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72 Cards in this Set

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  • Back

What are the common symptoms of diabetes


2. Polydispia

3. Polyphagia

What is the Fasting Glucose and the Post Meal Glucose levels for diabetics

Fasting Glucose = ≥7

Post Meal Glucose = ≥11

What is a normal glucose level

4.4-6.1 mmol/L

What is Type 1 Diabetes

Autoimmune destroys beta cells

Insulin dependent/Juvenile onset

What is type 2 diabetes

Insulin resistant

Non insulin dependent/maturity onset

What are 4 things Diabetes is caused by

1. Decreased insulin secretion

2. Insulin resistance

3. Excess glucagon & corticosteroids

4. Anti-insulin Antibody

Which 6 tissues are insulin sensitive

1. Skeletal, Cardiac, Smooth Muscle

2. Adipose

3. Leukocytes

4. Pituitary

Which 5 tissues are non insulin senstivie

1. Brain

2. Kidney

3. Intestinal

4. RBC

5. Endothelium

What are 3 defects you see in diabetes

1. Increased Extracellular glucose

2. Decreases Intracellular glucose (insulin sensitive)

3. Increase Intracellular glucose (non insulin sensitive)

What are the 4 long term complications of Diabetes

1. Micro and macro vessel disease

2. Retinopathy

3. Nephropathy

4. Neuropathy

What are the goals of therapy for type 2 diabetes

1. Get normal blood glucose

2. Delay/prevent mobility/mortality from long term complications

What is the Insulin Synthesis Pathway

Preproinsulin => signal sequence removed => proinsulin => chain C removed => insulin (2 chains linked by disulfied bridge)

What does 1 Unit of Insulin equal

1 Unit = amount of insulin needed to reduce fasting glucose of a rabbit to 45 mg/dL (2.5mM)

What is the Short Acting Insulin Medication

Insulin Lispro

1. What is Insulin Lispro an analog of

2. What is its duration

3. What is its impact on Pharmacodynamics

1.Insulin (Amino acid 28 & 29 in beta chain reversed)

2. Rapid absorption and short action

3. No impact on pharmacodynamics

1.When do you use Insulin Lispro

2. Which type of diabetes is it used in

1. 15 min before a meal (typical insulin 30-45 min before meal)

2. Type 1 and late stage Type 2

What are the benefits of Insulin Lispro

Decrease incidence and risk of hypoglycaemia

1.What are the 2 long acting insulin medications

2. When are they good to use

1. a. insulin Glargine

b. insulin Detemir

2. Good for bedtime

What are the 3 benefits of using long acting insulin medication

1. Slowly absorbed

2. Long duration (20.5 hours)

3. Loss of nocturnal hypoglycemia

What are the 3 adverse effects of Glargine

1. Pain at injection site

2. Possible tumor growth

3. Can not be diluted or mixed with any other insulins

What are 3 new types of technology for insulin administrations

1. Nasal spray

2. Insulin inhaler

3. Insulin pump (juvennile diabetes research fund)

What 5 things decrease the actions of Insulin

1. Glucocorticoids

2. Glucagon

3. Epinephrine

4. Growth Hormone

5. Thyroid Hormone

What 5 things increase the actions of Insulin

1. ACEi

2. Alcohol

3. Salicylates

4. Beta Blocker

5. MAO inhibitor

What are the side effects of Insulin

1. Hypoglycemia (Hunger, sweating, blurred vision, death, be careful in elderly)

2. Lipotrophy (loss of fat)

3. Allergy

What are the 2 Sulfonylureas

1. Gilburide

2. Tolbutamine

What are the MOA of the Sulfonylureas

1. Release insulin from beta cells

2. Reduce Glucagon from blood

3. Potentiate the action of insulin

What are the adverse effects of the Sulfonylureas


2.Secondary failure (don't work as well as time goes on)

3.Skin rash, photosensitivity, GI, intolerance to alcohol

What is the meglitinide


What is the MOA of Repalglinide

1. Increase insulin secretion by binding to ATP sensitive K+ channels at a distinct site from that of sulphonylurea

What are the adverse effects of Repalglinide

1. Weight gain

What medication is in the Biguanide class


What is the MOA of metformin

Not fully understood

Activated cylic AMP activated protein kinase which reduces glucose release from the liver

