Term
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Definition
| common pancreatic disease that results in a deficiency of insulin production |
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Term
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Definition
| disease in which extrapancreatic peripheral tissues show resistance to actions of insulin like glucose uptake |
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Term
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Definition
| synthesized in pancreatic beta cells; Type I DM pts require exogenous forms to sustain life; Type II DM pts have the ability to make it up but cannot secrete enough insulin to overcome their resistance |
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Term
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Definition
| it increases uptake of glucose by skeletal muscle, liver, & fat; decreases output of glucose by liver --> decreases circulating glucose; |
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Term
| Actions of Insulin in Liver |
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Definition
| it decreases glycogenolysis (glycogen --> glucose); increases glycogenesis (glucose --> stored glycogen) --> increased synthesis of glucose transporters, increases synthesis of glycogen-related enzymes; --> decreases hepatic output of glucose; decreases protein catabolism, decreases conversion of fatty acids to keto acids; increases synthesis of TGs, cholesterol, VLDLs |
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Term
| Actions of Insulin in Skeletal Muscle |
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Definition
| increases glycolysis; stimulates glycogen sythesis; increases glucose transport into cells by increasing glucose transporters; stimulates amino acid uptake & protein synthesis |
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Term
| Actions of Insulin in Adipose Tissue |
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Definition
| activates extracellular lipoprotein lipase --> FFAs for TG synthesis; increases glucose transport into cells by increased synthesis of glucose transporters; reduces intracellular lipase activity (stops breakdown of TGs) |
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Term
| regular insulin (Novolin-R, Humulin-R) |
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Definition
| original "fast-acting" injectable insulin; soluble crystalline zinc insulin; readily soluble & can be used IV in emergencies (ketoacidosis) or SC for general glycemic maintenance; usually mixed with intermediate- or long-acting preps |
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Term
| insulin lispro (Humalog), insulin aspart (Novolog) |
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Definition
| fastest-acting injectable forms of insulin; "prandial" formulations; for SC injection; usually mixed with intermediate- or long-acting preparations |
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Term
| NPH insulin (Novolin-N, Humulin-N) |
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Definition
| isophane insulin suspension given by SC injection; NOT suitable for emergency IV situations because it is not very soluble; give once in AM and once in PM --> basal 24 hr insulin level; may be supplemented w/ rapid/short-acting forms to better meet requirements of periodic carbohydrate intake with meals |
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Term
| insulin detemir (Levemir) |
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Definition
| slow onset longer-acting SC injectable insulin; NOT very soluble, DO NOT give IV; provides basal level of insulin for 24 hrs; supplement with rapid/short-acting forms throughout day to better meet requirements of perioid carb intake |
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Term
| insulin glargine (Lantus) |
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Definition
| slowest onset & longest-acting SC injectable form of insulin; NOT very soluble --> DO NOT use IV; provides basal level of insulin for 24 hrs; provides basal level of insulin for 24 hrs; supplement with rapid/short-acting forms throughout day to better meet requirements of perioid carb intake |
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Term
| Side Effects of Exogenous Insulin Use |
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Definition
| severe hypOglycemia (brain damage may result); Immunologic rxns due to formation of antibodies --> reduced systemic actions; Local Lipodystrophy at sites of SC injection; Weight Gain (in Type II DM pts, NOT Type I DM pts) |
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Term
| glyburide [Diabeta, Micronase], glipizide [Glucotrol] |
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Definition
| sulfonylurea drugs that lower blood glucose by stimulating release of endogenous insulin --> close certain K channels in pancreatic beta cells --> changes voltage gradient --> opens Ca channels --> Ca influx --> insulin release; acts independent of blood glucose level; used to treat Type II DM only; metabolized by liver, excreted by kidneys; DoA: a few-several hours |
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Term
| Side Effects of Sulfonylureas (glipizide [Glucotrol], glyburide[Diabeta, Micronase]) & Meglitinides (repaglinide [Prandin}, nateglinide [Starlix]) |
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Definition
| Too much HypOglycemia; Weight gain (less with newer meds); allergy with older generation meds; |
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Term
| repaglinide (Prandin), nateglinide (Starlix) |
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Definition
| newer insulin secretagogues that lower blood glucose by stimulating release of endogenous insulin via K channels but in a MUCH more blood-glucose dependent manner than older drugs (stimulate release when glucose is high, less when it is low); used only in Type II DM; more rapid-acting; metabolized by liver, protein-bound; |
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Term
| Sulfonylurea Drug Interactions |
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Definition
