Week 11 Diabetes Flashcards
b cells in the pancreas produce?
insulin
a cells in the pancreas produce?
glucagon
Type 1 diabetics require exogenous insulin to avoid severe hyperglycemia & the life-threatening catabolic state of _________.
ketoacidosis
6 indications for insulin therapy
- significant insulinopenia
- instability of glucose patterns (usually d/t significant insulinopenia)
- difficulty with hypoglycemia
- lifestyle needs
- achieving therapeutic goals
- weight loss
What is the most serious and common adverse reaction insulin injection?
hypoglycemia
Lispro, Aspart, Glulisine and Regular insulin are classified as?: Rapid/Short Acting Intermediate Acting Long Acting Mixed
Rapid/Short Acting
Glargine and Detemir are classified as?: Rapid/Short Acting Intermediate Acting Long Acting Mixed
Long acting
NPR (neutral protamine Hagedorn) insulin is classified as? Rapid/Short Acting Intermediate Acting Long Acting Mixed
Intermediate acting
How many minutes prior to a meal should regular insulin be administered?
30 minutes
clear insulin vs cloudy insulin?
clear = short or rapid-acting cloudy = long-acting
7 Symptoms of hypoglycaemia: neurogenic (autonomic)
trembling palpitations sweating anxiety hunger nausea tingling
8 symptoms of hypoglycaemia (neuroglycopenic)
difficulty concentrating confusion weakness drowsiness vision changes difficulty speaking headache dizziness
CI to insulin
hypersensitivity
hypoglycemia
precautions of insulin
- liver or kidney disease
- lactation (exogenous insulin is excreted into breastmilk)
In non-diabetic individual, 40-50% of insulin secreted by pancreas is extracted during its first passage through the liver. Consequently, the kidney plays a smaller role in disposing of insulin secreted in non-diabetic individual than in disposing of insulin injected into diabetic patients. Endogenously secreted insulin is degraded by liver, exogenous insulin is primarily eliminated by the kidney.
The kidneys play an important role in the clearance of insulin from the systemic circulation. Insulin has a molecular weight of 5734 and is therefore freely filtered at the glomerulus and then extensively reabsorbed by the proximal tubule. Of the total renal insulin clearance, approximately 60% occurs by glomerular filtration and 40% by extraction from peritubular vessels. Insulin in the tubular lumen enters the proximal tubular cell by carrier-mediated endocytosis and is then transported into lysosomes where it is metabolized into amino acids that are released into peritubular vessels by diffusion. In addition to luminal clearance via glomerulal filtration, the kidneys clear insulin from the post-glomerular peritubular circulation. These intrarenal pathways of insulin removal involve both receptor and non-receptor mediated uptake. The net effect is that less than 1% of filtered insulin appears in final urine.
Name 7 drugs that decrease hypoglycaemic effect of insulin
OC corticosteroids diltiazem diuretics estrogens niacin thyroid hormones
Name 7 drugs that increase hypoglycaemic effect of insulin
alcohol ACE inhibitors b blockers salicylates fluoroquinolones tetracycline sulfonamides
What percentage of diabetic population is type 2 DM?
90-95%
7 major diabetes complications
cerebrovascular disease retinopathy coronary heart disease nephropathy neuropathy PVD in lower limbs ulceration & amputation for diabetic foot
abnormalities of b-cell function in type 2 diabetes?
- disrupted pulsatile insulin response
- decreased first phase
- increased proinsulin/insulin ratio
- decreased b-cell responsiveness to glucose
- decreased insulin production
what is somatostatin
also known as growth hormone-inhibiting hormone (GHIH)
Somatostatin is secreted in several locations in the digestive system:
stomach
intestine
delta cells of the pancreas
Somatostatin: A hormone that is widely distributed throughout the body, especially in the hypothalamus and pancreas, that acts as an important regulator of endocrine and nervous system function by inhibiting the secretion of several other hormones such as growth hormone, insulin, and gastrin.
T2DM is marked by blunted _________ response and inadequate __________ suppression after meals.
insulin
glucagon
inherited influences on insulin resistance?
Largely unidentified!
- insulin receptor
- glucose transporter
- signaling proteins
these are rare mutations!!
acquired influences on insulin resistance?
overeating overweight inactivity aging medications illness hyperglycemia elevated FFAs in blood & tissues
what percentage of people with DM are estimated to be overweight or obese?
80-90%
why should healthy bodyweight be encouraged in DM patients who are overweight or obese?
A modest weight loss of 5 to 10% of initial body weight can substantially improve insulin sensitivity and glycemic, blood pressure and lipid control.
9 ss and sxs of diabetes
unusual thirst freq. urination weight change (loss or gain) extreme fatigue or lack of energy blurred vision frequent or recurring infections (vaginitis/pruritis) cuts & bruises that are slow to heal tingling/numbness in hands or feet trouble getting/maintaining erection
**type 2 can be asymptomatic!
lab findings on urinalysis?
looking for ketones in the urine.
Ketones are a metabolic product produced when fat is metabolized. Ketones increase when there is insufficient insulin to use glucose for energy.
Urine tests are also done to look for the presence of protein in the urine, which is a sign of kidney damage.
Urine glucose measurements are less reliable than blood glucose measurements and are not used to diagnose diabetes or evaluate treatment for diabetes. They may be used for screening purposes.
