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Flashcards in Diabetes Deck (37):
1

Pancreatic Hormones

insulin - glucose storage; glucagon - metab glycogen stores; IAPP/amylin - modulates apetite/emptying/gluc & insul release; somatostatin - secretory inhibitor

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Insulin release from beta cells

glucose at cell -> ATP prod & K+ channel closure -> depolarization and Ca+ channel opens -> Ca+ entry stim insulin reslease via exocytosis

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Type 1 Diabetes

10%; B cells destoyed; exogenous insulin to survive (DKA/coma/death if not)

4

Type 2 Diabetes

increased insulin resistance -> high blood glucose; correlated with obesity; uncontrolled is life-threatening

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Other Types

Type 3: due to specific factor (pancreatitis or meds); Type 4: gestational

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Diabetes Symptoms

polyuria; polydipsia; polyphagia; extereme fatigue; blurred vision; imparied healing

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Diagnosis

A1C: >6.5; FPG >126; OGTT >200

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Controlled

A1C <7; preprandial capillary glucose 80-130; 2 hr postprandial glucose <180

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Antidiabetic Classes

insulin seretagogues (sulfonylureas/meglitinides/D-phenylalanine derivs) - stim insulin secretion from B cells; biguanides - decrease hepatic glucose production; thiazolidinediones - decrease insulin resistance; a-glucosidase inhib - slow digestion and absorption of starches; bile-acid sequestrant - decr absorption/glucose prod; incretins - increase post-meal insulin and reduce glucagon prod; amylin analogs - decr post meal glucose and appetite; insluin - direct replacement of hormone

10

Biguanides

metformin (glucophage); decreases glucogenesis; increases insulin sensitivity; FIRST LINE Type 2; LACTIC ACIDOSIS CONCERN - to not use with contrast dye

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Biguanide Advantages/Disadvantages

adv: no hypoglycemia; decr cardiovascular events; no weight gain disadv: diarrhea; nausea; less B12 absorption; lactic acidosis - renal/hepatic failure/CHF/dehydration

12

Sulfonylureas

increase insulin release from B-cells; 2nd Gen: Glyburide; glipizide; glimepiride - less side effects and drug interactions

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Sulfonylurea Characteristics

A1C reduction 1-2%; once daily; hypoglycemia; weight gain; contraindicated with renal/hepatic failure; start low & go slow

14

Thiazolidinediones (TZDs)

INCREASE INSULIN SENSITIVITY - fat/liver/muscle; A1C .5-1.5% reduction; CYTOCHROME metabolism - drug interactions

15

TZD Drugs

pioglitazone (actos): LOWERS TRIGLICERIDES; increased risk bladder cancer rosiglitazone (avandia): possible MI risk; incr LDL; restricted

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TZD Characteristics

edema weight gain; 50% reduc in bone fracture women; no hypoglycemia; contraindicated in heart and liver failure

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Meglitinides

rapaglinide (prandin); nateglinide (starlix) - increase insulin release; A1C 1-2% reduc; peak 1 hr after taking with fast onset - take before meals

18

Alpha-glucosidase Inhibitors

acarbose (precose); miglitol (glyset) - decrease carb digestion and absorption; A1C .5-8% reduc (not useful monotherapy); contraindicated renal/hepatic/intestinal issues; prevention of new Type 2 in pre-diabetics

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Bile Acid Sequestrants

colesevelam (welchol) - binds bile acids (lower cholesterol and A1C .5%); interferes with other drugs; N/V/C/GI

20

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

degrade incretin hormones - decr postprandial hyperglycemia and glucagon prod; incr insulin secr

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DPP-4 Drugs

sitagliptin (januvia); saxagliptin (onglyza); linagliptin (trajenta) NO special dosing for renal; alogliptin (nesina) - all oral; A1C .5-1% reduc; no hypoglycemia; well tolerated

22

Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors

NEWEST DRUG - may cause DKA in pts with normal glucose; block glucose reabsorption in prox nephron; 5.-1% A1C reduc; no hypoglycemia; weight loss; decr BP; genitourinary infetions; incr LDL

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SGLT2 Drugs

canagliflozin; canagliflozin + metformin; dapagliflozin; dapagliflozin + metformin XR; empagliflozin; empagliflozin + linagliptin

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Amylin Analog

pramlintide (symlin): used with insulin; decr postprandial hyperglycemia; slows glucagon secr/decr hunger/slows gastric emptying

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Amylin Analog Uses

Type 1 and Type 2; subQ premeal; rapid/short acting insulin dose must be reduced; some NAV

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Glucagon-like Polypeptide-1 (GLP-1) Receptor Agonists

increase insulin secretion; decrease glucagon secretion; increase satiety; slow emptying

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GLP-1 Drugs

exenatide; liraglutide; dulaglutide; albiglutide: weight loss; adjust dose for renal; hypoglycemia only with sulfonylureas; watch if endocrine cancers or pancreatitis

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Exogenous Insulin

stimulate normal basal and stim insulin secretion

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Rapid Acting Insulin

insulin lispro (humalog)/aspart (novolog)/glulisine (apidra): before meal; 15min onset/peak 1 hr/duration 2-4hr; PREFERRED IN INSULIN PUMPS

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Short Acting Insulin

regular insulin (humulin R/novolin R): ONLY TYPE GIVEN IV - good for ketoacidosis/fluctuating levels; onset 30 min/peak 2-3 hr/duration 3-6 hr

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Intermediate Acting Insulin

NPH (humulin N, novolin N): "basal-type"; unpredictable; 2-4x/day; onset 2-4hr/peak 4-12 hr/duration 12-18 hr

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Long Acting Insulin

insulin glargine (lantus/toujeo): "peakless"; onset 3-6hr/max 4-6hr/ duration 11-24hr; crystalline depot under skin; cannot give with other insulins insulin

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Long Acting Insulin (2)

detemir (levemir): "peakless"; RELIABLE; onset 1-2hr/duration 12-24hr

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Ultralong Acting Insulin

insulin degludec (tresiba): onset 1hr/peak 9hr/duration 25+hr; "basal" insulin

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Insulin Mixtures

mix NPH with lispro/aspart/glulisine for short or longer coverage

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Complications of Insulin Therapy

allergy (rare); immune resistance; hypoglycemia - mismatched carb/insulin ration; incr exertion; warning signs: palpitations/sweating/nausea/hunger; tx: glucagon if pt unconscious or unable to eat

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Delivery

subQ: understanding/dexterity; pens: expensive; continuous infusion; V-GO patch