Flashcards in Exam 2 Study Guide Diabetes Deck (40):
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
What are diabetes statistics?
8-9% of US population
73000 die per year
about 50% undiagnosed
14% of population is prediabetic
What are the functions of insulin?
Promote glucose and amino acids through membrane of all muscle cells, fibroblasts, FAT cells.
Insulin doesn't affect glucose reuptake in...
insulin and C-peptide are secreted from B cells in pancreas in response to ...
Consequences of Diabetes....
-Increased lipolysis = blood ketosis and increase triglycerides
- Increased glycogenolysis and gluconeogenesis
-anabolic effect (Muscle wasting)
Type 1 diabetes is found in
in young patients who lose islet beta cells
Characteristics of Type 1 Diabetes...
loss of beta cells from autoimmunity (virus)
Characteristics of Type 2 Diabetes
Excessive Visceral fat
Older (starting to see more younger)
minimal ketoacidosis but high glucose
Indians, hispanics, and african-americans = higher risk
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
What is the pathogenesis of Type II Diabetes?
impaired glucose metabolism and insulin sensitivity
Hepatic inflammation and cirrhosis
Major metabolic complications of Type II...
Very high glucose
Hyperosmolar consequences (Coma)
What is Gestational Diabetes?
diabetes in pregnant women due to dress of pregnancy
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
What are the 4 oral problems of diabetics?
Gingivitis and Periodontitis
Poor wound healing
Abnormal infections (Candidiasis)
*make sure patients avoid hypoglycemia.
What treatment is used for Type 1 and advanced Type II?
Insulin replacement therapy
(try to replicate natural insulin patterns)
What is the most common dose of Insulin?
Insulin can be obtained by which 2 ways?
Genetically modified e-coli. (Humulin)
or cow and pigs for special cases
What are the different types of insulin?
NPH (natural protein hagedorn)
What is characteristic of Rapid acting insulin?
-Rapid onset, early peak onset, 4 hour duration
-Taken immediately before a meal
What is an example of Rapid acting insulin?
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
What is characteristic of NPH insulin?
-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
What is characteristic of glargine insulin?
Long acting sustained insulin
good background insulin
What is characteristic of determir insulin?
What are the two means of insulin delivery?
Continuous S.c. infusion (pump)
Side effects of Insulin...
-Local irritation and subdermal atrophy
What are hypoglycemic drugs for Type II DM?
DPP 4 Inhibitor/Stigaliptin
How do insulin secretagogues work?
Increase the release of insulin from beta cells
What are examples of insulin secretagogues?
- Tolbutamide (Orinase)
- glitinides (Prandin)
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)
How do Biguanides work?
not fully understood; decreases glucose production in the liver and increases efficiency of insulin binding.
What are examples of Biguanides?
Benefits of Metformin...
Insulin sparing (no hypoglycemia)
May prevent CVS effects of type II DM
Side effect of Biguanides...
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.
What is and example of a DPP-4 Inhibitor?
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)
What do Thiazolidinediones such as rosiglitazone do to treat Type II DM?
Reduces insulin resistance (especially fat and muscle cells)