| salicylates (aspirin), antibiotics (sulfonamides, chloramphenicol), alcohol, & insulin help INCREASE hypOglycemic action of this drug --> displaces from protein-binding |
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Term
| metformin (Glucophage, Fortamet, Riomet) |
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Definition
| biguanide oral antihypERglycemic; used in managing Type II DM; it DOES NOT increase pancreatic insulin secretion; MoA: reduces blood glucose by improving sensitivity of peripheral tissues to insulin action on glucose uptake & storage (insulin "sparing"), also decreases hepatic glucose output; helps LOWER BP & serum lipid levels (VLDL, LDL); can cause WEIGHT LOSS; also used to treat polycystic ovary syndrome; excreted renally, requires good renal fcn; NOT protein bound |
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Term
| SEs & D-D interactions with metformin (Glucophage) |
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Definition
| GI: nausea, anorexia, diarrhea --> Take w/ food, titrate doses up slowly; Lactic acidosis (serious, but rare); Impairs vitamin B12 & folic acid absorption; increased blood levels when taken with other renally-cleared meds (digoxin, morphine, quinidine, triamterene); also w/ radio-contrast dye (D/C drug prior to administration of dye, wait 48 hrs to start drug again) |
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Term
| rosiglitazone [Avandia] & pioglitazone [Actos] |
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Definition
| antihypERglycemic agents for use in Type 2 DM; they DO NOT stimulate pancreatic insulin secretion; MoA: activates PPARs --> increased insulin-mediated synthesis of new glucose transport molecules in nucleus of insulin-resistant tissues --> increased glucose uptake & decreased serum glucose; "corrects" insulin resistance; decreases plasma TG levels, BP, and increases HDLs; metabolized by liver; relatively long half-life; highly plasma bound |
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Term
| Side Effects of rosaglitazone [Avandia] & pioglitazone [Actos] |
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Definition
| vascular fluid retention & edema --> NOT recommended for diabetics with CHF; possible liver injury --> watch LFTs; Weight Gain; increases LDLs; possible increase incidence of MIs |
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Term
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Definition
| alpha-glucosidase inhibitor; lowers plasma glucose by reversibly inhibiting alpha-glucosidase enzymes that digest complex carbs in small intestine; delays postprandial absorption of glucose --> attenuation of postprandial increases in plasma glucose; beneifical in both types of DM by "smoothing out" postprandial glucose peaks; NO DIRECT effects on insulin secretion or sensitivity; used as ADJUNCTIVE therapy; metabolites found in breast milk & crosses placenta; excreted unchanged in feces; wide interdividual variation in intestinal glucosidase activity, no fixed dose, titrated per individual |
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Term
| Side Effects & D-D Interactions with Acarbose [Precose] |
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Definition
| GI: flatulence, abdominal cramping, distension, diarrhea; C/I: inflammatory bowel disease, intestinal obstruction; D-D: adverse hypOglycemia rxns to concurrent use of insulin or insulin secretagogues (glyburide, glipizide, Prandin, Starlix) |
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Term
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Definition
| incretin mimetics; injectable DDP-IV-resistant incretin mimetic that binds to & activates GLP-1 receptors --> enhances insulin secretion, inhibits glucagon secretion, slows gastric emptying, & increases sensation of satiety --> modest lowering of fasting glucose & makred lowering of postprandial glucose; adjunctive therapy for Type 2 DM; administer SC before meals |
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Term
| SEs & D-D Interactions of exenatide [Byetta] |
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Definition
| hypoglycemia, usually when combined w/ sulfonylurea; GI side effects; D-D: decreases absorption of orally administered drugs --> slows gastric emtpying; Take oral contraceptives & antibiotics 1 hr before injecting |
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Term
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Definition
| NON-peptive DPP-IV inhibitor that increases GLP-1 effects; adjunctive therapy for Type 2 DM in combo with diet, exercise, & other antidiabetic drugs; ORAL; SEs: hypOglycemia; D-D: increases digoxin plasma levels, increases risk of ACE-I-associated angioedema |
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Term
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Definition
| stable injectable amylin analog that slows gastric emptying, inhibits glucagon secretion, & increases sensation of satiety; used with insulin in both Type 1 & 2 DM; inject separately from insulin sites (2 inches apart); administer SC; SEs: hypOglycemia, GI side effects; D-D: slows gastric emptying |
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Term
| Plan of Treatment for Type 1 DM |
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Definition
| 1) dietary instruction; 2) parenteral insulin administration (usually mixture of long-acting & short-acting forms); 3) careful attention to outside factors that change insulin requirements (stress, infections, etc); to better control postprandial peaks, possibly add an alpha-glucosidase inhibitor (ascarbose [Precose]) or possibly pramlintide [Symlin] just before meals |
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Term
| Plan of Treatment for Type 2 DM |
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Definition
| 1) change diet (reduce obesity, blood glucose), start with metformin, then add a sulfonylurea, a glitazone, or insulin as recommended; 2) use insulin secretagogue if not obese, use metformin if obese; 3) add on alpha-glucosidase inhibitor (ascarbose) if postprandial peaks are still high; 4) possible use of meglitinides (Prandin, Starlix); 5) adjunctive use of exenatide, pramlintide, & sitagliptin |
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