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60 Cards in this Set
- Front
- Back
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What does the Pancreas do?
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Secretes digestive enzymes and bicarbonate into small intestine via pancreatic duct
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What are the Islets of Langerhans?
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Specialized cells present throughout the pancreas
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Glucagon(Alpha cells)?
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Raises glucose levels(gluconeogenesis, glycogen breakdown)
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Insulin (Beta cells)?
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Stimulates glucose uptake by cells, glycogen production
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Somatostatin?
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Regulates secretion of glucagogons and insulin
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Type I DM?
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Possibly autoimmune or infectious process
(5-15%) Previously called "insulin dependent or Juvenille Onset |
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Type II DM?
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*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. |
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Gestational Diabetes?
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Glucose intolerance diagnosed in some women during Pregnancy(Type IV)
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What are some (many) comlications of Diabetes...?
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Heart dz and stroke, High BP, Blindness, Kidney dz, nervous system dz...to name a few...
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What accounts for 65% of deaths with diabetes?
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Heart disease and stroke
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What are some preventions of complications of Diabetes?
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Glucose control, BP control, Control of blood lipids, prev. care of eyes, kidneys, and feet.
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What is Insulin?
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Protein secreted for beta-cells of Pancreas.
Stimulated or inhibited by blood glucose levels |
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Types of Insulin?
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-Rapid
-Short -Intermediate -Long acting |
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Human insulin are made by?
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E-coli or yeast
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All new pts should be started on what kind of Insulin?
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Human
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What are the Rapid acting insulins?
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Lisoro(Humalog)
Aspart (NovoLog) |
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Lispro or Aspart are recommended for...
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Use in Insulin Pumps
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Lispro or Aspart...
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- 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 |
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What can Lispro or Aspart be combined with?
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NPH
Withdraw rapid-acting insulin first, then draw up NPH and inject immediately. |
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Short acting insulins-Regular insulin?
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- Quickly absorbed from the SC site
- A solution so can be given IV, IM. or SC. - can be given via insulin pump |
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What is the intermediate acting insulin?
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NPH (Humulin)
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NPH?
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-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. |
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What is the Long acting Insulin?
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Glargine (Lantus)
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Glargine?
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-Once daily injection for Type I and Type II
-low PH, cannot be mixed with other insulins -very convienent. |
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What is the advantage of Glargine?
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-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. |
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Insulin Mixtures?
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NPH/Regular
NPH/Lispro NPH/Aspart |
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What is Insulin avail as?
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100 units/mL
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What type of insulin for Pregnancy?
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Human only!
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Precautions/contraindications for Insulin?
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1) Hypoglycemia
2) Diabetic Ketoacidosis 3) Allergy 4) Lipodystrophy |
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Dosing for Insulin?
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-Begin all new pts on Human Insulin
- Range generally between 0.1-1U/Kg daily |
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Dosing for all new pts on Insulin?
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-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 |
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Prandial dosing of inuslin?
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-25% of total at breakfast
-15% at lunch -15% at dinner |
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Dosing sites for Insulin?
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-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 |
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TYPE I dosing:
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-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 |
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TYPE 2 dosing:
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Initial: 0.2-0.6
Split dose: 0.5-1.2 With insulin resistance: 0.7-2.5 |
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Methods of dosing:
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-SC injection
-Insulin pump |
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Monitoring glucose levels?
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-Pt monitoring should occur between 4-7 times daily
-Cont glu monitors, not practical |
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HBA1c?
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-Monitor long term glucose control
-Glycosylated hgb -Goal < 7 |
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Rapid acting Insulins?
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-Novolog
-Lispro (Humalog) -Apidra |
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Regular Insulin?
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-Humulin
-Novolin |
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Inrtermediate acting Insulins?
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-Humulin
-Novolin -Lente |
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Long acting Insulins?
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Levermir
Glargine Ultralente |
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Acarbose(Precose)?
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Alpha-glucosidase inhibitor
-Orally active drug used for tx of DM II. -MOA: Decrease glucose absorption Take with meals |
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Metformin(Biguanide)?
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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 |
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What is DOC for newly diagnosed DMII?
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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 |
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Metformin warnings
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-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 |
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Metformin precautions and advse rxns?
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-elderly
-hypoxic states ADR -Diarrhea -Abd discomfort -Metallic taste - Nasuea and anorexia |
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Rosiglitazone (Avandia)?
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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 |
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What do you need to monitor with Rosiglitazone?
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Liver fxn
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Warnings/advse rxns with Rosiglitazone?
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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 |
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What is the biggest problem with Rosiglitazone?
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Hepatotoxic!
Fluid retention worsening HF, wt gain etc.... |
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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 |
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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 |
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Use for Acarbose?
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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 |
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Metformin?
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-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. |
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DMI?
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-DOC**
Human insulins |
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Why can't use Metformin?
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-Renal impairment, kidney problems, low creatinine, lactic acidosis == Renal failure....
so use Sulfonylureas. |
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avandia?
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Drug see mostly in combo with Glipizide, metformin, and when single agent not doing the job.
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Avandia?
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Does not result in hypoglycemia
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With DMII on meds how often pts check their own glucsose?
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3 times a day.
Find the times. |
