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Flashcards in Diabetes Deck (22)
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1
Q

Diabetes Mellitus
Pancreatic hormones
-Islet of Langerhans
–4 types of cells
-A(alpha), B (beta), D(delta), and F/G cells
- a cells produce ________
-B cells produce _____ and _____ (amyloid)
-Delta cells produce _________
-F and G cells: ______ and ______ peptides

  • _____ & ____
  • -primarily role in regulation of glucose metabolism
  • _______
  • -increases hepatic glucose output and blood glucose concentration
A
glucagon
insulin, amylin
somatostatin
gastrin, pancreatic peptides
glucagon, insulin
glucagon
2
Q

Insulin

  • 51amino acids linked by 2_____ bridges
  • resting pancreatic beta cells store _____ in secratory vesicles
  • promotes the uptake, utilization and storage of glucose
  • thereby lowers ________ concentration
  • exists as _____ insulin, which is converted to _____ and ______
A
disulfide
insulin
plasma glucose
pre-pro
insulin, C-peptide
3
Q

Insulin secretion

  • released at a low _______
  • released at a ______ rate (stimulated) in response to a variety of stimuli
  • -GLUCOSE, ______, AND ______ (parasympathetic) stimulation
  • high blood _____ is the main trigger, but other hormones and autonomic mediators are involved
  • -digestive hormones
  • drugs can stimulate release
  • -_______, ______, _____ agonists
A
basal rate
higher
amino acids, vagal
glucose
sulfonylureas, meglitinides, B2
4
Q

Insulin secretion
Mechanism
-Glucose is taken up by _ cells (via glucose transporter _____)
-Glucose undergoes ______ with production of high energy ATP
-this process is ________
-intracellular ___ levels increase
–ATP dependent __ channels close, leadung to membrane _________
-influx of __ causes ______ of insulin

A
b,  GLUT2
glycolysis
phosphorylation
ATP
K+
depolarization
Ca2+, exocytosis
5
Q

Insulin
-binds to insulin receptors located on the plasma membrane of target cells - _____, cells, ______ muscle, and ______ tissue
-receptor stimulation activates ________
-leads to _______ of target proteins
-phosphorylated proteins after synthesiso f enzymes involved in gluconeogenesis, glycolysis and other metabolic processes
-insulin is the classic _____ hormone (energy storing)
-in muscle: insulin increases _____ uptake
in adipose tissue- increased uptake of _____
-in all tissue: increased glucose movement ____ cells

A
hepatic, skeletal,  adipose
tyrosine kinase
phosphorylation
anabolic
amino acid
fatty acids
INTO
6
Q

HbA1c

  • elevated blood glucose causes non enzymatic ______ of proteins
  • hemoglobin gets _______ on its ____ residue (A1c)
  • higher levels of HbA1c are found in people with persistantly elevated blood ____
  • concentration of HbA1c is established since the half life of glycosylated cells is the same as ____
  • The International Diabetes Federation and American College of Endocrinology reccomend values below __% while Ameriican Diabetes Association reccommends that the HbA1c be below ___%for most patients
A
glycosylation
glycosylated
valine
sugar
RBCs
6.5
7
7
Q

Diabetes Mellitus
Type 1 (insulin dependent diabetes mellitus)
-5-10% of diabetes in the US
-_______
-severe/absolute deficiency of production
–mainly in _______
-destruction of pancreatic beta cells
–no circulating ______
–______ like response of the body
–_______ and ______ occur
–constant delivery of glucose to the ____
–muscle breakdown and amino acids fuel gluconeogenesis
-adipose tissue: _____ which form _______ which c ause serum ______ depletion
–__________ results

