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23 Cards in this Set
- Front
- Back
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Describe the 2 key hormones in the pancreas
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1. Insulin: helps to stimulate uptake of glucose from the blood
2. Glucagon: stimulates release of glucose to bloodstream |
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What is the effect of insulin on metabolism
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Facilitates movement of glucose out of bloodstream and to liver for storage (as glycogen)
Also moves glucose into other tissues via facilitated transport Promotes protein and lipid storage in muscle and adipose tissue |
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What mechanism does insulin use to interact with receptors
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Surface receptors linked directly to enzymes
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Give the difference bt type 1 and 2 diabetes
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Type 1: Not enough insulin being produced by B-cells because they are being destroyed--without exogenous insulin these people will die
Type 2: Insulin receptors not working--enzyme not being stimulated within the cell--known as insulin resistance as peripheral tissues show decreased sensitivity to circulating insulin--usually occurs in older adults (90-95% of DM is type II) -Most likely rationale for decreased insulin response is bc of changes in the way the cell responds after insulin binds to the surface receptor |
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What are some complications that occur from poorly controlled DM
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1. Neuropathies
2. Retinopathy 3. Increased CV disease 4. Amputations 5. Renal Failure 6. Seizures 7. Venous Stasis 8. Pressure Ulcers |
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How is insulin commonly treated
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Replace or supplement endogenous insulin with synthetic
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GIve 3 types of insulin used in txt
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1. Rapid-Acting (Lispro or Humalog)-- 30min to 4 hrs
2. Intermediate-Acting (Humulin L or Insulin Zinc)--6-12 hrs 3. Long-Acting (Glargine or Lautus-- 5-24 hrs Combinations are often used and premixed so pt doesnt have to perform as many injections |
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What is one thing that affects insulin absorption
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Change in diet
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Give 5 ways to administer insulin
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1. IV--quick
2. Subcutaneous Injection 3. Insulin Pump 4. Patches 5. Sprays |
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What are the 2 most common adverse rxn's to insulin
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1. Immune rxn's--often with animal form
2. Hypoglycemia--d/t increased insulin so less in the blood |
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Give common early and later signs of adverse effects on insulin
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1. HA
2. Dizziness 3. Shaky 4. Flushing 5. Pre syncopal sx's 6. Tachycardia 7. Hunger 8. Anxiety Later Sx's: LOC, Death, Convulsions |
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What is the best way to treat increased insulin with adverse effects
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Sugar--a fast source
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List the Oral antidiabetic drugs for type II diabetes--their mechanisms--and their side effects
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1. Sulfonylureas
2. Benzoic Acid -Both increase B cell insulin production -Adverse effect of both is hypoglycemia 3. Biguanides (Metformin or Glucophage) 4. Thiazoidinediones (TZD's) -These two decrease glucose production (liver) and increase insulin sensitivity (in peripheral tissues) -GI disturbances and rarely lactic acidosis are side effects of #3 -HA, dizziness, fatigue, and rarely hepatic toxicity are side effects for #4 5. a-glucosidase inhibitors -Inhibit intestinal breakdown and delay glucose absorption -Main side effect is GI disturbances |
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Give 3 non-oral drugs other than insulin used for DM
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1. Glucagon--injectable but potential for allergic rxn--immediately increases glucagon in bloodstream if hypoglycemic
2. Glucagon-like peptide 1 (GLP-1)--lowers glucose levels 3. Immunosuppressants--autoimmune response to breaking down B-cells--thus more for Type 1 DM bc this is the one where B cells are not functioning properly |
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Give 2 ways to treat DM non-pharmacologically
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Diet and Exercise
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What is HbA1c? What is a normal value? What is normal value for glucose?
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HbA1c= Glycalated Hemoglobin-- used primarily to identify the average plasma glucose concentration
-Normal Level: 4-6.7% Normal Glucose <140mgdL non fasting |
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What does glycemic control refer to?
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How well the pt maintains consistent glucose levels--dont want large fluctuations--help control with proper diet
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What are the tissues called that contain the cells that produce pancreatic hormonres (insuling & glucagon)
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Islets of Langerhans
-B Cells produce insulin -a cells produce glucagon |
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When is a common time that blood glucose sharply increases and insulin goes into effect
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After a meal
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How does glucose enter the liver and muscle cells differently
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Hepatic cells are permeable to glucose so glucose enters the liver easily without the presence of insulin
Insulin directly stimulates facilitated diffusion of glucose into muscle since muscle is relatively impermeable to glucose |
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What is the primary effects of insulin on the liver
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Promote the sequestration of the glucose in the liver and store glucose in the form of glycogen
Does this by stimulating enzymes that promote glycogen synthesis and inhibits enzymes that promote glycogen breakdown |
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How do insulin disturbances effect energy substrates
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The storage and use of all energy substrates will be damaged
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Summarize the cellular mechanism of insulin action
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1. Insulin binds to a receptor located on the surface of the cell--a glycoprotein highly specific for insulin
2. The complete insulin receptor consists of an alpha and a beta subunit--the alpha subunit is the binding site for insulin 3. Binding of insulin to the alpha subunit causes the beta subunit to undergo autophosphorylation (addition of a phosphate group) 4. This addition of a phosphate group then initiates a series of biochemical changes within the cell--including the addition of a phosphate group to the insulin receptor substrates 5. IRS's initiate the movement of glucose transporters (GLUT's) from intracellular storage sites to the cell membrane of skeletal muscle cells 6. The outcome of these interactions is increased glucose uptake and storage by the cell/tissue |
