Week 7- Drugs that control blood glucose Flashcards
(112 cards)
1
Q
Is the pancreas an endocrine or exocrine gland?
A
both endocrine and exocrine
2
Q
Where are the endocrine hormones of the pancreas produced?
A
Produces hormones in the islets of langerhans
3
Q
What exocrine function does the pancreas gland have?
A
- releases sodium bicarbonate and pancreatic enzymes into the common bile duct to be released into the small intestines
- neutralizes chyme
4
Q
What ethnicities are as higher risk for diabetes?
A
hispanic, asian, aboriginal and …
5
Q
What is insulin?
A
- Hormone produced by the beta cells of the islets of Langerhan
- Released into circulation when glucose levels around the cells rise
6
Q
What does insulin do?
A
- Released when glucose levels increase around the cells
- Stimulates the synthesis of glycogen, the conversion of lipids into adipose tissue and the synthesis of needed protein from amino acids
7
Q
Define hyperglycemia in occurrence of insufficient insulin
A
increased blood sugar
8
Q
Define glycosuria in occurrence of insufficient insulin
A
Sugar in the urine
9
Q
Define polyphagia in occurrence of insufficient insulin.
A
Increased hunger
10
Q
Define polydipsia in occurrence of insufficient insulin.
A
increased thirst
11
Q
Define lipolysis in occurrence of insufficient insulin.
A
Increased breakdown of fats
12
Q
Define ketosis in occurrence of insufficient insulin
A
ketones cannot be removed effectively
13
Q
Define acidosis in occurrence of insufficient insulin.
A
lover cannot remove all of the waste products
14
Q
What are the metabolic changes that occur when there is insufficient Insulin released?
A
Hyperglycemia Glycosuria Polyphagia Polydipsia Lipolysis Ketosis Acidosis
15
Q
What is Diabetes Mellitus?
A
- Complex disturbance in metabolism that affects carbs, proteins and fat metabolism
- Signs: hyperglycaemia & glucosuria
16
Q
What is normal glucose?
A
4-6 mmol/L
17
Q
Consideration when checking for glucosuria…
A
in pregnancy it is common to have glucose in the urine
18
Q
Define Atherosclerosis.
A
heart attach and stroke related to the development of atherosclerotic plaque in the vessel lining
19
Q
Define retinopathy
A
with resultant loss of vision as tiny vessels in the eye are narrowed and closed
20
Q
Define neuropathies
A
with motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen is cut off
21
Q
Define nephropathy.
A
with renal dysfunction related to changes in the basement membrane off the glomerulus
22
Q
What are some disorders related to diabetes?
A
- Atherosclerosis (macrovascular change)
- Retinopathy (microvascular change)
- Neuropathies
- Nephropathy
23
Q
How do you minimize associated disorders with diabetes?
A
tight glucose control
24
Q
What are the classifications of diabetes mellitus?
A
Type 1- Insulin dependant diabetes mellitus (IDDM)
Type 2- Non-insulin dependent diabetes mellitus (NIDDM)
25
What are the characteristics of type 1 DM?
- usually a rapid onset; seen in younger people
| - connected in many cases to viral destruction of the beta cells of the pancreas
26
What are the clinical signs and symptoms of hyperglycaemia?
fatigue, lethargy, irritation, glucosuria, polyphagia, polysipsia, skin itching
27
What is more common, type 1 or type 2 DM?
type 2
28
What is type 2 DM caused by?
insulin deficiency and insulin resistance (reduced number of insulin receptors, or less responsive insulin receptors)
29
First line treatment for Type 2 diabetes is...
lifestyle changes
30
What things make you more susceptible to developing type 2 diabetes?
- Increased risk African, aboriginal, south Asian
- Gestational diabetes means you are more likely to develop type 2
- Polycystic ovarian system are more likely to develop type 2
- Cortical steroids and antipsychotics increase risk
- High glycemic index and low exercise increase risk
31
What is OGTT?
oral glucose tolerance test
| - for diagnosis of of DM 2hPG in a 75g OGTT would be greater than or equal to 11.1 mmol/L
32
What is A1C?
