Diabetes Mjm

Front 1

Action of insulin

Back 1

inhibits glycogenolysis and gluoneogenesis
increases glucose transport into muscle
increases glycolysis in fat and muscle
stimulates glycogen synthesis

Front 2

factors that stimulate the release of insulin?

Back 2

glucose, mannose, sulfonylurea

Front 3

factors that amplify glucose induced insulin release?

Back 3

GLP-1, GIP, cholecystokinin, secretin, beta adrenergic stim

Front 4

inhibitors of insulin release?

Back 4

alpha adrenergics, somatostatins

Front 5

counter regulatory hormones?

Back 5

epi and norepi, released during sustained exercise. They stimulate hepatic glucose production and cause lipolysis to get FFAs to supply muscle with fuel

Front 6

can short term exogenous insulin be turned off?

Back 6

no, increases in temp and blood flow cause its release from skin

Front 7

food considerations when exercising and you a Diabetic?

Back 7

It is important to eat pre-wod. Slow releasing carbs are preferential for post workout meal. If possible consider food during wod

Front 8

what metabolic pathways must be coordinated after eating a meal?

Back 8

secrete adequate insulin, prevent rapid absorption of glucose, suppress hepatic glucose, insulin mediated muscle glucose absorption

Front 9

whats the dysfunction in DM?

Back 9

continued hepatic glucose production even when insulin is high, muscles are resistant to insulin effects, decreased insulin secretion for high glucose levels

Front 10

3 p's of dm?

Back 10

polyuria, polydypsia, polyphagia

Front 11

clinical presentation of someone with DM?

Back 11

skin ulcers/breaksdown, retinopathy, charcot foot, acanthosis nigricans, enlarged liver, obesity

Front 12

Type 1 DM?

Back 12

beta cells of pancreas are destroyed

Front 13

Type 2 DM?

Back 13

characterized by hyperglycemia, varying degrees of insulin deficiency/decreased secretion, insulin resistance

Front 14

Endocrine disorders associated with DM?

Back 14

increases in growth hormones, catacholamines, glucocorticoids, glucagon, somatostatin, hyperthyroid

Front 15

secondary causes of DM?

Back 15

thiazides (hypokalemia), steriods, PCP, B-cell injury

Front 16

syndrome x?

Back 16

metabolic syndrome characterized by abdominal obesity >40 in waist for men, triglycerides: > 150, HDL: < 40, BP >130/85, FBS >100

Front 17

How is vit D related to DM?

Back 17

as insulin goes down, DM goes up. 200% increase in ppl at high latitudes

Front 18

Normal FBS and OGTT?

Back 18

<100
<140 (2 hrs)

Front 19

pre-diabetic FBS and OGTT?

Back 19

100-125
140-199

Front 20

dx of dm is based on what 3 criteria?

Back 20

FBG: >126
OGTT: >200 after 1hr, >140 after 2
random glucose: >200
4th can be HgA1C: >6.9

Front 21

lab difference between type 1 and 2?

Back 21

???

Front 22

initial management for DM?

Back 22

educate, DM control, CV risk factors

Front 23

non-pharm DM therapy?

Back 23

diet, surgical therapy, exercise, intense lifestyle mod, psycho intervention

Front 24

who do give insulin to?

Back 24

type 1 diabetics, type 2 with fasting glucose of >280, gestational DM, as beta cell function declines

Front 25

Choice of insulin?

Back 25

if combined with orals use long acting only
if only insulin than you can combine long acting with short injections

Front 26

timing of insulin?

Back 26

give long acting (glargine, detemir) and NPH at bed time, usually only once a day unless no improvement.
Give shorts (lispro, aspart) at meal times

Front 27

insulin side effects?

Back 27

hypoglycemia
hyperglycemia

Front 28

Symogii phenomenon?

Back 28

AM hyperglycemia after too much insulin

Front 29

Dawn phenomenon?

