Hormones and Diabetes (Chapter 14) Flashcards Preview

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Flashcards in Hormones and Diabetes (Chapter 14) Deck (132):
1

what are the two thyroid hormones ?

T3 triiodothyronine
T4 thyroxine

2

what effect do thyroid hormones have on basal metabolic rate ?

increase it

3

what effect do thyroid hormones have on protein synthesis and catabolism ?

increase both

4

what are the main symptoms of hyperthyroidism?

excitability, sweating, weight loss, nervousness, tremor

5

what are the main symptoms of hypothyroidism?

somnolence, muscular sluggishness, slow HR, increased weight

6

depressed growth of hair- hyper or hypothyroidism?

hypo

7

decreased blood volume and CO- hyper or hypothyroidism?

hypo

8

what are 4 reasons hyper or hypo-thyroidism may occur ?

autoimmunity
cancer
diet
bad genetics

9

how can autoimmunity cause hypothyroidism?

destruction of thyroid gland

10

how can autoimmunity cause hyperthyroidism?

errant stimulation of thyroid receptors (Grave's disease)

11

how can cancer lead to hyperthyroidism?

tumor of thyroid gland

12

how can diet cause hypothyroidism

lack of iodine

13

what are goiters? in what disease do they occur ? what do they result in

large protrusions in neck, can occur from hyper or hypothyroidism. result in higher level of TSH activity

14

what kind of drugs treat hypothyroidism?

T3 and T4 drugs taken orally
usually T4 drug taken

15

what is the most popular drug given to treat hypothyroidism?

levothyroxine (T4)

16

how long does it take for a hypothyroidism drug to take effect

6-8 weeks

17

what kind of substances will decrease T4 absorption?

calcium, aluminum antacids

18

how drugs will enhance destruction of T3, T4 hormones ?

those that induce cytochrome p450

19

what are adverse effects of drugs against hypothyroidism?

similar to hyperthyroidism symptoms (nervousness, tachycardia, weight loss)

20

what are the 2 treatments for hyperthyroidism

destruction of thyroid gland by thyroidectomy or radioactive iodine (may become hypothyroid and need T4)

inhibit thyroid hormone synthesis with thioamide drug

21

what is the main goal of birth control ?

inhibit ovulation and fertilization

22

what are the two types of oral birth control?

combined oral contraceptive pill (estrogen and progestogen) OR progestogen-only.

23

what ingredient in high dosage is in the morning after pill ?

progestin

24

what are major adverse effects of birth control? (6)

breast fullness
fluid retention
depression
headache
nausea
vomiting

25

who is contraindicated for birth control? (5)

people at risk of thrombosis
estrogen-dependent cancer
liver disease
pregnancy
heavy smokers over 35

26

what condition is common in menopause ?

estrogen deficiency

27

what is estrogen therapy for ?

estrogen deficiency in menopause

28

what are the adverse effects of estrogen therapy ?

although smaller doses than in birth control, same adverse effects

29

what drugs can stimulate estrogen receptors?

selective estrogen-receptor modulators can be agonists of antagonists of estrogen
used to treat various estrogen-related diseases

30

what are androgens ?

anabolic steroids with masculinizing effects

31

where are androgens produced ?

in testes or in ovaries

32

what are three examples of androgens from testes ?

testosterone, DHT, DHEA

33

what are 4 uses of androgens ?

therapeutic uses:
- males with hypogonadism
- osteoporosis
- endometriosis

non-therapeutic:
-cheating in sports

34

which androgen is an anti-ager that may increase performance

DHEA

35

what are adverse effects of androgens ?

heart disease, mood disorders, etc

36

what drug treats gigantism and acromegaly ?

somatomedin drug

37

what is a somatomedin drug ?

a formulation of a hormone that suppresses growth hormone

38

what are adverse effects of using growth hormone in the face ?

protrusion of jawbone and forehead

39

what are adverse effects of using growth hormone in the extremities ?

joint pain, carpal tunnel syndrome, continued growth of soft tissues

40

what drug do athletes use even though there is no adequate research showing that it can provide benefits ?

human growth hormone

41

gestational diabetes leads to which kind of diabetes ?

type II

42

what is the age of onset of type I diabetes ?

usually in 20s

43

which type of diabetes is insulin-dependent ?

type I

44

what proportion of the diabetes patients do type I patients represent ?

10%

45

what proportion of the diabetes patients do type II patients represent ?

