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60 Cards in this Set

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What does the Pancreas do?
Secretes digestive enzymes and bicarbonate into small intestine via pancreatic duct
What are the Islets of Langerhans?
Specialized cells present throughout the pancreas
Glucagon(Alpha cells)?
Raises glucose levels(gluconeogenesis, glycogen breakdown)
Insulin (Beta cells)?
Stimulates glucose uptake by cells, glycogen production
Somatostatin?
Regulates secretion of glucagogons and insulin
Type I DM?
Possibly autoimmune or infectious process
(5-15%)

Previously called "insulin dependent or Juvenille Onset
Type II DM?
*90-95%
Risk factors: Old age, obesity, family hx of diabetes, hx of gestational diabetes, impaired glu metabolism, race...
Previously called non-insulin or adult onset diabetes.
Gestational Diabetes?
Glucose intolerance diagnosed in some women during Pregnancy(Type IV)
What are some (many) comlications of Diabetes...?
Heart dz and stroke, High BP, Blindness, Kidney dz, nervous system dz...to name a few...
What accounts for 65% of deaths with diabetes?
Heart disease and stroke
What are some preventions of complications of Diabetes?
Glucose control, BP control, Control of blood lipids, prev. care of eyes, kidneys, and feet.
What is Insulin?
Protein secreted for beta-cells of Pancreas.
Stimulated or inhibited by blood glucose levels
Types of Insulin?
-Rapid
-Short
-Intermediate
-Long acting
Human insulin are made by?
E-coli or yeast
All new pts should be started on what kind of Insulin?
Human
What are the Rapid acting insulins?
Lisoro(Humalog)
Aspart (NovoLog)
Lispro or Aspart are recommended for...
Use in Insulin Pumps
Lispro or Aspart...
- Absorbed from injection site more rapidly than regular.
- Provide better glucose control when compared to regular human Insulin
- Peak serum concentrations are higher, time to peak is faster, and the duration of action is half as long
What can Lispro or Aspart be combined with?
NPH
Withdraw rapid-acting insulin first, then draw up NPH and inject immediately.
Short acting insulins-Regular insulin?
- Quickly absorbed from the SC site
- A solution so can be given IV, IM. or SC.
- can be given via insulin pump
What is the intermediate acting insulin?
NPH (Humulin)
NPH?
-absorbed more slowly from injection site
Can be combined with Regular in same vial or syringe
-Protamin is added to delay absorption and biologic activity.
What is the Long acting Insulin?
Glargine (Lantus)
Glargine?
-Once daily injection for Type I and Type II
-low PH, cannot be mixed with other insulins
-very convienent.
What is the advantage of Glargine?
-decreased hyoglycemia at night.
-Type II adult pts can use once daily at bedtime, along with other oral meds
- Good for Type I also. convienent once a day tx.
Insulin Mixtures?
NPH/Regular
NPH/Lispro
NPH/Aspart
What is Insulin avail as?
100 units/mL
What type of insulin for Pregnancy?
Human only!
Precautions/contraindications for Insulin?
1) Hypoglycemia
2) Diabetic Ketoacidosis
3) Allergy
4) Lipodystrophy
Dosing for Insulin?
-Begin all new pts on Human Insulin
- Range generally between 0.1-1U/Kg daily
Dosing for all new pts on Insulin?
-Begin all new pts on Human Insulin
-Range is between .1 to 2.5 U/kg daily
-some begin with .6U/kg/day with 45% of total being basal
Prandial dosing of inuslin?
-25% of total at breakfast
-15% at lunch
-15% at dinner
Dosing sites for Insulin?
-Most rapid absorption from abdomen followed by upper arm, thigh and buttocks.
-Attempts should be made to inject no closer that from previous site for one month
TYPE I dosing:
-Initial dose: 0.5-0.6U/kg/d
-Honeymoon phase: 0.1-0.4
-Split-dose tx: 0.5-1.2
-With ketosis/acute illness:0.5-1.0
TYPE 2 dosing:
Initial: 0.2-0.6
Split dose: 0.5-1.2
With insulin resistance: 0.7-2.5
Methods of dosing:
-SC injection
-Insulin pump
Monitoring glucose levels?
-Pt monitoring should occur between 4-7 times daily
-Cont glu monitors, not practical
HBA1c?
-Monitor long term glucose control
-Glycosylated hgb
-Goal < 7
Rapid acting Insulins?
-Novolog
-Lispro (Humalog)
-Apidra
Regular Insulin?
-Humulin
-Novolin
Inrtermediate acting Insulins?
-Humulin
-Novolin
-Lente
Long acting Insulins?
Levermir
Glargine
Ultralente
Acarbose(Precose)?
Alpha-glucosidase inhibitor
-Orally active drug used for tx of DM II.
-MOA: Decrease glucose absorption
Take with meals
Metformin(Biguanide)?
Glucophage:
MOA: anti-hyperglycemic agent
-does not stim release of inuslin
-Doese not result in hypoglycemia when used alone
-Decreases hepatic glucose production
-Improves insulin sensitivity by increasing peripheral glucose uptake and utilization
-Does not produce hyperinsulinemia or hypoglycemia in pts with type II Diabetes
What is DOC for newly diagnosed DMII?
Metformin, and may be used alone or in combo and with Insulin too.
-commonly used with sulfonylurea therapy
-Improves lipid profile
-decreased LDS, TG
-Modest weight loss
Metformin warnings
-Lactic acidosis****
-fatal in 50% of pts(LA)
--very rare LA
aavoid use in Renal impairment (Creatinine >1.5males, >1.4 females, withold post radio-contrast dyes due to renal impairment
Metformin precautions and advse rxns?
-elderly
-hypoxic states

