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Flashcards in Diabetes Deck (25):
1

what requires glucose absolutely - they can not burn fat for energy

RBC
neurons
renal medula

2

hyperglycemia level mg/dl

> 126mg/dl

3

HbA1c in diabetics goal

primary goal <6%

4

main cause of death in DM

Cardia Vascular disease
Kidney Failure

5

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

6

what is insulins counter

glucagon
pancreatic alpha-cells
stimulate liver gluconeogenesis

7

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

8

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

9

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

10

aspart

ultra shorrt acting insulin

IV
insulin pumps

11

lispro

ultra short acting insulin
rapid onset
short duration of action

IV
insulin pumps

12

regular

short acting
rapid onset

IV

13

NPH

intermediate acting
cannot be used IV

14

glarcine

peakless
very long acting
slow onset

15

detemir

peakless
very long acting
slow onset

16

group insulin types by duration

aspart, lispro (ulta-short)

regular (short)

NPH (intermediate)

glargine, detemir (long)

17

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

18

DM2 Rx common side effects

hypoglycemia
weight gain

19

name 2 insulin secretagogues

glyburide
repaglinide

20

glyburide
(sulfonylurea)

blocks K-ATP channel in beta cells = depolarization

ADR:
hypoglycemia
weight gain
sulfa allergies
liver toxic
disulfram reaction

21

repaglinide

causes K-ATP channel to close

ADR:
hypoglycemia
weight gain

22

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

23

name insulin sensitizers

pioglitazone
rosiglitazone
metformin

24

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

25

metformin

sensitizes insulin receptors in adipose, liver, muscle

ADR:
lactic acidosis (increased anion gap)
GI discomfort
alteration of taste
megaloblastic anemia