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Diabetes 411
Diabetes
| Question | Answer |
|---|---|
| Impaired Glucose Tolerance (IGT) | 140-199 mg/dl after 2 hr oral glucose tolerance test |
| Impaired Fasting Glucose (IFG) | 100-125 mg/dl after overnight fast |
| Autoimmune destruction of pancreatic beta cells | Type 1 DM, juvenile onset |
| Dependent on exogenous insulin for survival, 5-10% of diagnosed cases of DM | Type 1 DM |
| Usually begins as insulin resistance, 90-95% of all diagnosed cases of DM | Type 2 DM (Adult onset) |
| Normal FPG | < 100 mg/dl (OGTT 2hPG <140 mg/dl) |
| Prediabetes FPG | 100-126 mg/dl (OGTT 2hPG 140-199 mg/dl) |
| Diabetes FPG | > 126 mg/dl (Causal plasma glucose > 200 mg/dl, 2hPG > 200 mg/dl) |
| Neuropathy, Nephropathy, Retinopathy | Microvascular Complications |
| Coronary artery disease, cerebrovascular disease, peripheral vascular disease | Macrovascular Complications |
| Polydipsia, polyphagia, polyuria, nocturia, dry itchy skin, fatigue, slow healing cuts | Hyperglycemia symptoms |
| Shaky, fatigue, irritability, rapid heart beat, sweating, HA, poor concentration | Hypoglycemia symptoms |
| Stimulate pancreatic beta cells, results in increase in insulin secretion | Sulfonylureas MOA |
| hypoglycemia, weight gain | Sulfonylureas and Meglitinides (Insulin Secretagogues) SE's |
| Inexpensive, decrease in HbA1c, established track record, less SE's | Sulfonylureas advantages |
| Hypoglycemia, may lose efficacy over time as beta cell function declines | Sulfonylureas disadv. |
| First line therapy for new onset type 2 DM | Sulfonylureas (insulin secretagogues: Glyburide, Glipzide, Glimerpiride) |
| Novel class, rapid onset adn abbreviated duration. Control blood glucose levels by directly stimulating 1st phase insulin secretion in pancreatic beta cells | Meglitinides MOA |
| Don't cause continuous insulin secretion, more closely reproduces natural pancreatic response, less hypoglycemia/weight gain | Meglitinides advantages |
| Good alternative for pts at risk for hypoglycemia | Meglitinides |
| Repaglinide, Nateglinide | Meglitinides |
| Glyburide, Glipzide, Glimepiride | Sulfonylureas |
| Metformin, Phenformin | Biguanides (Insulin sensitizers) |
| Antihyperglycemia agent that lowers basal and postprandial plasma glucose. Decreases hepatic gluconeogenesis production. Decreases intestinal abs of glucose, improved insulin sensitivity | Biguanides (Insulin sensitizers) |
| GI, Lactic Acidosis | Biguanides (Insulin sensitizers) SE's |
| Lowers fasting and postprandial hyperglycemia, moderate weight loss, rarely causes hypoglycemia, improved insulin resistance | Biguanides (Insulin sensitizers) advantages |
| Use in caution w/ pts > 65 yrs, liver disease, alcohol abuse, severe dehydration, surgery, heart failure. | Biguanides (Insulin sensitizers) |
| SCr males > 1.5, females > 1.4, CrCl < 60 ml/min-disc use | Biguanides (Insulin sensitizers) |
| Enhancement of insulin sensitivity in adipose tissue, skeletal muscle, and liver | Thiazolidinediones (TZDs) |
| Decrease hepatic glucose output, lower free fatty acid conc., improve lipid profiles. | TZDs |
| Weight gain, edema, fluid retention, possible hepatotoxicity | TZDs SE's |
| Favorable effects on lipid profile, lowers HbA1c 1-2% | TZDs advantages |
| Insulin dependent action, fluid retention, expensive | TZDs disadvantages |
| May replace metformin, 2nd in line after metformin, may be used in combo | TZDs place in therapy |
| Poiglitazone, Rosiglitazone | TZDs |
| Miglitol, Acarbose | Alpha-Glucosidase Inhibitors |
| Blocks gut abs of complex sugars | Alpha-Glucosidase Inhibitors MOA |
| Gas, bloating, diarrhea | Alpha-Glucosidase Inhibitors SE's |
| improved postprandial hyperglycemia, no weight gain, HbA1c reduction by 0.5-1.0% | Alpha-Glucosidase Inhibitors advantages |
| Min effect on fasting glucose levels, SE's, must be taken 30 mins prior to meals | Alpha-Glucosidase Inhibitors disadv. |
| Hypersensitivity, liver disease, renal disease, GI disease, pregnancy, breast feeding | Alpha-Glucosidase Inhibitors contraindications |
| may be used to prolong time to insulin, use in those not candidates for insulin | Alpha-Glucosidase Inhibitors |
| Isolated from salivary gland venom of Gila Monster. Suppresses glucagon secretion, slows gastric emptying, reduces food intake, promotes beta cell proliferation | Exenatide (Hormone modifier) |
| Hypoglycemia, nausea, vomiting | Exenatide (Hormone modifier) SE's |
| promotes beta cell proliferation, helps to control weight | Exenatide (Hormone modifier) advantages |
| Nausea, vomiting, has to be injected | Exenatide (Hormone modifier) disadvantages |
| Severe GI disease, ESRD, GI bleeding, gastroparesis | Exenatide (Hormone modifier) contraindications |
| Slows gastric emptying, reduces postprandial rise in glucagon concentrations, causes satiety leading to decreased caloric intake, potential weight loss | Pramlinitide (hormone modifier) MOA |
| Hypoglycemia, N/V, lipidystrophy | Pramlinitide (hormone modifier) SE's |
| adjunct therapy for type 2 DM | Hormone modifiers-Exenatide & Pramlinitide |
| Inhaled, short acting insulin for type 1 and type 2 DM | Exubera |
| Lispro, Glulisine, Aspart (clear) | Rapid acting insulin |
| Administer 15 mins prior or post meals, fast onset of action, limit postprandial hyperglycemia peaks | Rapid acting Insulin |
| Regular | Short acting insulin |
| Administer 30-60 mins prior to meal, hypoglycemia may occur w/ skipped or delayed meals. | Short acting insulin/Regular |
| Mimic Bolus Insulin | Rapid and short acting |
| NPH | Intermediate Acting Insulin |
| Glucose lowering effects lasts < 24 hrs. | Intermediate Acting Insulin-NPH |
| Glargine (Lantus), Detimir | Long acting insulin |
| No peak, administer once daily | Long acting insulin |
| Lowers glucose btwn meals and overnight, nearly constant levels, 50% of daily needs | Basal insulin |
| Lowers glucose during and after meals, 10-20% of total requirement at each meal | Bolus insulin |
| Initial dose for type 1 diabetic | 0.5-0.6 units/kg/day |
| Initial dose for type 2 diabetic | 0.3-0.5 units/kg/day |
| After initial diagnosis and starting insulin requirements drop. | Honeymoon phase |
| Hypoglycemia in early morning followed by hyperglycemia. Mistaken for insufficient insulin dose. Treatment: add more carbs at bedtime snack, less NPH in evening | Somogyi Effect |
| Early am surge in blood glucose levels due to increased renal clearance or insulin during night, increase in circulating hormones. Begins around 5am, not preceded by hypoglycemia. Treatment: Give NPH before bedtime | Dawn Phenomenon |
Created by:
lbreimeir
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