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Pharmacology > Therapeutic Interventions for Diabetes Mellitus > Flashcards

Therapeutic Interventions for Diabetes Mellitus Flashcards

1
Q

Exocrine function of pancreas

A
  • secretes enzymes into duodenum to support digestion of macromolecules
  • secretes bicarbonate into duodenum to raise pH of chyme
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2
Q

Endocrine

A
  • islets of langerhan includes two types of cells that secrete hormones
  • alpha cells: secrete glucagon in response to low blood glucose and to activity of sympathetic nervous system
  • beta cells: secrete insulin in response to high blood glucose and to activity of parasympathetic nervous system
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3
Q

Insulin

A
  • promotes formation of glucose transporters that bring glucose from body into cells, thereby lowering blood glucose
  • promotes conversion of monosaccharides, lipids, and amino acids into storage forms of polysaccharides, triglycerides, and proteins
  • insulin secretion increases during fed state
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4
Q

Glucagon

A
  • promotes conversion of glycogen, proteins, and lipids into glucose (gluconeogenesis) and release of glucose into blood
  • glucagon secretion increases during fasted state
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5
Q

DM

A

metabolic disorder characterized by an imbalance between insulin availability and insulin need
- characterized by hyperglycemia, polydipsia, polyuria, polyphagia

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6
Q

Type 1 DM

A 
insulin-dependent. 
pancreas cannot produce insulin 
represents 5-10% of all cases of DM
usually underweight 
treated with insulin
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7
Q

Type II

A

pancreas does not produce enough insulin to meed needs of body or insulin receptors are not sensitive to insulin that is produced

  • 90-95% of cases
  • patients are usually overweight
  • treated with appropriate diet and exercise then with oral antihyperglycemic drugs, then finally insulin.
  • disease usually appears in middle adulthood
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8
Q

DKA

A
  • extreme hyperglycemia
  • ketones in blood and urine
  • fruity breath
  • treated with insulin and fluid replacement
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9
Q

Complications of not treating Type 1 or Type II

A
  • diabetic neuropathy (end-stage renal failure)
  • diabetic retinopathy (leading cause of acquired blindness)
  • Vascular disease (heart disease, stroke, poor circulation contributes to foot ulcers)
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10
Q

macronutrient intake

A
  • the distribution of Carbs, Fats, and protein is dependent on food preferences and metabolic factors like insulin sensitivity, lipid levels, and kidney function
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11
Q

Glycemic Index

A

a scale that ranks carbohydrates by how much they raise blood glucose levels compared to a standard food like glucose or white bread

  • foods low on glycemic index scale tend to release glucose slowly. foods high on he glycemic index release glucose rapidly
  • the slow and steady release of glucose in low-glucose in low-glycemic foods is helpful in keeping blood glucose under control
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12
Q

low
med
high
glycemic index

A

low: < 55
medium: 56-69
high: > 70

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13
Q

benefit to eating foods with low glycemic index

A
  • control BG level
  • control cholesterol level
  • control appetite
  • lower your risk of developing heart disease
  • lower your risk of developing type 2 diabetes
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14
Q

Sugars, whole grains and fibre, dietary fat, protein

A
  • sugar consumed moderately
  • fibre rich food encouraged
  • dietary fat intake is similar to general population - monosaturated fats and omega 3s are engouraged
  • protein intake similar to general population
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15
Q

Body weight:

A

weight los is encouraged especially early in type 2 diabetes as fat can increase insulin resistance - chronic state of inflammation. inflammation decrease insulin sensitivity

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16
Q

Carb counting

A
  • management of carb intake and insulin administration
  • need to know how to read nutritional info on food packages to determine how much insulin to give to account for the carbs
  • insulin to carb ration (ICR)
    Ex. 1 unit of insulin for every 10 carbs. 1:10 ratio
17
Q

Most common drugs for treatment of type II diabetes

A

drugs that promote release of insulin (secretagogues) or increase receptor sensitivity to insulin

18
Q

Secretagogues

A
  • Sulfonylureas
  • meglitinides
    promote release of insulin
19
Q

Biguanides

Thiazolidinediones

A

drugs that increase sensitivity to insulin

- used to treat DM II

20
Q

Alpha glucosidase inhibitors (DM II)

A

reduce absorption of glucose by preventing digestion of carbohydrates

  • block enzymes in the small intestine responsible for breaking down complex carbs into monosaccharies.
  • hypoglycemia may occur when combined with insulin or a sulfonylurea
  • cause flatulence, diarrhea, abdominal distension
  • ex. Acarbose
21
Q

Incretin Enhancers (DM II)

