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49 Cards in this Set

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which diabetic drugs stimulate insulin secretion
sulfanylureas
what is the major side effect of sulfanylureas?
Hypotension
Name the benefits of Biguanides(Metformin)
< liver glucose production
> glucose uptake by the muscles
Weight loss
what are the contra indications of Metformin?
Cannot be used in patients with:
hepatic DZ
renal insufficiency
CHF
which drugs delays and decreases absorbtion of glucose in the intestine
Alpha Glucosidase Inhibitors:

Acarbose
Miglitol
which drugs improve insulin sensitivity
TZDs:

Rosiglitazone
Pioglitazone
Which drug has GI disturbance as it's major side effect?
AGIs:

Acarbose
Miglitol
which drugs are contraindicated for patients with renal dysfunction, inflammatory bowel disease, colonic ulceration, or cirrhosis
AGIs
What is the function of delta cells?
produces somatostatin which
inhibits release of glucagon and insulin

inhibits gastrointestinal motility
what part of the pancreas produces digestive enzymes?
Exocrine acinar portion
what do alpha cells of the pancreas do?
produce glucagon which
antagonizes insulin by releasing glycogen from liver
where does gluconeogenesis take place?
in the liver, it converts glucose from amino acids, glycerol and lactic acid
what is the only hormone in the body that lowers sugar
Insulin
name some effects of catecholamines in diabetes?
Decreases insulin
Decreases movement of glucose into cells
Increases glycogenolysis
Mobilizes fatty acids
insulin and glucose reduce the release of this hormone
Growth hormone
this hormone decreases cell use of glucose
GH
this hormone antagonizes insulin and increases protein synthesis (builds muscle)
GH
this hormone stimulates gluconeogenesis
cortisol
name some conditions that stimulate cortisol production
hypoglycemia
infection
pain, trauma, surgery
strenuous exercise
anxiety
Describe Type I DM
20% of all diabetics
Destruction of beta cells
Prone to DKA
80% have islet antibodies
50% have insulin atibodies
describe Type II DM
80% of all diabetics
Older, overweight people
Impaired production of insulin
Cell resistance to insulin
neutralization by antibodies
increased gluconeogenesis
name some drugs that can cause secondary diabetes
thiazides ( by lowering K)
cortisol
levodopa
BCP
phenothiazines
dilantin
when should a pregnant women be screened for diabetis?
At 24 weeks
T/F Oral agents are contraindicated in gestational diabetis
TRUE: If diet does not control, insulin must be used.
what is the clinical presentation of Type 1 diabetes?
usually sudden onset
Polyuria
Polydipsia
Polyphagia
how do you Dx diabetes?
FBS > 126
or
random > 200 with SSx
what is the clinical presentation of type II?
slow onset
overweight
polyuria
polydipsia
blurred vision
fatigue
paresthesias
skin infections(toenails and yeast infections in women)
These drugs are examples of?

diabeta
amaryl
glucotrol
glynase
sulfonylureas; they stimulate insulin release from beta cells
these drugs decreases gluconeogenesis and increases cell sensitivity to insulin
Biguanides: Metformin
These drugs delay absorption of glucose from intestine
AGIs: glucosidase inhibitors - acarbose
name the short acting, intermediate and long acting drugs
short acting: Regular
Intermediate: NPH
Long acting: Lente, Ultra
what is the onset, peak and duration of regular?
Onset: 1 hr
Peak: 2-3 hrs
Duration: 4-6 hrs
what is the onset, peak and duration of NPH?
Onset: 2-4 hrs
Peak:4-8 hrs
Duration: 12-16 hrs
what is the onset, peak and duration of Lente?
Onset: 2-4 hrs
Peak: 4-8 hrs
Duration: 16-20 hrs
what is the onset, peak and duration of ultralente
Onset: 4-10 hrs
Peak: 12-16 hrs
Duration: 20-30 hrs
Hyperglycemia >250
HCO3 < 15
pH < 7.3
what are some lab values in DKA?
how does HHNK (Hyperglycemic, hyperosmolar, non-ketotic coma) present?
Presents with marked dehydration and CNS SSx often mimicking a stroke

Usually seen in Type 2
Osmolarity > 310
Glucose > 600
HHNK
S/Sx of hypoglycemia
CNS- confusion, delirium, coma

Autonomic - hunger, anxiety, SWEATING, tachycardia.
MC reason for hospitalization for diabetics
Foot ulcers; due to PVD
what are the features of Syndrome X?
> cholesterol
> triglycerides
Hypertension
obesity
DM
what causes Syndrome X?
Diet high in refined CHO,
low in fiber, high in saturated fats
which hormones stimulate glycogenolysis
glucagon and epinephrine
where is glycogen stored?
in liver and muscle
where does most of the glucose come from?
2/3 of glucose is derived from food stored as glycogen in liver and muscle
name 2 functions of Growth hormone
It reduces liver uptake of glucose, an effect that opposes that of insulin.

It promotes liver gluconeogenesis
how do you Dx gestational diabetes?
Give a 3hr GTT and if 2 or more results are above
how do you treat Gestational DM?
Start her on a 2000 calorie diet, monitor glucose QID for a week, and see her next week
what are the target glucose goals?
Fasting: 60 – 90
Non-fasting (before breakfast) 60 – 105
After meals: < 120
2am – 6am: >60