conversion of lactic acid to glucose via gluconeogenesis in the liver by activating AMPK - stimulates glycolysis in tissues and reduces plasma glucagon levels
What can happen in chronic metformin use? and how is it treated?
lactic acidosis - MALA - drug builds up with no way to metabolize or clear - treated by sodium bicarbonate administration (to balance acid) or given dialysis (to clear drug)
What are thiazolidinediones?
Pioglitazone and rosiglitazone
Regulate PPAR-gama to regulate muscle and fat expression to increase insulin sensitivity by helping glucose metabolism and adipose storage