A
  • simulate amount of insulin produced by the pancreas
  • reduce the destruction of incretins
  • decreases rate of digestion of carbs
    Two Classes
    1. activating GLP -1 receptor
  • increased amount of insulin secreted by pancreas
  • decreased amount of glucagon secreted by pancreas
  • delayed gastric emptying
  • decreased food intake
  • ex. Sitagliptin
    2. Inhibiting dipeptidyl peptidase (DPP-4)
22
Q

Thiazolidinediones

A
  • reduce blood glucose by decreased insulin resistance and inhibiting hepatic gluconeogenesis
  • hypoglycemia does not occur with this class
  • ex. Rosiglitazone
23
Q

Sulfonylureas

A
  • divided into first - and - second generation categories
  • stimulate release of insulin from pancreatic islet cells
  • increase sensitivity of insulin receptors on target cells
24
Q

Sulfonylurea Prototype Drug: Glyburide

  1. therapeutic effects and uses
  2. mechanism of action
  3. side effects
  4. serious side effects
A

1 . lowers blood glucose levels in patients with type 2 diabetes

  1. stimulates release of insulin from pancreatic beta cells. increases sensitivity of peripheral tissues to insulin
  2. nausea & vomiting/heartburn/dizziness/urticaria/pruritis
  3. hypoglycemia/hepatoxicity/aplastic anemia
25
Q

Keeping patients safe when they are at risk of dehydration (vomiting/diarrhea) Hold SADMANS

A

s: sulfonylureas, other secretagogues
a: ace-inhibitors
d: diuretics, direct renin inhibitors
m: metformin
a: angiotensin receptor blockers
n: non-steroidal anti-inflammatory drugs
s: SGLT2 inhibitors

26
Q

Pharmacotherapy for Type I DM (IDDM - insulin dependent DM)

A

treated with insulin replacement.

  • insulin is given through subcutaneous route can be given IV
  • insulin available in many preparations categorized by time to onset, time to peak, concentration, and duration of action
27
Q

Forms of Insulin

A

Rapid-acting - lispro
Short-acting - regular
Intermediate acting - NPH
Long-acting - zinc

28
Q

How much insulin is needed

A

insulin administration is planned in conjunction with current blood glucose levels, nutrient intake, and exercise because there is increased glucose in the body and exercise increases sensitivity to insulin

29
Q

Timing of Insulin

A
  • the fundamental principle of insulin administration is that the right amount of it must be available to the cells when glucose is present in the blood
  • without insulin after a meal glucose can build up in the blood and cause hyperglycemia
  • if insulin is taken when food has not been eaten and there is little to no glucose in the blood hypoglycemia can occur
  • during heavy or prolonged exercise periods, hypoglycemia may occur
30
Q

Insulin prototype drug: Regular insulin

  1. trade names
  2. therapeutic effects and uses
  3. mechanism of action
  4. adverse effects
A
  1. Humulin/Novolin ge Toronto
  2. insulin replacement therapy for type I DM
  3. insulin produced through recombinant DNA techniques; replacement for endogenous insulin
  4. hypoglycemia (too much insulin given to a patient/given at wrong time/if a meal is skipped)
31
Q

Symptoms of Hypoglycemia

A

tachycardia, confusion, sweating, drowsiness, colvulsions, coma, death if not treated.
- treat with gucagon or a glucose source

32
Q

Further Adverse effects of Insulin

A
  • irritation at injection site - always rotate injection sites
  • hypokalemia because potassium follows glucose into cells
  • Somogyi effects
  • Dawn effect
33
Q

Somogyi effect

A
  • the tendency of the body to react to an extremely low BS to overcompensate and result in a high BS
  • Releases compensatory hormones - growth hormones, catecholemies
  • the liver reduces glucose
  • saves the person from dying from hypoglycemia, but it results in a hyperglycemic event
  • should set an alarm for 3 am and check their blood sugars.
34
Q

Dawn Effect

A
  • natural ‘wake up’ response
  • between 2 and 8 am, the body releases normal waking up hormones , causes BS to rise.
  • diabetics will wake up with hyperglycemia
  • avoid carbs at bedtime
  • adjust dose of med or insulin give more
  • change time you take med or insulin from dinnertime to bedtime
  • use an insulin pump
35
Q

Sliding Scale Insulin

A
  • doses of short-acting insulin can be adjusted depending on the individuals blood glucose levels.
  • typically used in hospitalized diabetic patients
  • subcutaneous regular insulin ordered in an amount that increases as the BG decreases
  • check BS, check chart and depending on the range they are falling into, give the appropriate amount of insulin
36
Q

IV insulin

A

used in critical care
perioperatively in-patient setting
during delivery
goal of BS 6-10 (high goals because it has such an immediate onset of action we want to create a buffer zone for ourselves to keep them from going into hypoglycemia)

Pharmacology (14 decks)

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