a polysaccharide of glucose, for short term energy, storage in liver and muscle tissue

catabolism of glycogen to glucose (breakdown of glycogen)

rxns that convert glucose to pyruvic acid + ATP (energy for cells)

pancreatic hormone released when BG(blood glucose) low, causes liver to convert stored glycogen into glucose

GI hormone causing an ↑ in the amount of insulin released by the beta cells after eating

pancreatic peptide hormone secreted at the same time as insulin.

"synergistic partner" contributing to glycemic control

d/o of carbohydrate metabolism.

short term- hypo & hyper glycemia

long term- HTN, heart disease; blindness; renal failure; neuropathy(nerve pain); amputations; impotence; stroke

undiagnosed s/s: sustained hyperglycemia; polyuria (↑ urine output); polydipsia (↑ fluid intake[excessive thirst]); ketonuria (ketones in urine); weight loss

s/s result from a deficiency of insulin or resistance to insulin's actions.

type 1 (IDDM[insulin dependant diabetes mellitus], juvenile)- 5-10%- destruction of pancreatic beta cells (autoimmune process)

type 2 (NIDDM[non-insulin dependant diabetes mellitus])- 22 millionamericans- insulin resistance & impaired insulin secretion

gestational diabetes- appears during pregnancy, subsiding rapidly after delivery

management: diet, exercise, medication (insulin, antihypertensives & cholesterol lower medications)

glycemic index= regulation of blood glucose levels

FSBG(finger stick blood glucose) & SMBG (self monitoring blood glucose): use a glucometer before meals (AC) & at bedtime (HS)

Target: 70-130mg/dL (AC); 100-140 mg/dL (HS)

insulin

type 1 and some type 2

stimulates cellular transport of glucose into the cells, and stored as glycogen; promotes synthesis of complex organic molecules

can't give PO- destroyed by digestive system

Use: diabetes; diabetic ketoacidosis; hyperkalemia

Effects: lowers serum glucose levels

AE: hypoglycemia; lipodystrophies[occurs when using same sit all the time](lipoatrophy & lipohypertrophy[enlargement of area]); allergic rxn; hypokalemia w/ excessive doses

DD: hypoglycemic agents; hyperglycemic agents; ETOH(acute use); beta blockers(masks s/s of hypoglycemia); glucocorticoids; sympathomimetics

Dextrose- IV; given for severe hypoglycemia; prefilled syringe

Glucagon- insulin overdose; raises BG levels (promotes breakdown of glycogen synthesis & stimulates biosynthesis of glucose); use in unconscious patients.

short duration, rapid acting: Humalog: onset- 15-30 min, duration- 3-6 hr; Novolog: onset- 10-20 min, duration- 3-5 hr; Apidra: onset 10-15 min, duration- 3-5 hr

short duration, slower acting: Humilin R: onset- 30-60 min, peak: 1-5 hr, duration- 10 hr 

all clear in color

NPH: allergy potential (due to protamine-foreign protein); cloudy in color; only one that can be mixed w/ short duration insulin

detemir(levemir): low doses- duration 12 hr; high doses- duration 24 hr

glargine(Lantus): only once daily

24 hr duration

NPH & regular or Aspart protamine, Lispro protamine w/ aspart or lispro

injection site: upper arms, thighs, abdomen(prefered site); rotate sites w/in general area

syringe & needle

given in units. U100 or U500

pen injector- prefilled cartridge

jet injector- no needle

pumps- infusion SQ of regular, lispro, aspart or glulisine(short duration insulins).

causes: not eat enough, too much insulin or oral agent, too much activity

s/s: shaking, ↑ HR, sweating, dizzy, faint, anxious, hungry, impaired vision, weakness & fatigue, HA(headache), emotional changes

Tx: simple sugar followed w/ complex carbohydrate

causes: too little insulin or oral agent, too much food

s/s: extreme thirst, frequent urination, blurred vision, weakness & fatigue, HA, N, V, abd cramps, hunger followed by ↓ appetite

Tx: insulin, fluids

metformin(glucophage)

oral hypoglycemics- biguanides

↓ glucose production in liver; ↓ absorption of glucose in gut; enhances muscle utilization of glucose

Use: type 2 diabetes

Effects: lowers serum glucose levels

AE: ↓ appetite, N, D; ↓ absorption of vitamin B12 & folic acid

Toxicity: lactic acidosis by inhibition of oxidation of lactic acid (rare, but 50% mortality rate), usually r/t renal insufficiency

DD: ETOH (↑ risk of lactic acidosis); IV contrast w/ iodine(↑ risk of lactic acidosis), stop 48 hr prior to test & restart 48 hr after procedure

needs annual labs to check vitamin levels

tolbutamide (Orinase)

oral hypoglycemic- sulfonylureas

stimulates release of insulin from pancreas

Use: type 2 diabetes; adjunct to diet/exercise program

Effects: lowers serum glucose levels

AE: hypoglycemia (fatigue, excessive hunger, profuse sweating, palpitations); avoid in pregnancy

