Lecture

• Glucagon stimulates glycogenolysis in the liver to turn glycogen to glucose and stimulates gluconeogenesis(amino acids into glucose)
• Insulin were initially derived from the pancreas of Swines and bovines
• Insulin delivery and its effects: size of insulin crystal, pH of the buffer and amount of secondary protein or zinc
• Regular insulin is short acting, contains zinc ions and insulin crystals. To increase DOA, proteins are added to reduce the absorption rate
• Analogs are genetically modified versions of insulin that have longer/shorter DOAs
• All insulin types are meant to coordinate to a single peak in BGL that coincides in peak daily activities
• Newer insulin types release a consistent amount of insulin over 24 hours and eliminates the glucose peak that occurs with traditional insulin. These cannot be subbed out for short acting insulin
• Adverse effects of insulin admin: lipodystrophy and hypoglycemia
• Lipodystrophy is the disappearance of subcutaneous fat at the injection site from repeated insulin injections at the same spot. The skin appears pitted
• Incretin mimetics are synthetic drugs that stimulate the production of insulin. There are 2 main incretin hormones involved: GLP-1 and GIP. They each stimulate insulin secretion, delay stomach emptying and inhibit glucagon secretion.
• Secretagogues are antidiabetic pills that by definition are substances that cause the secretion of another(T2DM respond to this). Secretagogues include sulphonylureas and nonsulphonylureas
• The mechanism of secretagogues: enters beta cells of pancreas and bind and close K+ channels. This induces the influx of CA+ which triggers the release of insulin
• Glucose absorption inhibitors interfere with the function of glycoside hydrolase and alpha amylase and it delays absorption of glucose in small intestine
• Glucose absorption inhibitors eliminates postprandial(After dinner) BGL peak. This makes it easier for a compromised system to cope. It's taken with meals
• Biguanides are other diabetes drugs that decrease formation of glucose by the liver, decrease intestinal glucose absorption and enhance utilization of glucose by other tissues.
• Adverse effects of biguanides are nausea/vomiting/diarrhea and flatulence(heartburn/indigestion)
• Thiazolidinediones are insulin sensitizers and they decrease insulin resistance. They increase insulin sensitivity of fat, skeletal muscles and liver cells. They're recommended in type 2 diabetes.
• Dipeptidyl Peptidase 4 inhibitors or DPP-4 inhibitors inhibit DPP-4 in hte intestine so GLP-1 can increase insulin secretion and decrease glucagon secretion. It's often used in combo with metformin or insulin sensitizers
• SGLT2 inhibitors inhibit glucose reabsorption in the PCT. Side effects are : dehydration, hypotension, light headedness and urinary tract infection
• Glucagon is of little or no help in stages starvation, adrenal insufficiency or chronic hypoglycemia.
• dextrose is a hypertonic solution of principal form of carbs. It's duration depends on the extent of hypoglycemia. The side effects are: warmth, pain and burning from the medication infusion