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68 Cards in this Set
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Due to pancreatic islet B cell destruction by an autoimmune process
these patients are prone to ketoacidosis Children and young adults with a peak incidence before school age and again at around puberty. |
Type 1 DM
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|
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Circulating insulin is virtually absent
plasma glucagon is elevated and the pancreatic B cells fail to respond to all insulinogenic stimuli. |
Type 1 DM
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|
|
|
The more prevalent form and results from insulin resistance with a defect in compensatory insulin secretion
over 40 years of age and obese Ketonuria and weight loss generally are uncommon at time of diagnosis. |
Type II DM
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Ketonemia
ketonuria or both may be present in what type of DM? |
Type II DM
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Primary mechanism is to stimulate insulin release from pancreatic B cells
What drugs? What type of DM do these tx? |
Sulfonylureas
Nm Them? |
glyburide
glipizide glimepiride Type II DM. |
|
|
Major adverse effect is causing prolonged hypoglycemia
Contraindications w severe -liver impairment -kidney impairment -Weight Gain |
Sulfonylureas
Nm Rx-s |
glyburide
glipizide glimepiride |
|
|
Structurally similar to glyburide but lacks the sulfonic acid-urea moiety
Undergoes complete metabolism in the liver to inactive biliary products giving it a plasma half-life of less than 1 hour Less hypoglycemia then with glipizide |
Insulin secretagogues
Repaglinide Nateglinide |
|
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|
Primary action is on the liver reducing hepatic gluconeogenesis
Particularly good for those type 2 pts that are obese and are not responding to sulfonylureas. |
Metformin
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|
Tends to improve fasting and postprandial hyperglycemia in obese pts without weight gain associated with sulfonylureas and insulin
Hypoglycemia does not occur |
Metformin
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|
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Contraindications:
diabetics with serum creatinine of 1.5 mg/dl or higher hepatic insufficiency alcoholism or propensity to develop tissue hypoxia Not for type 1 |
Metformin
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|
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|
Gastrointestinal symptoms (anorexia
nausea vomiting abdominal discomfort diarrhea) which occur in up to 20% of patients These effects are dose-related tend to occur at onset of therapy and often are transient |
Adverse affects of metformin
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-Sensitize peripheral tissues to insulin
-result in lower doses of insulin needed can lower -cholesterol -triglycerides -Improvement of nonalcoholic fatty liver disease |
Thiazolidinedione
Nm Rx-s ? The Representative drugs are: ~MOA ~Results in? ~Benefits Are: |
Rosiglitazone
Pioglitazone -Sensitize peripheral tissues to insulin -result in lower doses of insulin can lower -cholesterol -triglycerides -Improvement of nonalcoholic fatty liver disease |
|
|
Safety concerns and troublesome side effects limit their use
May increase risk of MI or Angina Decrease in bone density Anemia Weight gain in combo with sulfonylurea Caution in pts with liver disease. |
Thiazolidinedione
(“Glitazone”) Rosiglitazone Pioglitazone |
|
|
|
Inhibit the alpha-glucosidase enzymes in the gut that digest dietary starch and sucrose
Lower postprandial glycemic excursion Flatulence 20-30% - by 3 years 60% had discontinued drug due to this. |
Alpha-Glucosidase Inhibitors
Acarbose Miglitol |
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|
Gut hormone that is released on glucose ingestion that amplifies insulin release.
|
Glucagon-like-peptide (GLP)
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|
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|
GLP-1 receptor agonist
|
Exenatide
Class? isolated from the saliva of |
(an incretin)
the Gila Monster |
|
|
When this drug is given to patients with type 2 diabetes
by subcutaneous injection twice daily It lowers blood glucose and hba1c levels Appears to have the same effects as GLP-1 on -Glucagon suppression and gastric emptying. |
Exenatide
Class? When this drug is given to patients with type ? DM |
Incretin
-Type 2... -....It lowers blood glucose and hba1c levels Same effect as GLP-1 on -Glucagon suppression -Gastric emptying. |
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Advantages include weight loss
Adverse effects are: -nausea -pancreatitis -delay of gastric emptying |
Incretins (exanatide)
-Advantages include: -A/E? 3ct |
~weight loss
-nausea -pancreatitis -delay of gastric emptying |
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|
~Which incretin causes weight loss?