- gives an average of blood glucose control over 2-3 months
| - for diagnosis of DM, would be greater than or equal to 6.5% in adults
33
What is FPG?
fasting concentration of blood glucose (fasting meaning no caloric intake for at least 8 hr)
- for diagnosis of DM would be greater than or equal to 7.0 mmol/L
34
What is random PG
testing glucose concentration any time of day with out regards to the last meal
- for diagnosis of DM would be greater than or equal to 11.1 mmol/l
35
For a diagnosis of DM what criteria is met?
- for diagnosis of of DM 2hPG in a 75g OGTT should be greater than or equal to 11.1 mmol/L
- for diagnosis of DM, would be greater than or equal to 6.5% in adults
- for diagnosis of DM would be greater than or equal to 7.0 mmol/L
- for diagnosis of DM would be greater than or equal to 11.1 mmol/l
36
What type of weight puts you at higher risk of developing DM?
abdominal obesity
37
For controlling DM what are the recommendations for glucose control?
- A1C less than or equal to 7%
- Preprandial (before eating) PG between 4-7 mmol/L
- 2-h postprandial PG between 5-10 mmol/L (5-8 mmol/L if AIC is not at target)
38
What does prandial mean?
relating to meals
39
What are the normal glucose ranges?
Normal ranges:
- Fasting glucose 4-6 mmol/L
- 2h after eating glucose should be 5-8mmol/L
40
What are the treatments for DM type 1?
- Characterized by a lack of insulin production or the production of defective insulin
- Insulin therapy
- Oral antidiabetic drugs are not effective
41
What are the treatments for DM type 2?
- Lifestyle changes
- Oral drug therapy (help your pancreas start releasing it)
- Insulin when the above no longer provide glycemic control
42
When are oral anti diabetic medications not effective?
When beta cells are not working
43
What are the routes for insulin?
```
Routes for insulin
SC
IV
IM
Pump
```
NO INSULIN ORALLY- gets digested and is ineffective
44
What are the different types of anti diabetic drugs?
- insulins
| - oral hypoglycemic drugs
45
What is the action of insulin?
- Hormone that promotes the storage of the body’s fuels
- Facilitates the transport of various metabolites and ions across cell membranes
- Simulates the synthesis of glycogen from glucose
- Reacts with specific receptor sites on the cells
46
What are the indications for insulin treatment?
- Treatment of type 1 diabetes mellitus
| - Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents
47
What are the contraindications or cautions for insulin?
just one caution
| - pregnancy and lactation
48
What are the adverse effects of insulin treatment?
hypoglycemoia and ketoacidosis
49
What drugs do insulins interact with?
- when given with any drug that decreases glucose levels
| - beta blockers
50
What are the 4 categories of insulin?
Bolus (pradial) insulins
- Rapid-actng insulin analogues (clear)
- Short-acting insulins (clear)
Basal Insulins
- Intermediate-acting insulins (cloudy)
- Long-acting basal insulin analogue (clear)
51
Name the 3 types of Bolus insulins.
- insulin aspart (NovaRapid)
- insulin glulisine (Apidra)
- Insulin lispo (Humalog)
52
What is the onset, peak and duration of rapid-acting insulin analogues?
Onset 10-15m
Peak 1-1.5h
Duration 3-5h
with slight variation in Humalog
53
Name the 2 types of short acting insulins.
- Insulin regular (Humulin-N)
| - Insulin regular (Novolin geToronto)
54
What is the onset, peak and duration of short acting insulins?
Onset 30m
Peak 2-3h
Duration 6.5h
55
Name the 2 types of Intermediate-acting insulins (cloudy).
- Insulin NPH (Humulin-N)
| - Insulin NPH (Novlin ge NPH)
56
What is the onset, peak and duration of intermediate-acting insulins?