What are the uses for Metformin

1. Euglycemic rather than hypoglycaemic

2. Mild weight loss

What is the metabolism of metformin

Not metabolized therefore excreted through kidneys as active form

(less secondary failure)

What is the adverse effects of the early forms of metformin (i.e. phenformin)

Killed patients from lactic acidosis

What are the 2 Glitazones

1. Rosglitazone

2. Pioglitazone

What is the MOA of the Glitazones

1. Decrease insulin resistance by binding nuclear receptors that regulate genes responsible for lipid metabolism

2. Decrease gluconeogenesis, glucose output and TG synthesis in liver

3. Increase glucose uptake in skeletal muscle and adipose

What is the metabolism of Glitazones

Liver (CYP)

Better absorbed with food

What are Glitazones used for

1. Type 2 diabetes (not 1st line more adjunct with metformin) (need > 30 units of insulin a day and HgbA1C > 8.5%)

What is the Glucosidase inhibitor


Who does Acarbose work well with


What is the MOA of Acarbose

Acts ONLY on gut and slows CHO breakdown

What do you use Acarbose for

Type 2 diabetes

What are the side effects of Acarbose

Bloating and farting

What is the MOA of Orlistat

Blocks intestinal lipase

Reduce absorption of dietary fat

When is Orlistat effective

Only at meal time

What is the use of Orlistat

Improve insulin sensitivity

What are the side effects of Orlistat

Fatty stool, nausea, diarrhea

What is Pramlintide

Synthetic analog of Amylin

(amylin = hormone co-secreted with insulin from beta cells)

What is the MOA of Pramlintide

Suppresses glucagon secretion

Decreases glucose absorption from gut

What are the uses of Pramlintide

Mixed with regular insulin just before injecting

Good for type 1 and 2

What are incretins

Glucagon like peptides (GLP-1)

What are the function of incretins

Mimics effects of insulin

When are incretins secreted

after a meal

What are the 2 types of DPP-4 Inhibitors

1. Sitagliptin-PO4

2. Saxagliptin

What is the function of DDP-4

breaks down GLP-1

What type of diabetes do you use the DPP-4 inhibitors

Type 2 diabetes

What is the side effect of DDP-4 inhibitors


What are the two types of GLP-1 Analoges

1. Exenatide

2. Liraglutide

What is the function of the GLP-1 Analoges

1.Enhances insulin secretion

2.Suppresses Glucagon secretion during hyperglycemia

3.Decreases food intake and slows gastric emptying

Can you use Exenatide alone

No, used in adjunct with metformin or sulphonylurea

What is Exenatide

Synthetic version of Extendin-4

Is Exenatide hyper, hypo, or euglycemic on its own


What are the side effects of exenatide

1. Pancreatitis

2. Renal dysfunction

What is Dapaglifozin

Sodium Glucose Transport Protein 2 inhibitor (SGLT-2)

What is the MOA of Dapagliflozin

Works in kidney to prevent reabsorption of glucose

What are the side effects of Dapaglaiflozin


Hypotension, UTI, bladder infection

What is the treatment option for Type 1 (insulin dependent) Diabetes

Control blood glucose with insulin and diet

What are the treatment options for type 2 (non insulin dependent) diabetes

1. Diet (exercise does not work)

2. Mild = oral hypoglycemic as 1st line

3. Oral combination therapy and diet

4. Insulin

5. Reduce hypertension (to prevent complications)

What are some future therapies of Diabetes

1. CGM + insulin pump

2. Beta cell transplantation

3. Aldose reductase inhibitors

4. Dapagliflozin

How do you treat diabetes in the elderly

1. Oral agent

2. Sulfonylurea used with causation because of hypoglycemia

3. Doses should be halved and increased slowly

What are the steps for type 2 diabetes

1. Nonpharmacotherapy

2. Oral agent monotherapy

3. Oral combination therapy

4. Bedtime insulin +/- oral agent

5. Insulin injections 1-4 days