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Module 15 - Drugs to Treat Diabetes
Terms in this set (81)
Polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased hunger), weight loss
What are the four classic symptoms of diabetes?
Insulin is a _________________________ hormone synthesized by _________________________ cells of the islets of Langerhans of the pancreas
Glycogen, protein, triglyceride
In liver cells, glucose results in _________________________ synthesis
In muscle cells, glucose is used for _________________________ synthesis
In fat cells, glucose is used for _________________________ synthesis
Type I, type II, gestational
What are the three types of diabetes?
Approximately ____% of diabetics have type I diabetes and ___% have type II diabetes
Autoimmune reaction where body's immune cells destroy pancreatic beta cells
What causes type I diabetes?
F (not preventable)
T/F: eating too much can cause type I diabetes
Cells are resistant to insulin
What causes type II diabetes?
Diabetes that occurs during pregnancy
What is gestational diabetes?
When during pregnancy does gestational diabetes occur?
Pregnant women with gestational diabetes tend to have babies of _________________________ size and these babies are born with _________________________ for the first few days
F (increases risk of type II diabetes in 5-10 years)
T/F: once a pregnant woman has gestational diabetes, she will have type II diabetes after pregnancy
T/F: diabetes can cause blindness
Hyperglycaemia damages retinal capillaries
How does diabetes cause blindness?
Once a year
How often should diabetes patients have eye exams?
Proteinuria (protein in urine), decreases glomerular filtration, increased blood pressure
What are the three signs of diabetic nephropathy?
Diabetic nephropathy is the leading cause of morbidity and mortality in type ____ diabetic patients
ACE inhibitors, ARBs (angiotensin II receptor blocker)
What are the two classes of drugs that prevent diabetic nephropathy?
Cardiovascular diseases including heart attack and stroke are the leading causes of morbidity and mortality in type ____ diabetics
Cardiovascular disease in diabetics is caused by hyperglycaemia and altered _________________________ metabolism
What class of drugs reduces cardiovascular diseases in diabetic patients, regardless of their LDL cholesterol levels?
What is the most common cause of hospitalization of diabetic patients?
Fasting plasma glucose test*, casual plasma glucose test, oral glucose tolerance test
What are the three tests used to diagnose diabetes? Put a * beside the preferred test for diagnosing diabetes
Fasting plasma glucose test:
patients fast for at least ____ hours and then have a blood sample drawn to measure blood glucose. If fasting plasma glucose is equal to or above ____ mmol/L, then diabetes is diagnosed
Casual plasma glucose test:
blood can be drawn at any time no matter what the interval was since the last meal. For diagnosis of diabetes, the casual plasma glucose is equal or greater to _____ mmol/L AND the patient displays classic signs of diabetes
Follow up with fasting plasma glucose test
What do we do if an initial causal plasma glucose test suggests diabetes?
Oral glucose tolerance test:
Patients are given an oral ____ gram dose of glucose and plasma glucose is measure 2 hours later. If the plasma glucose levels are equal to or greater than ____ mmol/L, then the patient will be diagnosed with diabetes
When the other tests are unable to definitely diagnose diabetes
When would we do an oral glucose tolerance test?
What method is used to determine the average blood glucose levels over the previous 2-3 months?
What is the most common glycosylated hemoglobin derivative?
4, 7, 5, 10, 7
Normal range of plasma glucose:
Fasting: ____ to ____ mmol/L
After meal: ____ to ____ mmol/L
HbA1C < ____% of all hemoglobin
130, 80, 2.6, 1.7, 1, 1.3, 30
Target blood pressure: ____/____
LDL: < _____ mmol/L
Triglycerides < _____ mmol/L
HDL (men) > _____ mmol/L
HDL (women) > _____ mmol/L
Urine albumin:creation ratio < _____ mg/g
F (only type II - type I diabetics often lose weight, so they should maintain it)
T/F: type I and type II diabetic patients should lose weight as a lifestyle modification
Increases cellular response to insulin and increases glucose tolerance
Type I diabetes should moderately exercise. Why?
How many times do type I diabetics need to monitor their blood glucose levels?
What are the two main lifestyle modifications that type II diabetic patients should make?
T/F: insulin can be thought of as anabolic
Insulin _________________________ [glucose] in the blood
Glycogenolysis, gluconeogenesis and decreased glucose utilization are _________________________ effects seen in insulin deficiency
There are ____ main types of insulin available to treat diabetes that differ in their appearance, time course of action, and route of administration
Short duration rapid acting, short duration slower acting, intermediate duration, long duration
The 7 types of insulin can be classified based on time course of actions. What are the four classifications?
