Topic 18 Diabetics Flashcards
The Endocrine Pancreas produces what ?
Produces insulin (signalling a “fed” state), glucagon (signalling a “hungry” state), gastrin, somatostatin, and many others
Beta cells secrete
The Endocrine Pancreas
insulin which causes BldGlucose to DECREASE (after all, you’re in the fed state and need to stash that energy)
Alpha cells secrete
The Endocrine Pancreas
glucagon which causes BldGlucose to INCREASE
Delta cells secrete
The Endocrine Pancreas
somatostatin which regulates a LOT of things (and gets very, very complicated!)
What goes awry with pancreatitis?
The Exocrine Pancreas
•Releases bicarb and digestive zymogens to break down fats and proteins
Diabetes insipidus- Critter doesn’t produce or kidneys
don’t respond to Vasopressin (Antidiuretic Hormone/ADH)
Type 1 DM is an absolute what?
Broadly, Type 1 DM is an absolute insulin deficiency and Type 2 DM is a relative deficiency of insulin
All DM is characterized as what?
as an absolute or relative deficiency of insulin
Type 1 DM:
“Insulin-Dependent DM (IDDM)”
Type 2 DM:
“Non-Insulin-Dependent DM (NIDDM)”
Classic symptoms of hyperglycemia (4)
- Polyphagia
- Polydipsia
- Polyuria
- weightloss
Women may develop extreme insulin
resistance – what kind of diabetes is this???
DM TYPE 4
Women may develop extreme insulin
resistance during their third trimesters of pregnancy (same time they might be prone to blowing out mitral valves, eh?) as a result of hormonal changes
•Controlled with insulin: uncontrolled Type 4 DM can lead to extremely large babies, dystocia, and neonatal hypoglycemia
Insulin is a small polypeptide consisting
of two chains connected by what?
a disulfide bond
31 amino acid peptide used to differentiate Type 1 DM from Type 2 DM
C-Protein
Insulin is produced by ____ in the _____ in response (generally) to glucose (the archetypical ______)
β-cells in the pancreas
glucose (the archetypical “fed state”)
Insulin exhibits _____ on these target tissues
anabolic effects
What increasingly being used by perfusionists for hyperkalemia therapy ?
Insulin
often in conjunction with glucose to
“drive” potassium intracellularly
Regular insulin
Humulin R, Novolin R
Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)
Insulin aspart
Novolog
Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)
Insulin glulisine
Apidra
Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)
Insulin lispro
Humalog
Rapid onset/short-acting Insulin
Given IV or subcutaneously (SQ)
Neutral Protamine Hagedorn (NPH) insulin
Humulin N, Novolin N
Intermediate onset/intermediate acting Insulin
Only given SQ
Insulin glargine
Lantus
Long acting insulins
Do NOT mix with other types of insulin
Give only SQ
Insulin detemir
Levemir
Long acting insulins
Do NOT mix with other types of insulin
Give only SQ
Long-term BG measurement is via what?
Glycated (glycosylated) Hb (HbA1c)
Pramlintide
Symlin
Injectable Antihyperglycemics
An “Amylin” analogue
Amylin
is a polypeptide released by the pancreas in conjunction with insulin
works with insulin to moderate physiologic glucose levels by slowing gastric emptying and digestion
Exenatide
(Byetta) : SHORT ACTING
Incretin Mimetics
Liraglutide
(Victoza) : LONG ACTING
Incretin Mimetics
Incretins are hormones released by what and that stimulate the pancreas to release what?
-by the GI tract post-prandially
-the pancreas to release insulin, slow gastric
emptying, decrease glucagon release, and
encourage β-cell growth
Incretins side affects
[Exenatide and liraglutide]
Side effects are mainly GI
Incretins both are given how?
[Exenatide and liraglutide]
Both are proteins that are given SQ prior
to eating
Oral Insulin adjuncts (5)
- Insulin Secretagogues
- Insulin Sensitizers
- α-Glucosidase Inhibitors
- Dipeptidyl Peptidase-IV Inhibitors
- Sodium Glucose Co-Transporter Inhibitors (SGLT Inhibitors)
Oral Insulin adjuncts often used as port of what?
Often used as part of “progressive combination therapy” for Type 2 DM
Glyburide
Diabeta, Micronase
Sulfonylureas, Insulin Secretagogues
Insulin Secretagogues do what?
*Increase β-cells production of insulin (so critter must still have functioning pancreas), lower hepatic glucose production, and increase peripheral insulin sensitivity
Glimepiride
Amaryl
Sulfonylureas, Insulin Secretagogues
Glipizide
Glucotrol
Sulfonylureas, Insulin Secretagogues
Nateglinide
Starlix
Glinides, Insulin Secretagogues
Repaglinide
Prandin
Glinides, Insulin Secretagogues
Insulin Sensitizers do what?
*Increase peripheral cellular sensitivity to
insulin without increasing insulin secretion
Two types: Biguanides and Thiazolidinediones
Metformin
Glucophage
Biguanides, Insulin Sensitizers
Pioglitazone
Actos
Thiazolidinediones, Insulin Sensitizers
Rosiglitazone
Avandia
Thiazolidinediones, Insulin Sensitizers
Biguanides prevents what?
Prevents hepatic gluconeogenesis (huh?)
***This is very important because hepatic glucose production is the main source of excessive glucose in Type-2 DM!
Thiazolidinediones do what?
Increase intracellular receptors in skeletal muscle, liver, and adipose tissue to become more sensitive to endogenous insulin.
α-Glucosidase Inhibitors (2)
Acarbose (Precose)
Miglitol (Glyset)
α-Glucosidase Inhibitors work by inhibiting what? which delays what?
Work by reversibly inhibiting an enzyme in the
small intestines that helps digest polysaccharides into simple sugars.
*This delays complex sugar digestion which “spreads out” the post-prandial blood glucose spike.
α-Glucosidase Inhibitors cause hypoglycemia??
Don’t cause hypoglycemia by themselves, but will contribute significantly in combination RX
Saxagliptin
Onglyza
Dipeptidyl Peptidase-IV Inhibitors
Sitagliptin
Januvia
Dipeptidyl Peptidase-IV Inhibitors
Miglitol
(Glyset)
α-Glucosidase Inhibitors
Acarbose
(Precose)
α-Glucosidase Inhibitors
Sodium Glucose Co-Transporter Inhibitor
SGLT Inhibitor
Canagliflozin (Inkovana)
Only one is currently approved for use in the U.S.
Inkovana
Canagliflozin
Sodium Glucose Co-Transporter Inhibitor
SGLT Inhibitor
Dapagliflozin what is it and what is unique about it?
(Farxiga)
Sodium Glucose Co-Transporter Inhibitor
(SGLT Inhibitor)
was almost approved for use in the U.S. (and is still used extensively in Europe) but it was found to have one small side-effect (besides nasty intractable urinary tract yeast infections