A
autoimmune
juveniles
insulin
starvation
glycogenolysis, gluconeogenesis
blood
ketones
acetocetates
bicarbonate
metabolic acidosis
8
Q
Diabetes Mellitus
Type 1 diabetes
-clinical features
-tired, unwell
-\_\_\_\_ loss: inability to thrive
-polyuria,  polydipsia, prone to \_\_\_\_\_\_\_
-extreme: \_\_\_\_\_\_\_\_ respirations/ \_\_\_\_\_\_\_\_ emesis

management: insulin
- ______ insulin , at the time of diagnosis to maintain acceptable levels of glycosylated ______ and avoid ________

A
weight
ketoacidosis
kussmaul
coffee ground
exogenous
hemoglobin
ketoacidosis
9
Q

Type 1 Diabetes Mellitus

  • management: insulin (injected)
  • IV or IM or SC (long term)
  • -human insulin (Humulin) recombinant DNA
  • is less ________ ,shorter duration of action than animal preparations
  • start with lower doses to avoid _______, adjust dose upwards
  • optimum control, regular insulin should be administered 20 to 30 mins ____ meals
  • continuous subcutaneous insulin infusion, provides better. ____ but more expensive
  • insulin occurs in the ______ complexed with _____
A
immunogenic
hypoglycemia
before
control
pancreas
zinc
10
Q
Insulin Preparations
Injected:
-rapid acting: insulin \_\_\_\_\_; insulin \_\_\_\_\_\_ (ultra-short)
-short-acting: \_\_\_\_\_\_
-intermediate-acting: \_\_ (isophane) \_\_\_\_ (insulin Zn)
-long-acting - \_\_\_\_\_; insulin \_\_\_\_\_\_\_
-pre mixed combinations
-50% NPH/ 50% regular
-70% NPH/ 30% regular
SC absorption - abdominal wall, arm, buttock, thigh
-inhaled: Exubera
beef/pork insulin are no longer produced
A
lispro
aspart
regular
NPH
Lente
Ultralente
Glarginine
11
Q

Insulin - adverse effects
Hypoglycemia
Very common, more frequent in patients on tight diabetic control
–missed _____, unusual amounts of exercise
–hypoglycemic unawareness
-mild hypoglycemia: _____, _____ tachycardia, ______, sensation of weakness
severe hypoglycemia:
-_______; altered ______; disorientation progression to seizures and coma
-unconcious patient - 1 mg of _____ im/sc followed by intake of _________
-glucagon not effective in _______ patients or _________ hypoglycemia - IV of 5-% dextrose

A
meals
sweating, tremors
hunger
confusion
behavior
glucagon
malnourished
alchohol induced
12
Q

Insulin adverse effecs -
-localized fat ______ at injection site
-________-
-result of frequent reutilization of the same injection site
allergic reactions:
-____ with human insultin
-uticaria, angioedema rashes, local erythema
-immune-mediated insulin resistance
-production of anti-insulin antibodies, rare with uman insulin

A

hypertrophy
lipodystrophy
RARE

13
Q

Type 2 Diabetes

  • non-insulin dependent diabetes mellitus
  • late adult onset; 90% of diabetes
  • overall insulin production is decreased by up to __%
  • sufficient insulin to prevent ________
  • tissue insensitivity or tissue resistance
  • _____ is a major factor
  • ______ predisposition 95% concordance in identical twins
A

50%
ketoacidosis
obesity
genetic

14
Q

Diabetes Mellitus
Type 2 Diabetes
-deficiency in ___ cell response to glucose
-tissue _____ and impaired _ cell response
-initial management by ___ and ___
-pharmalogical management indicated when ____ reduction fails to correct hyperglycemia

A
B
insensitivity
B
diet, exercise
weight
15
Q
Antidiabetic Drugs
Oral:Secretagogues
Sulfonylureas: Tolbutamide, Glyburide
Biguanides: Metformin
Meglitinides: Repaglinide; Nateglinide
Alpha glucosidase Inhibitors: Acarbose; Miglitol
Glitazones: Rosiglitazone; Troglitazone
Dipeptidyl peptidase 4 inhibitors: Sitagliptin; Saxagliptin 