90%

46

what is the age of onset of type II diabetes ?

usually 40s

47

which cells release insulin ?

the beta-islet cells of pancreas

48

what is the normal response to high blood glucose ?

high blood glucose
this is sensed by the beta cells in islets of Langerhans in pancreas
insulin is released and interacts with insulin receptors on tissues
insulin receptors cause glucose transporters to become active and glucose is uptaken into the tissue

49

what is the only tissue that glucose is not transported into with the help of insulin ?

brain

50

what is the effect of insulin on glycogen storage ?

insulin will cause the formation of glycogen in the liver

51

what is the effect of insulin on fat ?

insulin will increase fat storage

52

what is the fancy word for post-meal ?

post-prandial

53

insulin helps to maintain blood glucose at what fasting and post-meal level ?

fasting: <100mg/dL
post meal: <120mg/dL

54

what is the main thing insulin does in the blood ?

it gets rid of everything: glucose gets uptaken, amino acids get uptaken, and FFA get stored into fat

55

what is the pathophysiology of type I diabetes ?

the beta islets of the pancreas get damaged and destroyed by an autoimmune disease, and insulin is not produced at sufficient levels.

56

what explains the high level of peeing, as well as weight loss and hunger as a symptom in type I diabetes ?

the blood glucose rises and it cannot be used by tissues or stored as glycogen or fat because there is not enough insulin to facilitate that. therefore, it acts as a diuretic: the kidney starts excreting it in the urine. This causes a loss in calories meaning that the person loses weight and becomes hungry more often.

57

what explains diabetic ketosis ?

since the tissues can't use glucose appropriately, they start using fat instead, which leads to an increase in ketoacids.

also, low insulin means the brain tricks itself into thinking there is low glucose. because of this, there is more gluconeogenesis and FFA are released to make ketoacids for the brain to utilize. this increases the blood glucose and contributes to ketosis, increasing the acidity of blood, and acetone is produced which produces a weird fruity smell.

58

what is the pathophysiology of type II diabetes, by stages?

insulin receptors do not work properly. islet cells may be working just fine.

the pancreas makes extra insulin because insulin isn'w working. this leads to insulin resistance in the tissues.

the disease develops, and over time the pancreas gets burnt out because it's producing too much insulin, and stops working, therefore resembling type I diabetes.
at this point insulin injections are needed.

59

what type of diabetes does ketoacidosis happen in ?

only type I

60

what type of diabetes often goes undiagnosed for years ?

type II

61

what are the 4 hormones involved in diabetes ?

insulin
incretin
glucagon
amylin

62

what do incretins do ?

modulate insulin release, increase insulin release after eating, before blood glucose levels get elevated

63

what does glucagon do ?

its effect is opposite to insulin, and it works to raise blood glucose levels

64

what does amylin do ?

slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels.

65

what are cardiovascular long term implications of diabetes ?

hypertension, heart disease, stroke

66

what are musculoskeletal long term implications of diabetes ?

diminished sensation in hands and feet
amputation
foot infections

67

what are face long term implications of diabetes ?

retinopathy
periodontal disease (gums)

68

what are the two causes of type I diabetes ?

environmental and genetic

69

what are the four causes of type II diabetes ?

genetic
obesity
sedentary lifestyle
old age

70

what are the four diagnostic tests for diabetes ?

glycosylated hemoglobin : HbA1c <7% is goal, indicative of plasma glucose concentration

fasting plasma glucose levels

two hour plasma glucose levels (after ingesting glucose)

symptoms of hyperglycemia

71

what are the three poly symptoms of uncontrolled diabetes ?

polyuria
polyphagia (increased appetite)
polydipsia (increased thirst)

72

what are the main non drug control of type II diabetes ?

diet and exercise

73

what is the dietary strategy for control of type II diabetes ?

control protein intake
lower saturated fat intake
reduce carbs, cholesterol

leave vitamins and minerals

74

why is exercise important in diabetes type II ?

improves glucose uptake by muscles and reduces risk of cardiovascular complications

75

what are the excluding factors for exercise in diabetes ?

neuropathy or retinopathy

76

can diabetics participate in sports ?

yes if they have good glycemic control

77

what is the rapid/short acting treatment for type I diabetes

intravenous injection of insulin, used for postprandial glycemic control, but injected before the meal

78

what kind of dose is the rapid/short acting treatment for type I ?

a "bolus" loading dose

79

what is the intermediate acting/long acting treatment for type I diabetes ?

subcutaneous injection
after meal

80

what kind of dose is the intermediate/long acting treatment for type I ?

maintenance dose

81

what is the major adverse effect of insulin injection ?

hypoglycemia

82

what is hypoglycemia in diabetes treatment due to usually ?

a calculation error or an unplanned change in diet and exercise

83

what 2 drugs can affect blood glucose and lead to hypoglycemia ?

beta blockers and alcohol which decrease glucose release from liver

84

what 3 drugs can cause hyperglycemia ?

