Term
Drugs for glucose regulation |
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Definition
insulin preparations:
-analog: prototype- insulin aspart (NovoLog)
-short-Acting: P-Regular
-intermediate: P-NPH
-Long acting: P-extended insulin, zinc (Ultralente)
-Combination: P-humalin 50/50
oral hypoglycemia agents
-sulfonylurea: prototype-first generation: chlorpropamide (Diabinese) second generation: glipizide (Glucotrol)
-Beguinides: P-metfomin (Glucophage)
-Thiazolidinediones: P-proglitazone (Actos)
-alph-glucosidase inhibitors: P-acarbose (Precose)
-meglitinides: P-repaglinide (Prandin)
-combination: P-glyburide/metformin (Glucovance)
hyperglycemic agents: P- glucagon |
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Term
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Definition
Islets of Langerhans: 3 types of secretory cells
alpha (A)-glucagon
beta (B)-insulin
delta (D)-somatastatin-CHO, fat and protein metabolism |
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Term
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Definition
usually occurs before age 30
-little of no endogenous insulin
-islet beta cells decreased or absent-insulin absent or decrease and beta cell fail to respond to stimuli
-ketosis prone-insulin therapy required |
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Term
diabetes mellitus type II |
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Definition
maturity onset usually after 40
-some insulin function, but response decrease
-gradual progression from normal to impaired glucose tolerance
-obese, genetic
-management: dietary, exercise, oral hypoglycemic (perhaps insulin)
-goal: FBS<126 mg/dl, HbA1c>7% |
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Term
clinical manisfestation: decreased insulin resistance-hyperglycemia |
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Definition
CHO: glucose
-urination (glucouria)
-thirst (polydipsia)
-hunger (polyphagia)
Fat: fatty acid breakdown
-ketones (acidosis-coma)
Protein: catabolism
-weight loss, fatigue, polyphagia |
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Term
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Definition
transport of glucose across cell membrane
conversion of glycogen to glucose
amino acid utilization-enhances synthesis of protein and inhibits protein breakdown
utilize fatty acid by cell and inhibits lipolysis |
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Term
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Definition
lispro (Humalog)
aspart (NovoLog)
glulisine (Apidra)
onset: 15 min
peak: 30-1hr 15 min
effective duration: 3-4 hours
SQ, IV |
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Term
Short-acting insulin
(regular) |
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Definition
regular: Humalin R, Novolin R
Actrapid
onset: 30-60 min
peak: 2-3 hours (snack)
duration: 5-7 hours
clear: IV, SQ |
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Term
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Definition
Humalin N, Novolin N (NPH)
Humalin L, Novolin L (zinc)
onset: 2-4 hours
peak: 8-12 hours
hypoglycemia-midafternoon
effective duration: 18-24 hours
cloudy-sq only |
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Term
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Definition
Ultralente, Humulin U, glargine (Lantus)
onset:3-4 hours
peak: 8-16 hours
effective duration: 18-20 hours
SQ |
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Term
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Definition
subq: fast to slow: abdomen, arm, thigh
physical activity will accelerate absorption
rapid or short-acting IV, or sq, or insulin pumps
SE: hypoglycemia
local allergic:itching, redness, swelling, lipodystrophies |
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Term
Hypoglycemia
drug therapy |
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Definition
glucagon
-hyperglycemia agent-emergency for acute hypoglycemia
-subq, IM, IV
must administer food
IV glucose to prevent recurrence of hypoglycemia
monitor glucose level
monitor blood glucose prior to administration
-may be on sliding scale baseline
signs of hypoglycemia-insulin, decreased food intake, emotional upset
15 g of CHO |
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Term
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Definition
used for type II diabetes
need some endogenous insulin
part of management plan |
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Term
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Definition
first generation: diabinese, orinase
second generation: glyburide (Micronase), glipizide (Glucotrol)
-low cost, fast reduction in fasting glucose
-weight gain, strong risk of hypoglycemia
-take with breakfast |
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Term
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Definition
-act similar to sulfonylureas
-very short acting-acts directly on beta cell
repaglinide (Prandin), nateglinide (Starlix)
-lower risk for hypoglycemia, short acting, meal adjust dosing
-expensive
-take 15-30 minutes before each meal |
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Term
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Definition
stop liver from making extra sugar when its not needed
metformin (Glucophage) with meals
Glucophage XR-one daily with evening meals
-weight loss, insulin sensitization, positive lipid effect, mild hypotensive, effect and low risk of hypoglycemia
-GI side effect, expensive, rare lactic acid (liver disease)
stop 2 days before procedures that may decrease renal profusion: IV contrast, surgery |
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Term
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Definition
thiazolidinediones help body cells use insulin better
rosiglitazone (Avandia), pioglitazone (Actos)
-take without regard to meals
-decrease amount of insulin, decrease risk of hypoglycemia, decrease in triglyceride level, used safely with renal disease
-expensive, weight gain, slow onset (12 weeks), possible liver toxicity |
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Term
alpha-glucosidase inhibitors |
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Definition
slow the digestion of starches
acarbose (Precose), miglitol (Glysert)
-decrease risk of hypoglycemia
-expensive, GI side effect, must be taken with the first bite of each meal
-contraindicated-inflammatory bowel
treat hypoglycemia with oral glucose not sucrose |
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Term
Dipeptidyl Peptidase-4 (DPP-4)
inhibitors |
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Definition
vildagliptin (Galvus), sitagliptin (Januvia)
-once a day
-lowered A1c, works well in elderly, fewer side effects, take with other oral hypoglycemic agents
-upper respiratory infection, sore throat, diarrhea |
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