Back 29

AM hyperglycemia due to too little insulin and elevated growth hormone

Front 30

Non insulin injectables?

Back 30

GLP-1 agonist: exanatide, liraglutide: stimulates insulin secretion decreasing fasting and post prandial gluc. good for type 2
pramlintide acetate: amylin analogue that slows gastric emptying and regulates glucagon. type 1 and 2

Front 31

use insulin first for?

Back 31

poorly controlled DM A1C>10, FBS >250, random>300

Front 32

MOA of metformin?

Back 32

works in the presence of insulin, decreases hepatic glucose, increases glucose use,

Front 33

Positives of metformin?

Back 33

promotes weight reduction

Front 34

contraindications of metformin?

Back 34

renal failure, liver failure, heart failure, alcohol abuse, pregnancy

Front 35

drug interactions with metformin?

Back 35

cimetadine, stop 24hrs before dye use

Front 36

sulfonylurea?

Back 36

glimepiride, glipizide, glyburide
Action: stimulates beta cells which enhances insulin secretion

Front 37

adverse effects of sulfonylurea?

Back 37

weight gain, pancreas burnout, hypoglycemia, skin rash, nausea,

Front 38

Alpha-glucosidase inhibitors?

Back 38

block enzymes that metabolize starches in the intestines, less effective with low carb diet.
cannot cause hypoglycemia alone, no weight gain

Front 39

action of meglitinides?

Back 39

stimulate insulin release when glucose is present

Front 40

adverse effects of meglitinide?

Back 40

hypoglycemia if taken without meal, meal has to have carbs, weight gain, nausea, back pain, not for use in liver dz and pregnancy

Front 41

Action of TZD or glitazones?

Back 41

increases insulin sensitivity in adipose, muscle and liver tissue to increase glucose utilization and decrease glucose production

Front 42

positives of TZD?

Back 42

no hypoglycemia, safe with renal failure, may have anti-inflammatory/anti-thrombotic effects

Front 43

Adverse effects of TZD?

Back 43

edema, weight gain, contraindicated in liver dz and heart failure

Front 44

Is TZD first line therapy?

Back 44

no

Front 45

incretin mimetics?

Back 45

GLP-1 receptor agonist: stimulates release of insulin (exenatide)
DDP-4 inhibitors: which stops the break down of GLP-1 (liptin). also inhibit release of glucose from liver

Front 46

advantage of incretin therapy?

Back 46

no weight gain

Front 47

Adverse effects of DDP-4?

Back 47

URT infx, sore throat, headache, inflammation of pancreas

Front 48

Initial medical therapy for DM?

Back 48

1. Metformin 2. Sulfonylurea w/ lifestyle changes 3. pt with renal failure/hypoglyc try TZD first. 4. Incretin therapy if non of the above work

Front 49

besides the previous meds what other meds might you admin?

Back 49

ACE/ARB for HTN or proteinuria, statins, routine eye and foot exams

Front 50

target HgA1C?

Back 50

<7

Front 51

50% of pt that were well controlled on a single drug will need ___ in 3 yrs?

Back 51

dual therapy

Front 52

DM complications?

Back 52

DKA, osmotic diuresis, anorexia, kussmaul breathing, low K, low PO4, low Na
Tx: hydration, insulin, K, and PO4
Coma: profound dehydration, mental status changes

Front 53

3 types of fasting hypoglycemia?

Back 53

ENdocrine, hepatic, gluconeogentic substrate defects (preg, CRF, malnutrition)

Front 54

2 causes of endocrine fasting hypoglycemia?

Back 54

fasting: increased insuline levels
deficiency of anti-insulin hormones: addisons, hypopit

Front 55

fasting hypoglycemia without hyperinsulinemia?

Back 55

liver damage, renal failure, sepsis, ethanol ingestion, cortisol, growth hormone low

Front 56

nonfasting hypoglycemia?

Back 56

post gastrectomy