Lispro, aspart, glulisine, meals, subcutaneous, clear
Short duration rapid acting insulin include insulin _________________________, insulin _________________________, insulin _________________________. They're administered in association with _________________________. The route of administration is _________________________, but IV may be used if required. These are _________________________ solutions
Unmodified human, before, subcutaneous, intramuscular, clear
Short duration slower acting insulin is _________________________ insulin. It is injected or infused _________________________ meals. The route of administration is _________________________ but _________________________ is used in rare occasions. These are _________________________ solutions
After injection, insulin forms small aggregates (dimers) which slows absorption
Why does short duration slower acting insulin react slowly?
NPH (Neutral Protamine Hormone), detemir, meals, subcutaneous
Intermediate duration insulins include _________________________ insulin and insulin _________________________. They have a delayed onset of action, so they're not taken with _________________________. The route of administration of both of them is _________________________.
Cloudy suspension, clear
NPH insulin is a _________________________ while insulin detemir is a _________________________ solution
It's conjugated with a large protein, protamine which makes the molecule less soluble and decreases absorption
Why does NPH insulin act slowly?
Molecules bind strongly together which delays absorption
Why does insulin detemir act slowly?
Glargine, subcutaneous, once, clear
Long duration insulin includes insulin _________________________. The route of administration is _________________________ and it's taken _________________________ a day. It's a _________________________ solution
It has low solubility at physiological pH
Why does insulin glargine last long?
F (can mix NPH insulin with any short acting insulins)
T/F: insulins shouldn't be mixed, as there may be contamination
Only _________________________ can be mixed with short acting insulins
Short acting insulin
When mixing two insulins, which one should be drawn first?
How long are insulin mixtures stable for in a syringe?
Hypoglycaemia (>3 mmol/L)
What is the primary complication of insulin treatment?
Tachycardia, palpitation, sweating and nervousness may occur if blood glucose levels are _________________________
Fast acting oral sugar (if conscious), IV glucose (if unconscious)
What is the best way to treat hypoglycemia? (2)
Diabetic patients are recommended to keep _________________________ on hand in case of insulin overdose
There's no glycogen to break down
Why is glucagon ineffective in starving or malnourished patients?
Oral antidiabetic drugs are used to treat type ____ diabetes, but are quite ineffective to treat type ____ diabetes
Biguanides*, sulfonylureas, meglitinides, glitazones, alpha-glucosidase inhibitors, gliptins
What are the six classes of oral antidiabetic drugs? Put the * beside the preferred choice
Increase sensitivity and number of insulin receptors, decrease hepatic gluconeogenesis, decrease intestinal glucose absorption
What are the three ways biguanides decrease blood glucose?
Don't increase insulin, so they don't pose a risk of hypoglycaemia
What is the major advantage of biguanides in treating diabetes?
Nausea, decreased appetite, diarrhea, decreases absorption of vitamin B12 and folic acid, lactic acidosis (rare)
What are the 5 adverse effects of biguanides?
Stimulate insulin release from pancreaas, inhibit glycogenolysis
What are the two ways sulfonylureas decrease blood glucose?
2nd generation: more potent and less drug interactions
What's the difference between 1st generation and 2nd generation sulfonylureas?
What is the major adverse effect of sulfonylureas?
Prolonged use of sulfonylureas can cause _________________________, reduced capacity to synthesize insulin
Have a shorter half life, less likely to cause hypoglycaemia and pancreatic burnout
How are meglitinides different from sulfonylureas?
Decrease hepatic gluconeogenesis, increase insulin sensitivity
How do glitazones decrease blood glucose? (2)
How do glitazones increase insulin sensitivity?
HDL, triglycerides, PPAR-alpha
Glitazones also increase _________________________ and decrease _________________________ via activation of _________________________
Edema, headache, myalgia
What are the three adverse effects of glitazones?
Delay carbohydrate absorption by inhibiting alpha-glucosidases which break down complex carbohydrates
How do alpha-glucosidase inhibitors decrease blood glucose? (1)
Diarrhea, gas, decreases iron absorption, cramps, abdominal distention
What are the 5 side effects of alpha-glucosidase inhibitors?
How do gliptins decrease blood glucose? (1)
Breaks down incretin hormones GLP-1 and GIP. GLP-1 and GIP increase insulin release and decrease glucagon release
What does DPP-4 do? What do GLP-1 and GIP do?
T/F: gliptins have no major adverse effects
Synthetic incretin that increase insulin release and decrease glucagon
What are incretin mimetics? What do they do?
What are the two oral antidiabetics drug classes that incretin mimetics are taken with?
What are the two adverse effects of incretin mimetics?
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