Injected
Incretin mimetics: Exenatide; Liraglutide
Amylinomimetics: Pramlinitide

A

idk

16
Q

Oral Antidiabetic Drugs
Sulfonylureas
-_______ derivatives
-Increase release of ______ from a functioning pancreas
-Binds to sulfonylurea receptor associated with  cells
-Inhibits efflux of ______ ions
-Results in depolarization, which cause _____ influx, promoting insulin release
-_________ also increases sensitivity to Insulin

A
sulfonamides
insulin
potassium
calcium
Glimiprimide
17
Q

Oral Antidiabetic Drugs

  • Well absorbed ______, metabolized by liver and excreted in urine
  • Sulfonyureas - Adverse effects
  • ________
  • -Skipping or delaying meals; inadequate ingestion of carbohydrates, renal or hepatic diseases
  • Skin rash, nausea, vomiting,
  • Cholestatic jaundice more frequent with _________
  • _______ like reaction may occur with alcohol
  • Which antimicrobial drug produces a ‘dilsulfiram like reaction?’ _________
  • Allergy: Cross-sensitivity with sulfa drugs
A
orally
hypoglycemia
chlorpropamide
disulfuram
metronidazole
18
Q

Oral Antidiabetic Drugs
Biguanides
_________(Glucophage)
-Only biguanide approved for use in US
-Decrease hepatic _____ production
-Lower glucose absorption and enhance _____-mediate glucose uptake
-Used alone it does not cause _______
-May potentiate the hypoglycemic effects of Insulin and Sulfonyureas
-Increases tissue sensitivity to insulin
-Biguanides do not depend on a _________ pancreas for their action

A
metformin
glucose
insulin
hypoglycemia
functioning
19
Q

Oral Antidiabetic Drugs
Meglitindes
Repaglinide (Prandin) and Nateglinide
-Only in pts with _________ pancreatic cells
-Short acting, should be taken only with or before meals
-Fasting glucose usually _____ after about a month of regular use
-Act on the ________ channel and cause closing of this channel, thus stimulating Insulin release
-_________a is the main side effect if meal is skipped
NSAIDS, Azoles and Macrolides may potentiate the effects of -Meglitinides by decreasing breakdown

A

pancreatic
drops
potassium
hypoglycemia

20
Q

Oral Antidiabetic Drugs
Thiazolinediones (TZDs)
Rosiglitazone (Avandia) and Pioglitazone (Actos)
-Mechanism:
activate ______ (Peroxisome proliferator-activated receptor- gamma : Gene expression)
-increase _____ insulin sensitivity
-Increase _______ transport
-inhibit hepatic Gluconeogenesis
-increase peripheral glucose uptake
-enhance ___ cell sensitivity
-Thiazolinediones carry a ‘Black Box’ warning for ___ and __

A
PPAR-y
tissue
glucose
fat
CCF
MI
21
Q
Oral Antidiabetic Drugs
Thiazolinediones (TZDs)
Rosiglitazone (Avandia) and Pioglitazone (Actos)
Adverse effects: 	 
\_\_\_\_\_\_\_\_\_
-Fluid retention, exacerbation of heart failure
-Dose-related weight \_\_\_\_
-Hepatitis, elevated hepatic enzymes
-Ovulation in some perimenopausal anovulatory women
Drug Interactions:
-Decrease the blood levels of \_\_\_\_\_\_\_\_
-May inactivate Oral contraceptives
A

cardiovascular
gain
midazolam

22
Q

Oral Antidiabetic Drugs
a-glucosidase inhibitors: Acarbose and Miglitol
-a-glucosidase enzyme
Present in the intestinal brush border
-Cleaves complex C12H22O12 to yield simple Glucose
-Aids in the absorption of starch and polysaccharides
-Maltase, isomaltase, sucrose
Adverse effects: Flatulence, dyspepsia and pain
Contraindicated in _______

A

IBD