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Pharmacology: Ch. 21 Diabetes Mellitus

Terms in this set (25)

Two primary hormones secreted by islets of
Langerhans of the pancreas are:
• Insulin::* promotes fuel storage (glucose out of blood)

• Glucagon::* promotes fuel mobilization (glucose into the blood)
A group of metabolic disorders characterized by
persistent:
Hyperglycemia

• Type I (insulin-dependent)
• Type II (non-insulin-dependent)

Symptoms and complications result, usually from
inadequate or poorly timed secretion of insulin from the pancreas and/or insulin resistance of the cells
Type 1
• Usually develops in persons younger than age 30
years and results from autoimmune destruction of
pancreatic beta cells
• Associated with a complete lack of insulin secretion, increased glucagon secretion, rapid onset of disease, ketosis, and severe symptoms
• Without insulin, type I DM is fatal
• Must be treated with injections of insulin
Type 2
• Usually develops in persons older than age 40
years, but more and more cases are being reported in persons younger than age 20 years; attributed to lack of exercise
• The pancreas can secrete enough insulin to prevent ketoacidosis but not enough to normalize plasma glucose
• Insulin secreted does not reduce glucose levels in serum to normal levels
• Insulin resistance develops and the pancreas gives out
Complications of Diabetes
Xerostomia:pronounced susceptibility to caries; the xerostomia is secondary to an increase in urination
• Dry, cracking oral mucosa with presence of
mucositis, ulcers, infections, and an inflamed painful tongue

Periodontal disease: patients with uncontrolled or undiagnosed diabetes are more prone to periodontal disease
• Advanced glycation end-products (AGEs): collagen becomes cross-linked; thickening of blood vesselss* is associated with elevated AGEs
Dental appointments should not interfere with meals and should involve minimal:
Stress
Patients with diabetes have ____________ blood vessels, ______________ wound healing, and a tendency to develop infections.
Fragile//delayed

Surgical therapy should be approached with caution
Cautions and Contraindications
Drugs that may decrease insulin release or increase insulin requirements, such as epinephrine,
glucocorticoids, or opioid analgesics, should be used with caution in patients with diabetes
Systemic Complications of Diabetes
Cardiovascular system: incidence of problems is higher in pts with diabetes

Retinopathy: microvascular disease affects the blood supply to the retina

Neuropathy: leads to reduced and sometimes absent feelings, especially in the lower extremities

Infections: gangrene can occur in the peripheral extremities due to depressed immunity, less effective WBC, microvascular changes, and neurophathy

Healing: slower healing
Effect of Drugs on Complications of Diabetes
• Intensive treatment of patients with IDDM can
substantially reduce the onset and progression of
diabetic retinopathy, nephropathy, and neuropathy
• The risk of hypoglycemia is increased three times, and the increase in weight gain tends to be greater
Two laboratory tests useful in evaluating a patient's
glucose control are:
• Serum glucose::* a measure of the patient's glucose control at the time that the blood is sampled
• Glycosylated hemoglobin (HbA1C)::* reflects glucose control over a 2-to 3- month period
Treatment of Hypoglycemia
• It pt is conscious: any source of sugar (fruit juice, cake icing, glucose gel, or soluble carbohydrate)
• Unconscious: lacks swallowing reflex; IV dextrose (50%)
Drugs Used to Manage Diabetes
• Insulins
• Oral antidiabetic agents
• Other new drugs
• Glucagon
Insulins
• Usually administered by subcutaneous injection, large molecular size prevents it from being absorbed from the gastrointestinal tract
• Differ in onset and duration of action
• Human insulin is prepared by recombinant DNA synthesis and by modifying porcine insulin
• Recently, an inhaled dose form was approved to treat both type 1 and type 2 diabetes
• Can be used in place of short-acting injectable insulin that is used at mealtime for patients with type 1 diabetes
• It is added to regimens that also include long-
acting insulin
Selected Insulin Preparations
Rapid acting:
• insulin aspart (Novolog)
• insulin lispro (Humalog)
• insulin gallisin (Apidra)

Short acting:
• insulin regular (Novolin R, Humulin R)

Intermediate acting:
• insulin NPH (Humulin N, Novolin N)
• Humulin L Lente

Long acting:
• insulin detemir (Levimir)
• insulin glargine (Lantus)
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