Review module 6

• what is the primary defect in DM1?

  destruction of pancreatic beta cells that are responsible for insulin synthesis and release into blood stream

  result of autoimmune
• what is the primary defect in DM2?

  insulin resistance
• what are the primary cause of insulin resistance?

  reduced binding of insulin to receptors

  reduced receptor numbers

  reduced receptor responiveness
• why is gestational diabetes hard to manage?

  the placenta produces hormones that antagonize insulin

  increased production of cortisol that promotes hyperglycemia

  hyperglycemia in mother produces excessive insulin in fetus leading to hyperinsulinism
• what is criteria for dx diabetes?

  fasting plasma glucose: >126

  random plasma glucose >200 + symptoms of diabetes

  A1C of 6.5% or higher
• what are considered natural insulins?

  regular insulin or native insulin
• when is short duration insulin administered?

  in association with meals to control postprandial rise in blood glucose
• DM1 has to combine what two insulins at night and between meals?

  short action used in conjunction with intermediate or long acting
• Lispro (humalog) type of insulin and admin

  rapid acting

  given immediately before eat or after
• what are 3 rapid acting insulins?

  Lispro, Aspart, Glulisine
• what insulin is inhaled that acts like fast acting?

  human insulin (Afrezza)

  can be used in DM 1 and DM 2
• what are the two regular insulin?

  Humulin R and Novolin R
• when is regular insulin given?

  injected before meals

  used with insulin pump
• most people with insulin pumps use which insulin?

  Rapid-acting insulin instead of regular due to delay
• what are the long acting insulin that is conjugated with protamine?

  NPH insulin (Humulin N and Novolin N)
• when is NPH insulin used? and when cannot be given?

  used between meals and during the night

  only one suitable for mixing with short action

  do not give before meals to control postprandial hyperglycemia
• which insulin can cause allergic rxns?

  NPH insulin due to protamine as a foreign protein
• which insulin can be given once daily to cover for 24 hours?

  Glargine (Lantus or Basaglar)
• when must dosing be done for glargine?

  any time of the day but at the same time everyday
• when do you decrease insulin dosage?

  missed meal

  low carb meal

  physical activity increases
• what is the strategy for DM 1 insulin coverage?

  intensive basal/bolus

  long acting insulin with short acting
• what drugs can intensify hypoglycemia induced by insulin?

  sulfonylureas

  glinides

  alcohol
• what drugs that can raise glucose?

  thiazide diuretics

  glucocorticoids

  sympathomimetics
• what drug can delay awareness and response to hypoglycemia by masking the signs?

  Beta-blockers
• beta blockers impairs what that is a body's response to counteract drop in blood sugar?

  glycogenolysis
• what are the seven oral antidiabetic drug classes?

  biguanides

  sulfonylureas

  meglitinides

  thiazolidinediones

  alpha-glucose inhibitors

  DDP-4 inhibitors

  SGLT-2 inhibitors
• Metformin class and MOA

  biguanide

  inhibits glucose production in the liver

  reduces glucose absorption in the gut

  sensitizes insulin receptors in target tissues to increase uptake in response to available insulin
• what are the sided effects of metformin?

  GI disturbances

  lactic acidosis (rare but highest in renal impairment)
• how metformin effects weight and B12

  weight neutral drug

  decreases absorption in b12
• what are sulfonylureas MOA

  promoting insulin release and only used in DM 2
• how does the first and second generation of sulfonylureas differ?

  second generation are more potent, lower dosages, less drug interactions, and outcomes tend to be milder
• what are sulfonylureas second generation meds? and adverse effects?

  Second-generation sulfonylureas: Glimepiride, Glipizide, Glyburide Adverse effects: Hypoglycemia, weight gain,
• Meglitinides (glinides) MOA

  stimulation of pancreatic insulin release

  shorter acting than sulfonylureas and taken with each meal
• what are the two meglitinides?

  Repaglinide and nateglinide.
• repaglinide MOA

  blocks ATP-sensitive potassium channels on pancreatic beta cells that facilitates calcium influx to increase insulin release
• if a pt does not respond to sulfonylureas, what other diabetic med would they not respond to?

  Meglitinides
• what combination is repaglinide given with?

  Metformin or a glitazone
• Repaglinide adverse effects

  hypoglycemia
• what are thiazolidineiones (glitazones or TZDs) MOA

  reduce glucose levels by decreasing insulin resistance
• Pioglitazone adverse effects and contrindications

  Heart failure

  ovulation in anovulatory premenopausal women

  risk for bladder cancer with high doses

  risk for fractures in women but not men

  increase LDL but lowers trigs causing increase in HDLs