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49 Cards in this Set
- Front
- Back
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which diabetic drugs stimulate insulin secretion
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sulfanylureas
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what is the major side effect of sulfanylureas?
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Hypotension
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Name the benefits of Biguanides(Metformin)
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< liver glucose production
> glucose uptake by the muscles Weight loss |
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what are the contra indications of Metformin?
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Cannot be used in patients with:
hepatic DZ renal insufficiency CHF |
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which drugs delays and decreases absorbtion of glucose in the intestine
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Alpha Glucosidase Inhibitors:
Acarbose Miglitol |
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which drugs improve insulin sensitivity
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TZDs:
Rosiglitazone Pioglitazone |
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Which drug has GI disturbance as it's major side effect?
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AGIs:
Acarbose Miglitol |
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which drugs are contraindicated for patients with renal dysfunction, inflammatory bowel disease, colonic ulceration, or cirrhosis
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AGIs
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What is the function of delta cells?
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produces somatostatin which
inhibits release of glucagon and insulin inhibits gastrointestinal motility |
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what part of the pancreas produces digestive enzymes?
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Exocrine acinar portion
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what do alpha cells of the pancreas do?
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produce glucagon which
antagonizes insulin by releasing glycogen from liver |
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where does gluconeogenesis take place?
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in the liver, it converts glucose from amino acids, glycerol and lactic acid
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what is the only hormone in the body that lowers sugar
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Insulin
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name some effects of catecholamines in diabetes?
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Decreases insulin
Decreases movement of glucose into cells Increases glycogenolysis Mobilizes fatty acids |
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insulin and glucose reduce the release of this hormone
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Growth hormone
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this hormone decreases cell use of glucose
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GH
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this hormone antagonizes insulin and increases protein synthesis (builds muscle)
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GH
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this hormone stimulates gluconeogenesis
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cortisol
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name some conditions that stimulate cortisol production
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hypoglycemia
infection pain, trauma, surgery strenuous exercise anxiety |
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Describe Type I DM
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20% of all diabetics
Destruction of beta cells Prone to DKA 80% have islet antibodies 50% have insulin atibodies |
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describe Type II DM
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80% of all diabetics
Older, overweight people Impaired production of insulin Cell resistance to insulin neutralization by antibodies increased gluconeogenesis |
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name some drugs that can cause secondary diabetes
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thiazides ( by lowering K)
cortisol levodopa BCP phenothiazines dilantin |
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when should a pregnant women be screened for diabetis?
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At 24 weeks
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T/F Oral agents are contraindicated in gestational diabetis
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TRUE: If diet does not control, insulin must be used.
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what is the clinical presentation of Type 1 diabetes?
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usually sudden onset
Polyuria Polydipsia Polyphagia |
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how do you Dx diabetes?
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FBS > 126
or random > 200 with SSx |
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what is the clinical presentation of type II?
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slow onset
overweight polyuria polydipsia blurred vision fatigue paresthesias skin infections(toenails and yeast infections in women) |
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These drugs are examples of?
diabeta amaryl glucotrol glynase |
sulfonylureas; they stimulate insulin release from beta cells
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these drugs decreases gluconeogenesis and increases cell sensitivity to insulin
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Biguanides: Metformin
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These drugs delay absorption of glucose from intestine
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AGIs: glucosidase inhibitors - acarbose
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name the short acting, intermediate and long acting drugs
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short acting: Regular
Intermediate: NPH Long acting: Lente, Ultra |
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what is the onset, peak and duration of regular?
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Onset: 1 hr
Peak: 2-3 hrs Duration: 4-6 hrs |
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what is the onset, peak and duration of NPH?
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Onset: 2-4 hrs
Peak:4-8 hrs Duration: 12-16 hrs |
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what is the onset, peak and duration of Lente?
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Onset: 2-4 hrs
Peak: 4-8 hrs Duration: 16-20 hrs |
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what is the onset, peak and duration of ultralente
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Onset: 4-10 hrs
Peak: 12-16 hrs Duration: 20-30 hrs |
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Hyperglycemia >250
HCO3 < 15 pH < 7.3 |
what are some lab values in DKA?
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how does HHNK (Hyperglycemic, hyperosmolar, non-ketotic coma) present?
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Presents with marked dehydration and CNS SSx often mimicking a stroke
Usually seen in Type 2 |
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Osmolarity > 310
Glucose > 600 |
HHNK
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S/Sx of hypoglycemia
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CNS- confusion, delirium, coma
Autonomic - hunger, anxiety, SWEATING, tachycardia. |
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MC reason for hospitalization for diabetics
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Foot ulcers; due to PVD
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what are the features of Syndrome X?
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> cholesterol
> triglycerides Hypertension obesity DM |
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what causes Syndrome X?
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Diet high in refined CHO,
low in fiber, high in saturated fats |
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which hormones stimulate glycogenolysis
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glucagon and epinephrine
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where is glycogen stored?
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in liver and muscle
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where does most of the glucose come from?
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2/3 of glucose is derived from food stored as glycogen in liver and muscle
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name 2 functions of Growth hormone
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It reduces liver uptake of glucose, an effect that opposes that of insulin.
It promotes liver gluconeogenesis |
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how do you Dx gestational diabetes?
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Give a 3hr GTT and if 2 or more results are above
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how do you treat Gestational DM?
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Start her on a 2000 calorie diet, monitor glucose QID for a week, and see her next week
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what are the target glucose goals?
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Fasting: 60 – 90
Non-fasting (before breakfast) 60 – 105 After meals: < 120 2am – 6am: >60 |
