Diabetes Flashcards
(25 cards)
what requires glucose absolutely - they can not burn fat for energy
RBC
neurons
renal medula
hyperglycemia level mg/dl
> 126mg/dl
HbA1c in diabetics goal
primary goal <6%
main cause of death in DM
Cardia Vascular disease
Kidney Failure
where is insulin coming from and what does it do
pancreatic beta-cells
stimulates GLUT in muscles and fat
inhibits glycogenolysis in liver
inhibits gluconeogenesis in liver
what is insulins counter
glucagon
pancreatic alpha-cells
stimulate liver gluconeogenesis
mechanism of insulin release
glucose enters beta-cell
increased oxidation i.e ATP rise
increased ATP opens K-channel to close
efflux of K stopped so cell now depolarizes
depolarization opens Ca channels
Ca influx causes insulin release from secretory granules
insulin pathway to GLUT
insulin binds extracellular alpha-unit on tyrosine receptor
intracellular beta-unit autophoshorylates
IRS autophoshorylates and activates several kinases that causes up regulation of GLUT to membrane
when do you give a patient insulin and ADR
DM1
DM2
severe hyperKalemia
stress induced (cortisol) hyperglycemia
ADR:
hypoglycemia - (hunger, sweat, weak, drowsy, warm, dizzy, blurred vision, seizure, coma)
»> give oral glucose, IV glucose or glucagon
lipoatrophy, lipohyperthrophy at injection site
aspart
ultra shorrt acting insulin
IV
insulin pumps
lispro
ultra short acting insulin
rapid onset
short duration of action
IV
insulin pumps
regular
short acting
rapid onset
IV
NPH
intermediate acting
cannot be used IV
glarcine
peakless
very long acting
slow onset
detemir
peakless
very long acting
slow onset
group insulin types by duration
aspart, lispro (ulta-short)
regular (short)
NPH (intermediate)
glargine, detemir (long)
what is the aim of Rx Tx in DM2
diet, exercise
increase insulin release from pancreatic beta-cells
increase peripheral insulin receptor sensitivity
decrease hepatic glucose production
inhibit alpha-glucoside hydrolase in gut
inhibit alpha-amylase in gut
administer insulin
DM2 Rx common side effects
hypoglycemia
weight gain
name 2 insulin secretagogues
glyburide
repaglinide
glyburide
sulfonylurea
blocks K-ATP channel in beta cells = depolarization
ADR: hypoglycemia weight gain sulfa allergies liver toxic disulfram reaction
repaglinide
causes K-ATP channel to close
ADR:
hypoglycemia
weight gain
Rx that inhibit sugar absorption
acarbose
blocks alpha-glucoside hydrolase in gut
blocks alpha-amylase in gut
duration is only 4-5 hours
ADR:
liver toxicity
GI discomfort
Osmotic diarrhea
name insulin sensitizers
pioglitazone
rosiglitazone
metformin
pioglitazone
rosiglitazone
activates PPAr nuclear receptors
increases GLUT-4 in muscle and adipose
increased fat synthesis and storage
decreased hepatic glucose production
ADR: weight gain !!! increased blood cholesterol fluid retention - heart issue MI (rosiglitazone) hepatoxic anemia
