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77 Cards in this Set
- Front
- Back
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What are the classic 3 p's od DM
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polyuria, polyphagia, polydipsia
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What is the fasting diagnosis of DM?
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overnight plasma glucose of 126mg/DL on two occasions
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What is the Dx of DM after 75g glucose?
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@ 2 hours, 200mg/DL
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What A1c level determines poorly controlled DM?
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10% or greater
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What causes secretion of insulin?
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Glucose, B2 agonists
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What receptor type inhibits insulin secretion?
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alpha 2 agonists
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What systems in the body clear insulin?
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the liver and kidney by hydrolysis
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In general, what does insulin promote?
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storage of glycogen, TAG's, and protein
glucose uptake into skeletal muscle, heart, fat tissues |
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How does insulin affect glucose production?
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this inhibits glucose production in the liver- decreases gluconeogenesis/glycogenolysis
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How does insulin affect catabolic proceses?
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this inhibits breakdown of all things
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What type of receptor is the insulin receptor?
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this is an RTK
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Where does insulin bind ot the insulin receptor?
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in the alpha subunit, which is extracellular only
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What is the tyrosine kinase portion of the insulin receptor?
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the Beta subunit- which is transmembrane
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What are the symptoms of hypoglycemia / hyperinsulinemia
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hunger, hypotension, fatigue, palpitations, pallor, lethargy
CNS** |
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How do you treat hypoglycemia?
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50-100ml of 50% glucose solution IV
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How do sulfonylureas work?
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these bind and block ATP-sensitive K+ channels, causing depolarization** of B cells
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What is the mechanism of sulfonylureas?
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these stimulate insulin RELEASE from B cells
Indirectly potentiate action of insulin on target tissues |
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What are the adverse effects of sulfonylureas?
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hypoglycemia
weight gain |
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What kind of drug is Tolbutamide?
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a 1st gen sulfonylurea
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What is tolbutamide used for?
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this is the safest 1st generation sulfonylurea- used in the elderly
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What kind of drug is Chlorpropamide?
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this a 1st generation sulfonylurea
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What kind of drug is Tolazamide?
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this is a 1st generation sulfonylurea
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How long does Chlorpropamide last? what does this cause
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this has a very long half life of 32 hours- and is thus likley to cause hypoglcyemia
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What kind of drug is Glybuirde?
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this is a 2nd generation sulfonylurea
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How potent is glyburide?
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Very potent- may cause hypoglycemia
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What kind of drug is Glipizide?
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this is a 2nd generation sulfonylurea
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How long does Glipizide last? what do this cause?
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this only lasts 2-4 hours, so this has the least hypoglycemic effect
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What kind of drug is Glimepiride?
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this is a 2nd generation sulfonylurea
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What is the most potent 2nd generation sulfonylurea?
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Glimepiride
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What do Meglitinides do?
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these act on K+ channels in B cells to increase insulin release, much like sulfonlyurea
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Why are Meglitinides different than sulfonylureas?
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these dont cause allergic reactions in people with Sulfonamide allergies
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What kind of drug is Repaglinide?
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this is a Meglitinide
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What kind of drug is nateglinide?
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this is a Meglitinide
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What is the half life of meglitinides?
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short, only about an hour
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What kind of drug is Metformin?
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this is a biguanide
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How doe metformin work?
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this increases insulins action on muscle and fat
slows glucose uptake from GI reduces plasma glucagon levels reduces gluconeogenesis |
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What is Metformin given for?
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reduces glucose to a Euglycemic state
safe in kids 10+ initial Tx of type 2 DM |
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Why is Metformin good for type 2 DM?
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doesnt make you fat
reduces macrovascular events |
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What are the adverse effects of Metformin?
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Lactic acidosis
Diarrhea |
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What are the conditions that predispose someone to lactic acidosis when taking metformin?
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renal disease, hepatic disease
CHF, COPD alcoholism |
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In general, who do Thiazolidinediones do?
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these are insulin sensitizers
acts by causing post-receptor insulin mimetic action |
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What kind of drug is Pioglitazone?
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this is a Thiazolidinedione "insuline sensitizer"
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What kind of drug is Rosiglitazone?
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this is a Thiazloidnedione insuline sensitizer
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What are the uses for Thiazolidinediones?
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Lowering insulin resistance
reducing the development of type 2 DM |
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What are the adverse effects of Thiazolidinediones?
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Edema- leading to heart failure in CHF pts
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What are the contrainducations of Thiazolidinediones?
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hepatic disease
CHF |
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What kind of drug is Acarbose?
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this is an alpha glucosidease inhibitor
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What kind of drug is Miglitol?
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this is an alpha glucosidase inhibitor
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What do alpha glucosidase inhibitors do?
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these delay intestinal carbohydrate digestion nd absorption
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How do alpha glucosidase inhibitors affect weight?
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these have no significant effects on weight
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What are the most common adverse effects of alpha glucosidase inhibitor?
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GI effects, diarrhea, Flatulence**
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What does Incretin do?
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this is released in response to glucose
this inhibits glucagon release, lowering hepatic glucogenesis (this is also called GLP-1) |
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What is Exendin-4, and where does it come from?
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this is a GLP-1 analog, and comes from the salivary gland of a Gila monster. sweet!
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What kind of drug is Exenatide?
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this is an Incretin Mimetic
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What kind of drug is Liraglutide?
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This is an incretin mimetic
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What are the uses of Incretin Mimetics?
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lower glucose
potential increase in B cells and functionality weight loss* |
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How is Exenatide given?
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this is given as 2 sub cue injections 60 min before two main meals
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How is Liraglutide given?
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this is a single daily subcue injection
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What are the possible adverse effects of Exenatide?
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acute pancreatitis
pancreatic cancer and thyroid cancer |
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What are the contraindications of Incretin usage?
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Thyroid cancer
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What kind of drug is Sitagliptin?
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this is the first and only FDA approved DPP-IV inhibitor
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How does Sitagliptin work?
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this potentiates the effects of the increatin hormones*
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What are the side effects of Sitagliptin?
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acute pancreatitis and pancreatic cancer
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What is Sitagliptin given for?
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lowers serum glucose
doesnt affect weight |
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How si Sitagliptin given?
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Orally
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What kind of drug is Saxagliptin?
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this is a DPP-IV inhibitor, which potentiates effect of incretin hormones
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What kind of drug is Pramlintide?
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this is an Adjunct** in type 1/2 diabetes
this is a synthetic analog of amylin |
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How does Pramlintide work?
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this works with insulin to regulate postprandial glucose concentrations
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How does Amylin affect glucose concentrations?
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slows gastric emptying without altering absorption
suppresses glucagon secretion modulates appetite |
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How is Pramlintide given?
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SC injection with meals
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What kind of drug is Bromocriptine?
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this is a dopamine agonist
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How does Bromocriptine work?
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this causes enhanced suppression of hepatic glucose production
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What is Bromocriptine given to treat?
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improve glycemic control
reduce fasting and postmeal plasma FFA/TAG levels reduces cardiovascular problems in pts |
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How is Bromocriptine metabolized?
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CYP3A4 -so beware of interactions
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What does Glucagon do?
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this is produced in alpha cells of pancreas
increases blood glucose levels by mobilizing glycogen |
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What is Diazoxide?
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this is a vasodilator, hyperglycemic agent
inhibits insulin secretion |
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What is Diazoxide given for?
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used in pts with insulinomas
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