Onset 1-3h
Peak 5-8h
Duration Up to 18h
57
Name the 2 long-acting basal insulin analogues.
- Insulin determir (Levemir)
| - Insulin glargine (Lantus)
58
What are the onset, peak, and duration of Long acting basal insulin analogues?
Onset 90m
Peak n/a
Duration Up to 24h
59
Can you give rapid acting insulin IV
NO
60
Which insulins can you NOT mix?
Long acting insulin analogues
61
What is the only insulin that is given IV bolus, IV infusion, and IM?
Intermediate acting insulin-
| Insulin regular
62
When is basal insulin given?
once or twice a day
63
When is Bolus insulin given?
at meal times
64
What is hypoglycemia?
abnormally low blood glucose levels (below 4mmol/L if on insulin or secretagogue)
65
When can hypoglycemia occur?
- Starvation
- Lowering the blood sugar too far with treatment of hyperglycemia
- More physical activity
- Not eating on time
- Eating insufficient amounts
- Alcohol consumption
66
What kind of symptoms develop from hypoglycemia?
Neurogenic or neuroglycopenic symptoms
67
What are some Neurogenic (autonomic) symptoms of hypoglycemia ?
- Trembling
- Palpitations
- Sweating
- Anxiety
- Hunger
- Nausea
68
What are some Neuroglycopeic symptoms of hypoglycemia?
- Difficulty concentrating
- Confusion
- Weakness
- Drowsiness
- Vision changes
- Difficulty speaking
- Dizziness
69
What are the early symptoms of hypoglycemia?
- confusion, irritability, tremors, sweating
70
What are the later symptoms of hypoglycemia?
- hypothermia, seizures
| - coma and death
71
What is the severity scale for hypoglycemia?
Mild
- autonomic symptoms present
- individual is able to self treat
Moderate
- autonomic and neuroglycopenic symptoms
- individual is able to self treat
Severe
- Requires assistance of another person
- Unconsciousness may occur
- Plasma glucose is typically <2.8mmol/L
72
What are the steps to address hypoglycemia?
```
Recognize
Confirm
Treat (15g fast sugars)
Retest (15m)
Eat (usual snack/meal +15g carbs+protein)
```
73
What are some examples of 15g simple carbs?
- glucose tab
- 15ml (3tsp) or 3 packets of sugar
- 175ml juice or soft drink
- 6 life savers
- 1T honey (15ml)-not for children under the age of 1)
74
How do you treat severe hypoglycemia in a conscious person?
- Treat (20g)
- Retest in 15m (ensure BG>4.0mmol/L) retreat if necessary
- Eat (usual snack/meal +15g carbs+protein)
75
How do you treat severe hypoglycemia in a unconscious person?
- Treat glucagon SC or IM
- Call 911
- Discuss with diabetes health care team
76
What is the IV solution used in severe hypoglycemia?
- 50% dextrose in water (D50W)
77
What route would glycogen be given?
IM or SC
78
What is the action of glucose elevating agents (glucagon (GlucaGen))?
Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose
79
What is the indication for glucagon?
hypoglycemia
80
What are the pharmacokinetics of glucagon?
- rapidly absorbed and distributed throughout the body
| - excreted in the urine
81
What are contraindications and cautions of glucagon?
Contraindication: known allergy, pregnancy and lactation
Caution: hepatic dysfunction/CVD
82
What are the adverse effects of glucagon?
- GI upset and vascular effect
83
What are the drug to drug interactions of glucagon?
- thiazide diuretics
| - Anticoagulants
84
What blood glucose reading indicates that you should not be driving?
- BG>5mmol/L
| - When BG has been greater than 5mmol/L for 45 min then you can drive
85
What is hyperglycemia?
BG greater than 11mmol/L
| may happen during illness or stressful time
86
What are the signs of hyperglycemia?
