Treatment of Diabetes Flashcards
How, specifically, does glucose stimulate the release of insulin from the beta cells of the pancreas?
- Glucose is taken up by the beta cells of the pancreas by facilitated transport.
- glucose undergoes glycolysis and increases ATP production
- Increased ATP inhibits K+ channels which causes the depolarization of the beta cells, increased Ca2+ influx, and release of insulin! WOW!
How do insulin lispro (Homolog)/insulin aspart (Novolog) work? (These are different drugs but they work the same way.)
Synthetic insulin analogs that are absorbed more rapidly than normal insulin (Can inject right before a meal)
Why do you have to wait 30-45 min after injecting normal insulin before eating?
Because normal insulin forms a dimer when injected and this slows its absorption.
What NPH insulin (Isophane)?
This is an intermediate acting insulin prep. Insulin and zinc react with protamine (a basic protein, chelsea’s favorite kind of protein). Insulin is released slowly from this complex
What is insulin glargine
SUPER ULTRA LONG ACTING synthetic insulin. It is modified so that it is soluble at pH 4, and precipitates at physiologic pH. The precipitate slowly dissolves and does not cause a peak insulin level
What is insulin detemir
Another long acting insulin that creates a smooth baseline of insulin. Works similar to insulin glargine in producing a baseline of insulin.
IF YOU DON’T REMEMBER ANYTHING FROM THESE FLASHCARDS REMEMBER THAT YOU CAN ONLY TREAT TYPE 1 DM WITH _______
INSULIN.
What is the first drug of choice for type 2 diabetes?
Metformin
How does metformin work?
It inhibits gluconeogenesis in the liver. Almost never causes hypoglycemia, and reduces both post-prandial and fasting hyperglycemia
If metfomin alone doesn’t work, what should you add?
Glipizide or a glitazone like pioglitazone
How does glipizide work?
Inhibits K+ efflux in the pancreatic beta cells, causing depolarization and the release of insulin. 200x more potent than tolbutamide and can cause hypoglycemia.
What are sulfonylureas? Whats the difference between 1st and 2nd generation?
Hypoglycemia agents that bind K+ channels in beta cells of the pancreas.
1st generation includes tolbutamide. Not as potent.
2nd generation includes glyburide and glipizide. 200x more potent than 1st generation like you just learned in the last card.
How does pioglitazone work?
Decreases insulin resistance by increasing the synthesis and translocation of glucose transporters in muscle and adipose tissue, and maybe (?) by decreasing glucose production in the liver by inhibiting gluconeogenesis.
Pioglitazone specifically may reduce heart attacks and strokes as well. Super duper.
How does acarbose work?
This is an alpha-glucosidase inhibitor, which prevents the break down of disaccarides like sucrose into monosaccharides that can be absorbed in the intestine. Now it takes longer to absorb your food and your blood sugar rises more slowly, preventing hyperglycemia.
If you get hypoglycemia from this, take glucose tablets (not food, because you can’t digest it fast enough duh)
Side effects: gas, bloating, diarrhea (undigested shit sitting in your tummy for long time)
What is glucagon-like peptide 1
It rapidly induces glucose-dependent insulin release while it inhibits glucagon release. It is rapidly broken down by dipeptidyl peptidase-4 (DPP-4)
