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Type 1 diabetes is a disruption of what?

β-cell failure at outset and determined
Insulin dependent

Describe Type 2 diabetes and its stages with regard to pharmacological intervention

Gradual β-cell deterioration
Early stages: Diet and Oral agents
Late-stage: Insulin therapy

Prediabetes is defined as what range of fasting plasma glucose levels?


DM is defined as what

is characterized by elevated blood sugar levels due to absolute or relative lack of insulin

How do we monitor the plasma glucose concentration over prolonged periods of time (4-6 weeks)

Glycosylated hemoglobin Hb-A1c test

Proinsulin is converted to what 2 products? Why does this matter?

Proinsulin is converted to insulin and C-peptide. If you find C peptide then the pancreas is producing insulin.

Alpha-2 agonists do what with regard to insulin

Alpha-2 agonist decrease insulin secretion and is the dominant regulator in sympathetic nervous system

What is the mechanism of action

Insulin binds to insulin receptors on the plasma membrane and activates tyrosine kinase - primarily in adipose tissue and skeletal muscle

What 3 organs will have different sorbitol types of pathway

nerves (neuropathy), kidneys and eyes (retinopathy).

What does insulin do in the liver

reduces gluconeogenesis

What does insulin do in the adipose tissue

increase storage of triglycerides in fatty acids in the adipose tissue

what is the problem with diabetes mellitus

Plasma glucagon is increased

When do oral insulin secretion activators not work

increase insulin secretion doesnt work in type 1 diabetes

Insulin is not active ________and it is inactivated by ________ found mainly in __________

orally: insulinase:liver and kidney

What is the biggest physical problem with too much insulin


What drugs should be given with caution in diabetic patients?

Beta Blockers may cause hypoglycemia and if you must use a Beta 1 blocker is best.

Hypoglycemia in older patients may not have warning signs and may cause.....


What is lispro

rapid acting insulin

What is another name for regular insulin


Which of the insulins are rapid and short acting and also available as an IV?

Lispro and regular Crystalline insulin

Most treatments for diabetes is delivered how

slow and uniform as a subqutaneous

When is an IV prepraration of insulin used

in ketoacidosis

Which of the insulin type is the fastest acting?


Which of the insulin type is the intermediate acting?


When an insulin regimen is designed what types of insulin are used

both a slow acting and a fast acting that mimics physioligical rates.

what is the main distinct advantage of the new insulins

they have lower rates of hypoglycemia.

Long acting or intermediate acting provide insulin during which physiological period

insulin levels during basal periods or rates

Rapid acting or short acting provide insulin during which physiological period

correct the postprandial hyperglycemia or short acting

Type II diabetes drugs include which 4 drugs

Biguanides, Sulfonylureas, Meglitinides, Thiazolindinediones

Sulfonylureas, Meglitinides do what

Stimulation of pancreatic insulin release

What drug reduces the bio-synthesis of glucose in liver


Increase the sensitivity of target cells to insulin

Glitazonez (Thiazolidinediones)

What drug is used to retard the absorption of sugars from the GI tract -

Acarbose, Miglitol

What are drugs known as sulfonylures?

Sulfonylureas :
Glipizide, Glyburide Glimiperide - more potent, more efficacious and fewer adverse effects.

Mechanism of action of Sulfonylureas and how do they treat diabetes?

Sulfonylureas stimulate the release of insulin by indirectly blocking β-cell K/ATP ase channel by binding to a specific site SUR (sulfonylurea receptor) on it

What are the side effects of the sulfonylreas

Hypoglycemia because it increases insulin and weight gain becuause it is an anabolic hormone.

What is the drug of choice for blood sugar control during pregnancy is


What is the most important drug for type II diabetics


How does metformin work or it's mechanism of action

It blocks gluconeogenesis via activation of AMP activated TK. It also increases muscle uptake

How does metformin or Biguanides better than other diabetic drugs

It upregulates insulin sensitivity no weight gain

What is the 1st line treatment for Type II diabetes


What is the most important Thiazolindinediones


What does pioglitazone (actos) do?

acts on gamma and alpha PPAR but specifically in the gamma PPAR it enhances glucose and lipid metabolism and sensitivity to insulin in the fat and muscle by increasing GLUT 4 receptors

What protein will be upregulated with pioglitazone use?

Increased Adiponectin and increase numbers of GLUT 4 receptors.

When the Thiazolindinediones were introduced what was the big side effect

increased liver enzymes and hepatitis although they are now not associated with the new drugs.

Thiazolindinediones like pioglitazone are black boxed with a warning of what side effect?

Fluid retention and weight gain, so not good in CHF

rosiglitazone also have what major side effects that have caused it to go out of favor

high risk of cardiovascular events and bladder cancer.

Alpha-glucosidase inhibitors work by what mechanism ......

inhibiting alpha glucosidase which converts dietary starch and complex carbohydrates into simple sugars so that they aren't absorbed

Alpha-glucosidase inhibitors cause what bad side effect that limit its use

Bloating, Diarrhea and flatulence

What are two Alpha-glucosidase inhibitors that are used today

Acarbose and miglitol

Sulfonylureas, how do they work

close K+ channel in beta-cell membrane, resulting in depolarization of cell triggering insulin release via Ca2+ influx; first generation [Tolbutamide, Cholorpropamide] disulfiram like effects, second generation [Glyburide, Glimepiride, Glipizide] can cause hypoglycemia

Via what method do we receieve the highest change in glucose

Oral delivery of glucose

What does GLP 1 agonists do?

It is the most effective incretin

What is the major side effect in metformin

Serious concern about lactic acidocis especially in alchoholics and Renal patients

Why is Metformin such a breakthrough drug for Type II diabetes?

Does not promote insulin secretion so it does not cause hypoglycemia

How long is the half life of GLP 1 and what enzyme degrades it

Half life is 3 minutes and DPPIV degrades it which is why we need inhibitors of DPP-IV and stimulators of GLP-1

Exenatide and liraglutide are what type of drugs

GLP-1 agonist that tries to stimulate the pancreas to make insulin and suppress glucagon release and suppress appetite.

What is a side effect of GLP-1 Exenatide and liraglutide

Rarely causes hemorrhagic pancreatitis

DDP-4 inhibitors include what type of drugs

Sitagliptin and Saxagliptin

Sitagliptin and Saxagliptin are what type of drugs and used for what?

an oral drug that is used as an adjunct therapy used to block the enzyme DPP-4 that breaks down GLP-1

Amylin Analogs include what drug


Pramlintide is used in what type of diabetes?

Type I and II

Pramlintide is used to do what

increase hypoglycemia by slowing gastric emptying and slows inappropriate glucagon secretion while improving blood sugar levels

Glucagon as a physiological drug does what

It has a positive inotropic action and increase the heart rate while stimulating glucagon receptors but not at the

You can treat a beta blocker overdose

You can treat a beta blocker overdose by using glucagon

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