ADR
-Diarrhea
-Abd discomfort
-Metallic taste
- Nasuea and anorexia
Rosiglitazone (Avandia)?
Thiazolidinediones:
-anti-hyperglycemia agent
-similar to Metformin
-does not alter insulin secretion from the pancreas -decreases Insulin resistance
-decreases hepatic glucose output and increases insulin-dependant glucose uptake in skeletal muscle, liver, and adipose tissue
*Indicated for Type II diabetes either alone or with sulfonylurea, metformin, or insulin
What do you need to monitor with Rosiglitazone?
Liver fxn
Warnings/advse rxns with Rosiglitazone?
A few pts may have experienced reversible liver injurey and hepatic failure.
Monitore LFT every 2 months for first year***
-Preg cat C
-Fluid retenteion
-Hepatic Failure
-Lactation:no
What is the biggest problem with Rosiglitazone?
Hepatotoxic!
Fluid retention worsening HF, wt gain etc....
Repaglinide (Prandin)?
Non sulfonylurea secretagogues
-Structurally distinct from sulfonylureas but work via similar mechanism
-Incerease Insulin resistance
-Take 25 minutes before each meal
-Also useful in pt who eat sporadically
-May be added to Metformin
-Adjunct to diet and exercise in pts with type II DM
-Can be used with Metformin and thiazolidinedione
* only active in pres of Insulin
Acarbose?
alpha-glucosidase inhibitor
-Alpha glucosidase is involved with digestion of carbs
-interferes with absorption of Glucose
-Results in a smaller increase in blood glucose following meals.
-work indep of Insulin
Use for Acarbose?
Adjunct to diet and exercise in pts with type II DM whose hyperglycemia cannot be managed on diet and exercise alone
-may be used in combo with insulin and metformin
-Prophylatic use of acarbose is effective in delaying the development of type 2 Diabetes
Metformin?
-decreased gluc from liver
-improves insulin sensitivity
-helps insulin be more sensitive : improves insulin sensitivity.
Helps glucose go to where to.
*decreases Glucose production.
Glucose bad, Metformin make glucose down, DOC for first line agent DMII.
**Also good for bad lipid profile.
DMI?
-DOC**
Human insulins
Why can't use Metformin?
-Renal impairment, kidney problems, low creatinine, lactic acidosis == Renal failure....
so use Sulfonylureas.
avandia?
Drug see mostly in combo with Glipizide, metformin, and when single agent not doing the job.
Avandia?
Does not result in hypoglycemia
With DMII on meds how often pts check their own glucsose?
3 times a day.
Find the times.