corticosteroids, nasal decongestants, beta-agonists

85

what drugs are used for type II diabetes (general)

orally administered+ insulin sometimes

86

what do sulfonylureas do ?

increase insulin release from pancreas

87

what are sulfonylureas called ?

insulin secretagogues

88

what do glinides/meglitinides do ?

stimulate pancreas to release insulin

89

which type II oral drug has a shorter effect ?

glinides/meglitinides

90

what do biguanides do ?

reduce release of glucose from liver

91

what is an undesirable effect of biguanides ?

lactic acidosis

92

when does drug therapy commence in type II diabetes ?

after a person eats healthy for 3 months and blood glucose still unhealthy

93

what does the lab test for A1C show ?

avg glucose levels for past three months

94

what does a blood glucose monitor show ?

current glucose levels

95

what is the goal of treating type II diabetes ?

bringing A1C to 7% in 6-12 months

96

what should be blood glucose goals before meals and 2 hours after for 7% A1C in 6-12 months ?

before: 4-7 mmol/L
after: 5-10 mmol/L

97

what should be blood glucose goals before meals and 2 hours after for 6% A1C in 6-12 months ?

before: 4-6 mmol/L
after: 5-8 mmol/L

98

what are the advantages of biguanides ?

they don't cause weight gain or hypoglycemia

99

what is an example of a biguanide ?

metaformin

100

what is an example of an insulin sensitizer ?

rosiglitazone

101

what do insulin sensitizers do ?

make tissue more able to use glucose

102

if blood glucose is very high, which two drugs will be combined and to what effect ?

insulin sensitizers with metamorfin (biguanide)
which will make tissue more able to use glucose and help liver decrease glucose production

103

do insulin sensitizers cause hypoglycemia ?

no

104

what are the two kind of insulin secretagogues ?

sulfonylureas and non-sulfonylureas

105

what drugs can cause hypoglycemia ?

alpha-glucosidase inhibitors

106

what is an example of an alpha-glucosidase inhibitor ?

prandase

107

what do alpha-glucosidase inhibitors do ?

prevent digestion of carbohydrates that are usually broken down into simple sugars that can increase blood sugar

108

what do anti obesity drugs help with in type II diabetes ?

decrease absorption of fat in intestine

109

what is an example of an anti-obesity drug ?

xenical

110

what is insulin used for in type I and type II

type I: insulin dependent for life
type II: used as needed, and in combination with pills

111

what is the goal of insulin regimen ?

to mimic insulin secretion in people without diabetes

112

what are some suggestions an AT may have for a diabetic (5)

write down medicines in schedule
write down problems with therapy to discuss later
medic alert bracelet
exercise with friend
take care of feet and have foot exams

113

what is crucial for good glycemic control in type I diabetes ?

insulin preparations

114

what are the 4 categories of insulin preparations ?

rapid, short acting, intermediate acting, and long acting

115

what are the properties of rapid acting insulin preparations ?

fastest onset and shortest duration of action

116

what are the properties of long acting insulin preparations ?

slowest onset and longest duration of action

117

what is the color, onset, peak, and duration of rapid acting insulin ?

clear

onset: 10-15 minutes
peak: 60-90 minutes
duration 4-5 hours

118

what is the color, onset, peak, and duration of short acting insulin ?

clear
onset: 0.5-1 hr
peak: 2-4
duration: 5-8

119

what is the color, onset, peak, and duration of intermediate acting insulin ?

cloudy
onset: 1-3 hrs
peak: 5-8
duration: up to 18

120

what is the color, onset, peak, and duration of long acting insulin ?

clear
onset: 90 min
peak: none/flat
duration: 24 hrs

121

why can't insulin be given orally ?

because it is a polypeptide, so it would just get broken down into aminoacids in the stomach

122

what is basal or bolus insulin ?

bolus= for rapid-acting and short-acting insulin
A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used.
basal= for intermediate acting and long-acting insulin
The role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting.

123

what is premixed insulin?

a single vial that contains a fixed ratio of insulins with a combination of basal or bolus insulins

124

when is rapid-acting insulin taken ?

right before eating or to lower high blood glucose

125

what are two examples of rapid acting insulin ?

humalog (insulin lispro)
novorapid (insulin aspart)

126

when is short acting insulin taken ?

30 minutes before eating or to lower high blood glucose

127

what are two examples of short acting insulin ?

humulin
novolin

128

when is intermediate acting insulin taken ?

bedtime, or twice a day

129

give two examples of intermediate acting insulin ?

humulin
novolin

130

when is long acting insulin taken ?

once or twice a day

131

two examples of long acting insulin ?

lantus (insulin glargine)
levemir (insulin detemir)

132

3 examples of premixed insulin ingredients ?

humalog, humulin (more short acting) with novolin (intermediate acting) in different ratios