```
Thirsty
Fatigue, lethary
Glycosuria
Polyphagia
Polydipsia
```
87
With high glucose reading you should ...
- adjust medication and/or insulin
- adjust meal plan
- increase physics activity
88
What are the signs of dangerous complications of hyperglycemia?
- fruity breath
- dehydration
- Kussmaul's resp
- loss of orientation and coma
89
What is a sliding-scale insulin dosing chart?
chart that indicates medication (SC short acting or regular insulin) dose to use based on glucose reading
90
What does TPN stand for?
total parenteral nutrition
91
When is a sliding-scale insulin dosing chart used?
typically used in hospital for patients on TPN or enteral tube feedings
92
What do you need to know about insulin injections?
- Need to know onset, peak, and duration of different types of insulin.
- Mixed insulin combine rapid and intermediate insulin together.
- Never shake insulin vials.
- Gently rotate cloudy insulin vials between hands to resuspend the particles.
- Regular insulin is the only insulin that is given IV.
93
When mixing 2 insulins what are the steps taken?
For an order of 30 units humulin N and 10 units humulin R
- Inject 30 units of air humulin N (intermediate)
- Inject 10 units of air humulin R (short)
- Withdraw 10 units of humulin R
- Finally with draw with the same syringe 30 units humulin N for a total volume of 40 units
94
Which insulin can you NOT contaminate short or long acting?
cannot contaminate short acting insulin
95
What is included in treatment of T2DM?
- oral antidiabetic meds (may only be effective with behaviour modification)
96
What are the 4 points on the T2DM checklist for pharmacotherapy?
- CHOOSE initial therapy based on glycemia
- START with METFORMIN +/- others
- INDIVIDUALIZE therapy (base on patient and agent)
- REACH TARGET within 3-6m of diagnosis
97
If initial A1C is less than 8.5% what are your treatment options?
Start metformin
OR
Reassess in 2-3 months then decide on starting metformin
98
If initial A1C is equal to or greater than 8.5% what are your treatment options?
Start metformin
AND
Consider combo therapy to achieve greater than or equal to 1.5% A1C reduction
99
What are the indications for biguanide (metformin (Glucophage)
adjunct to diet and exercise for the treatment of Type 2 diabetics older than 10 years of age
100
What is the action of metformin (Glucophage)?
may increase the peripheral use of glucose, increase production of insulin, decrease hepatic glucose production and alter intestinal absorption of glucose
101
What route are biguanides given?
PO
102
What are the adverse effects of metformin?
Hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn, allergic skin reaction
103
What do you consider when choosing treatment after metformin?
Patient characteristics
- Degree of hyperglycemia
- Risk of hypoglycemia
- Weight
- Comorbidities
- Access to treatment
- Patient preference
Agent Characteristics
- BG lowering efficacy &durability
- Risk of inducing hypoglycemia
- effect on weight
- contraindications and side effects
- cost and coverage
104
What is the action of sulfonylureas?
Stimulate insulin release from the beta cells in the pancreas
They improve binding to insulin receptors
105
What are the indications of sulfonylureas?
Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes
106
What are the pharmacokinetics of sulfonylureas?
- Rapidly absorbed from the GI tract and undergo hepatic metabolism
- Excreted in the urine
- Peak and duration varies with each drug
107
Who is contraindicated for sulfonylureas?
- Allergy
- Diabetic complications
- T1DM
108
What are the adverse effects of sulfonylureas?
Hypoglycemia
GI distress
Allergic skin reactions
109
What are the drug interactions of sulfonylureas?
- Drugs that acidifies the urine
- Beta blockers
- Alcohol
110
What considerations should you have for children taking anti diabetic agents
- schedule
- understanding/
teaching
- self-consepts
111
What considerations should you have for adults taking anti diabetic agents
- work schedule
| - reproduction
112
What considerations should you have for older adults taking anti diabetic agents
- comorbid conditions (arthritis etc)