~Which increases incidence of URI? |
-Exenatide
-Sitagliptin |
|
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|
Given subcutaneously
it delays gastric emptying suppresses glucagon secretion and decreases appetite It is approved for use in both types of DM Short-acting or premixed insulin doses be reduced by 50% when the drug is started. |
Pramlintide
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|
Insulin preparation used by most diabetics
|
U100
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|
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|
Used by persons with insulin resistance who require more than U100 as a single injection
|
U500
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|
Rapid
short intermediate or long acting? Lispro |
Rapid
|
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|
Rapid
short intermediate or long acting? Regular insulin |
Short
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|
Rapid
short intermediate or long acting? NPH insulin |
Intermediate
|
|
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|
Rapid
short intermediate or long acting? Glargine |
Long
|
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|
Rapid
short intermediate or long acting? Detemir |
Long
|
|
|
|
Which type of insulin can be administered IV
and describe clinical circumstances when this route would be indicated |
Regular Insulin can be given intravenously and is used in treating patients with diabetic ketoacidosis.
|
|
|
|
Which insulins can be obtained in premixed preparations?
|
NPH/regular
70-30 50-50 NPH/Lispro 75-25 50-50 Protamine/Aspart 70/30 |
|
|
|
May be a problem for Type I diabetics due to variability of absorption at different sites
especially with exercise Best absorption from abdomen. |
Insulin
|
|
|
|
The longer-acting insulin analogs cannot be mixed with
|
Either regular insulin or
the rapidly acting insulin analogs. |
|
|
|
Increases the effectiveness of insulin.
|
Exercise
|
|
|
|
Potential complications of insulin therapy- 4 things
|
Hypoglycemia
allergy resistance and lipodystrophy at the injection site. |
|
|
|
Rapid
short intermediate or long acting? Aspart |
Rapid
|
|
|
|
Due to pancreatic islet B cell destruction by an autoimmune process
these patients are prone to ketoacidosis Children and young adults with a peak incidence before school age and again at around puberty. |
Type 1 DM
|
|
|
|
Circulating insulin is virtually absent
plasma glucagon is elevated and the pancreatic B cells fail to respond to all insulinogenic stimuli. |
Type 1 DM
|
|
|
|
The more prevalent form and results from insulin resistance with a defect in compensatory insulin secretion
over 40 years of age and obese Ketonuria and weight loss generally are uncommon at time of diagnosis. |
Type II DM
|
|
|
|
Ketonemia
ketonuria or both may be present in what type of DM? |
Type II DM
|
|
|
|
Primary mechanism is to stimulate insulin release from pancreatic B cells
What drugs? What type of DM do these tx? |
Sulfonylureas
representative drugs: glyburide glipizide glimepiride Type II DM. |
|
|
|
Major adverse effect is causing prolonged hypoglycemia
Contraindicated in pts with severe liver kidney impairment Also weight gain |
Sulfonylureas
representative drugs: glyburide glipizide glimepiride |
|
|
|
Structurally similar to glyburide but lacks the sulfonic acid-urea moiety
Undergoes complete metabolism in the liver to inactive biliary products giving it a plasma half-life of less than 1 hour Less hypoglycemia then with glipizide |
Insulin secretagogues (representative drugs:
repaglinide nateglinide) |
|
|
|
Primary action is on the liver reducing hepatic gluconeogenesis
Particularly good for those type 2 pts that are obese and are not responding to sulfonylureas. |
Metformin
|
|
|
|
