Flashcards in Exam 2 Study Guide Diabetes Deck (40):
1
What is Diabetes?
Relative or absolute deficiency of insulin causing glucose intolerance.
Fasting sugar >126 mg/dL
75gm glucose tolerance test: >200mg/dL after 2 hours
hb1Ac >6.5%
2
What are diabetes statistics?
8-9% of US population
73000 die per year
about 50% undiagnosed
14% of population is prediabetic
3
What are the functions of insulin?
Promote glucose and amino acids through membrane of all muscle cells, fibroblasts, FAT cells.
*anabolic hormone
4
Insulin doesn't affect glucose reuptake in...
neurons
kidney
RBC's
5
insulin and C-peptide are secreted from B cells in pancreas in response to ...
Glucose
6
Consequences of Diabetes....
-Increased lipolysis = blood ketosis and increase triglycerides
- Increased glycogenolysis and gluconeogenesis
-anabolic effect (Muscle wasting)
7
Type 1 diabetes is found in
in young patients who lose islet beta cells
8
Characteristics of Type 1 Diabetes...
No insulin
loss of beta cells from autoimmunity (virus)
Ketoacidosis
9
Characteristics of Type 2 Diabetes
Insulin resistant
Excessive Visceral fat
Older (starting to see more younger)
minimal ketoacidosis but high glucose
Indians, hispanics, and african-americans = higher risk
10
Type II diabetes is also known as a ...
Metabolic Syndrome (X)
(a group of risk factors that increase chance of heart disease, diabetes, and stroke
11
What is the pathogenesis of Type II Diabetes?
Visceral fat
impaired glucose metabolism and insulin sensitivity
Hepatic inflammation and cirrhosis
12
Major metabolic complications of Type II...
Very high glucose
Hyperosmolar consequences (Coma)
Brain Swelling
13
What is Gestational Diabetes?
diabetes in pregnant women due to dress of pregnancy
(3-10%)
14
Consequences of Gestational Diabetes...
-insufficient placental function
-abnormally large babies w/ excessive insulin secretion and early hypoglycemia causing malformations.
-can become Type II later in life
15
What are the 4 oral problems of diabetics?
Gingivitis and Periodontitis
Poor wound healing
Abnormal infections (Candidiasis)
Xerostomia
*make sure patients avoid hypoglycemia.
16
What treatment is used for Type 1 and advanced Type II?
Insulin replacement therapy
(try to replicate natural insulin patterns)
17
What is the most common dose of Insulin?
U-100
18
Insulin can be obtained by which 2 ways?
Genetically modified e-coli. (Humulin)
or cow and pigs for special cases
19
What are the different types of insulin?
Rapid acting
Short acting
NPH (natural protein hagedorn)
Insulin Glargine
Insulin determir
20
What is characteristic of Rapid acting insulin?
-Rapid onset, early peak onset, 4 hour duration
-Taken immediately before a meal
21
What is an example of Rapid acting insulin?
Lispro (Humalog)
22
What is characteristic of Short acting insulin?
-Crystalline zinc helps to delay onset and lengthen duration
-30 min onset, peaks 2-3 hours, lasts 5-8 hours
23
What is characteristic of NPH insulin?
-immediate acting
-delayed absorption and onset (linked peptide protamine)
-Onset 2-5 hours
-Duration 4-12 hours
-often mixed with other insulins for immediate and sustained needs
24
What is characteristic of glargine insulin?
Long acting sustained insulin
good background insulin
25
What is characteristic of determir insulin?
Long acting
Background insulin
26
What are the two means of insulin delivery?
S.c. Injection
Continuous S.c. infusion (pump)
27
Side effects of Insulin...
-Hypoglycemia
Tachycardia
Perspiration
Tremors
Hunger
Confusion
Seizures
Coma
-Local irritation and subdermal atrophy
28
What are hypoglycemic drugs for Type II DM?
Insulin Secretagogues
Biguanides
DPP 4 Inhibitor/Stigaliptin
29
How do insulin secretagogues work?
Increase the release of insulin from beta cells
30
What are examples of insulin secretagogues?
Sulfonylureas
- Tolbutamide (Orinase)
- glipizide
- glitinides (Prandin)
31
What are side effects of insulin secretagogues?
hypoglycemia and weight gain
(bind to plasma proteins and can be dislodged by other drugs binding at the same sites)
32
How do Biguanides work?
not fully understood; decreases glucose production in the liver and increases efficiency of insulin binding.
33
What are examples of Biguanides?
Mefromin-Glucophage
34
Benefits of Metformin...
Insulin sparing (no hypoglycemia)
May prevent CVS effects of type II DM
35
Side effect of Biguanides...
Gi irritation
36
How do DPP-4 inhibitors work?
Slows the inactivation of incretin hormones which in turn, through glucose-dependent insulin tropic polypeptide (GIP) and glucagon like peptide-1, stimulates insulin synthesis and release.
*Increases storage of glucose and reduces glucagon activity leading to reduced hepatic glucose production and release.
37
What is and example of a DPP-4 Inhibitor?
sitagliptin (Januvia)
38
What does Acabose do to treat T II DM?
-slows digestion and absorption of starch, disaccharides from small intestines
-may help prevent Type II DM
*GI irritation (Bloating)
39
What do Thiazolidinediones such as rosiglitazone do to treat Type II DM?
Reduces insulin resistance (especially fat and muscle cells)
40