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Diabetes Pharm 331

What are the s/s of diabetes? polyuria polydypsia polyphagia ketosis acidosis muscle breakdown ^bun ^blood sugar Thickening of basement membranes
What does it mean when there's a thickening of basement membranes and where does it affect the most? The capillary beds get thicker eyes, kidneys
What is the most effective test to check blood glucose management? HbA1c
What is the goal for a HbA1c level? less then or equal to 7
What are the endocrine functions that the pancreas performs? Alpha cells: ^glycogen release, ^ blood sugar Beta cells: release insulin, lower blood sugar Delta cells: decrease blood sugar, blocks insulin and glucagon, slows GI emptying
What causes insulin to be released? Insulin released in response to incretins (GLP-1), released when you eat
What metabolizes incretins? DDP-4 metabolizes incretin, which halts the release of insulin, stimulates production of glycogen.
What vitamin is needed to push glucose into cells? K+
What is adiponectin? Where does it come from and how does it influence glucose management? secreted by fat cells increase insulin sensitivity decrease the release of glucose from liver
What 4 things increase insulin in the bloodstream? Catecholamines Corticosteroids Norep. and Epi Growth hormone
What are the ideal glucose levels for critically ill and non-critically ill patients? critically ill: 140-180 ml/dl non critically ill: 140 ml/dl pre-meal or less then 180 randomly
What are the s/s hyperglycemia? fruity breath thirst, hunger, glucose in urine ketoacidosis Kussmull respirations to decrease acid levels Dry, warm, flushed skin tachycardia, hyPOtension
What are the s/s hypoglycemia? What is the Blood glucose level indicitive of hypoglycemia less then 40 ml/dl Diaphoresis ^ BP parasymp. stimulation Cool, clammy skin sudden onset Anxiety seizures, weakness, muscle spasms tachycardia, hypERtension, palpitation
What are the three rapid acting insulins? When do you have to take them in regard to meals? Lispro Aspart Glulisine 15 min before meals-if delay could cause hypoglycemia
What is short acting insulin? When do you have to take it with regard to meals? Regular insulin 30 min before meal
When do you check fasting blood glucose? When do you check post-prandial glucose levels? fasting: before eating in the morning PP: 2 hours after meal
Which insulins can you mix in the same syringe? Which insulins are NEVER to be mixed? Rapid acting/regular and NPH ok to mix-clear before cloudy, always rapid first, NPH last Never mix glargine or detamir
Which two insulins are considered basal insulins? When are they given with regard to meals? How long do they last for? Glargine and Detamir are basal (long acting) insulins Given without regard for meals last for about 20 hours
Which classes of drugs can cause problems with diabetic patients by increasing glucose levels? Diuretics + steroids
How long is insulin good for out of the fridge? 28 days
What should you always check on a diabetic patient? Feet! Watch for lesions and poor circulation issues
What drugs are used to treat hypoglycemia? Either glucagon-elevate BG by stimulating liver to release glucose, might cause hypokalemia or diozoxide--don't use with thiozide diuretics!
What is the name of DDP-4 inhibitor and what does it do? Sitagliptin Prolongs effect of insulin secretion, decreases glucagon secrection No hypoglycemia bc body regulates
What is the name of the incretin mimetic drug and what does it do? Exenatide mimics effect of GLP-1: increased insulin secretion by beta cells, decreased glucagon secretion results in lowered BGL less hypoglycemia risk then sulfonylurias
What do you have to monitor with incretin mimetics? Renal fxn! Possible pancreatitis
What does Metformin do? What do you have to give with metformin and when? Metformin lowers glucose levels by working on the LIVER to decrease production of glucose and increase uptake of glucose Prevents B12 absorption so have to give with B12 2 hours before or after
What are the major SE of metformin and when is it contraindicated? AE: GI problems rare lactic acidosis Contrindicated when SrC is 1.5< for men and 1.4< for women
What is important pt. teaching for metformin? Always take after meals to reduce GI upset.
Does metformin cause hypoglycemia? No. (unless combined with other drugs)
What do the TZDs do? Work on receptor sites to decrease insulin resistance
What are the two TZDs? (-glitazone) pioglitazone rosiglitazone
When should you use caution with TZDs, and what are the Contraindications? Caution: hepatic impairment NOT: with CHF (can cause edema)
What are Alpha-glucosidase inhibitors and how do they work? Acarbose Miglitol Work by preventing conversion of polysaccharides to monosaccharides
What is the main AE of Alpha-glucosidase inhibitors? Severe hepatoxicity
What are the sulfonylurias and how do they work? -amide and -ide endings Chlorpropamide tolazamide tolbutamide glimepiride glipizide glyburide Work by stimulating pancreas to produce more insulin
What is the main AE of sulfonylurias? What do they need to work? AE: hypoglycemia! Need to have some fxn beta cells for them to work at all
Created by: SarahTzipporah