Tends to improve fasting and postprandial hyperglycemia in obese pts without weight gain associated with sulfonylureas and insulin
Hypoglycemia does not occur |
Metformin
|
|
|
|
Contraindications:
diabetics with serum creatinine of 1.5 mg/dl or higher hepatic insufficiency alcoholism or propensity to develop tissue hypoxia Not for type 1 |
Metformin
|
|
|
|
Gastrointestinal symptoms (anorexia
nausea vomiting abdominal discomfort diarrhea) which occur in up to 20% of patients These effects are dose-related tend to occur at onset of therapy and often are transient |
Adverse affects of metformin
|
|
|
|
Sensitize peripheral tissues to insulin
can result in lower doses of insulin needed Can lower cholesterol and triglycerides Improvement of nonalcoholic fatty liver disease |
Thiazolidinedione (“glitazone”) drugs (representative drugs:
rosiglitazone pioglitazone). |
|
|
|
Safety concerns and troublesome side effects limit their use
May increase risk of MI or angina Decrease in bone density Anemia Weight gain in combo with sulfonylurea Caution in pts with liver disease. |
Thiazolidinedione (“glitazone”) drugs (representative drugs:
rosiglitazone pioglitazone). |
|
|
|
Inhibit the alpha-glucosidase enzymes in the gut that digest dietary starch and sucrose
Lower postprandial glycemic excursion Flatulence 20-30% - by 3 years 60% had discontinued drug due to this. |
Alpha-glucosidase inhibitors (representative drugs:
acarbose miglitol). |
|
|
|
Gut hormone that is released on glucose ingestion that amplifies insulin release.
|
Glucagon-like-peptide (GLP)
|
|
|
|
GLP-1 receptor agonist isolated from the saliva of the Gila Monster
|
Exenatide (an incretin)
|
|
|
|
When this drug is given to patients with type 2 diabetes by subcutaneous injection twice daily
it lowers blood glucose and hba1c levels Appears to have the same effects as GLP-1 on glucagon suppression and gastric emptying. |
Exenatide (an incretin)
|
|
|
|
Advantages include weight loss
Adverse effects are nausea pancreatitis delay of gastric emptying |
Incretins (exanatide)
|
|
|
|
Which incretin causes weight loss?
Which increases incidence of URI? |
Exanatide
sitagliptin |
|
|
|
Given subcutaneously
it delays gastric emptying suppresses glucagon secretion and decreases appetite It is approved for use both in types of diabetes Short-acting or premixed insulin doses be reduced by 50% when the drug is started. |
Pramlintide
|
|
|
|
Insulin preparation used by most diabetics
|
U100
|
|
|
|
Used by persons with insulin resistance who require more than U100 as a single injection
|
U500
|
|
|
|
Rapid
short intermediate or long acting? Lispro |
Rapid
|
|
|
|
Rapid
short intermediate or long acting? Regular insulin |
Short
|
|
|
|
Rapid
short intermediate or long acting? NPH insulin |
Intermediate
|
|
|
|
Rapid
short intermediate or long acting? Glargine |
Long
|
|
|
|
Rapid
short intermediate or long acting? Detemir |
Long
|
|
|
|
Which type of insulin can be administered IV
and describe clinical circumstances when this route would be indicated |
Regular Insulin can be given intravenously and is used in treating patients with diabetic ketoacidosis.
|
|
|
|
Which insulins can be obtained in premixed preparations?
|
NPH/regular 70-30 or
50-50 NPL/lispro 75-25 or 50-50 aspart protamine/aspart 70/30 |
|
|
|
May be a problem for Type I diabetics due to variability of absorption at different sites
especially with exercise Best absorption from abdomen. |
Insulin
|
|
|
|
The longer-acting insulin analogs cannot be mixed with
|
Either regular insulin or
the rapidly acting insulin analogs. |
|
|
|
Increases the effectiveness of insulin.
|
Exercise
|
|
|
|
Potential complications of insulin therapy- 4 things
|
Hypoglycemia
allergy resistance and lipodystrophy at the injection site. |
|
|
|
Rapid
short intermediate or long acting? Aspart |
Rapid
|
|