DD: ETOH (disulfiram-like rxn, intensify hypoglycemia); NSAIDs (intensify hypoglycemia); sulfonamide antibiotics (intensify hypoglycemia); beta blockers (supress insulin release

pioglitazone (Actos)

glitazones aka TZDs

↓ insulin resistance

Use: type 2 diabetes

Effects: reduce blood glucose levels

AE: URI(upper respiratory infection), HA, sinusitis (sinus infection), myalgia (tenderness or pain in the muscles); fluid retention, edema; raises HDL, LDL and ↓ triglycerides; less hepatotoxicity but monitor ATL (liver) levels

DD: atorvastain (Lipitor) - leads to ↑ drug level and hypoglycemia

if pt is premenopausal drug can stimulate ova production, leading to unplanned/unexpected pregnancy.

repaglinide (Prandin)

glinides aka megalitinides

stimulates release of insulin from pancreas

Use: type 2 diabetes

Effect: lowers serum glucose levels

AE: hypoglycemia

DD: gemfribrozil (Lopid) - inhibits metabolism of prandin leading to ↑ levels and hypoglycemia

acarbose (Precose)

alpha-glucosidase inhibitor

delays absorption of carbohydrates from intestine

Use: type 2 diabetes

Effects: reduces rise in blood glucose after meals

AE: flatulence, cramps, abd distention, borborygmus (loud bowel sounds), D, liver dysfunction

sitagliptin (Januvia)

gliptins (DPP-4 inhibitor) - new class

prolongs active incretin levels, that ↑ insulin release and suppress release of glucagon

Use: type 2 diabetes

AE: HA, URI, hypoglycemia; rare: pancreatitis & severe hypersensitivity (allergic rxn)

ADJUST DOSE IN RENAL FAILURE PATIENTS

DD: none

T3 (triodothyonine - more potent) & T4 (tetraiodothyronine or thyroxine)

stimulate energy use - ↑ basal metabolic rate, O2 use & heat production

stimulate heart - ↑ HR & force of contraction, ↑ CO2, ↑ O2 demand

promote growth & development - brain, nervous system & skeletal muscle

low iodine - ↓ production of thyroid hormones; thyroid increases in size (goiter) & concentrates iodine

levothyroxine (Synthroid)

synthetic preparation of thyroxine (T4)

similar to thyroid hormone action

Use: hypothyroidism

Effects: ↑ thyroxine (T4) levels; ↑ T3 levels

AE: thyrotoxicosis (excessive dosages) - tachycardia, angina (chest pain), tremors, nervousness, insomnia, hyperthermia, heat intolerance, diaphoresis (sweating)

DD: drugs that ↓ levothyroxine absorption: H2 receptor blocker, PPI & Sulcralfate (GI protectant drugs); cholestyramine & cholestipol; calcium & Fe supplements; Mg salts

phentoin (Dilantin), cambamazepine (Tegretol), seraline (Zoloft), phenobarbital ↑ metabolism of levothyroxine so may need to ↑ dose

drug given in mcg; best absorbed on an empty stomach

methimazole (Tapazole)

blockade of thyroid hormone synthesis; suppresses conversion of T4 to T3

Use: Grave's disease (hyperthyroidism); radiation therapy adjunct; pre-op in prep to remove portion of thyroid

Effects: lower T3 & T4 levels

AE: agranulocytosis (lack of WBCs); hypothyroidism; caution in pregnancy (crosses placenta and mammory glands); rash

propylthiouracil (PTU)

used for emergencies

Action and Effect similar to Tapazole

Use: thyrotoxic crisis ("thyroid storm")

AE: can cause liver injury

vasopressin (Pitressin)

promotes renal conservation of H2O; vasoconstriction

drug for hypothalamus d/o's

Use: diabetes insipidus (ADH deficiency)

Effects: ↓ diuresis (urine output)

AE: H2O intoxication r/t excessive H2O retention (early s/s drowsiness, listless); HA; severe s/s: convlusions, terminal coma; cardiac - a.p. r/t coronary artery constriction

hydrocortisone (synthetic equivalent to cortisol), desamethasone, prednisone

drug for adrenal d/o's

Use: replacement therapy for adrenocortical insufficiency

Effects: improve carbohydrate metabolism, promotes glucose availability to the brain

AE: rare when used for endocrine d/o's

estrogen, progestin & combo

controversy r/t effects on uterine CA, breast CA, thromboembolism, ↑ bone density

conjugated estrogens (Premarin - from horse urine), Estradiol (Estrace)

"Bio-identical hormones": estradiol, estriol, estrone

used if women has no uterus

Progesterone (Prometrium, medroxyprogesterone (Provera))

combination: Prempro

pregestin and comvo given if uterus is present

progestion protects endometrium to present hyperplasia and cancer