CH 57 - DM

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Author:
rawritsjoie
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208925
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CH 57 - DM
Updated:
2013-03-24 11:55:48
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pharmacology Wk1
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Drug and theory questions about DM
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  1. What's the difference between DM1 + DM2?
    DM 1: hereditary, younger kid pts, body does not make insulin, aka insulin dependent diabetes

    DM 2: lifestyle, any age, body produces insulin that cant get into cells, aka non-insulin dependent
  2. Hyperglycemia vs Hypoglycemia
    hyperglycemia: high blood sugar, presents as polyuria, polydipsia, fatigue, headache, leads to ketoacidosis. call doc

    hypoglycemia: shaking, confusion, hunger, unconsciousness. give OJ
  3. What are some of the consequences of untreated DM?
    • Hypoglycemia/Hyperglycemia
    • Macrovascular damage
    • -heart disease, hypertension, stroke
    • Microvascular damage
    • - retinopathy, nephropathy, neuropathy, ED
  4. Common diagnosis test of DM
    • Fasting Plasma Glucose (FPG)
    • -test needs to be positive 2 separate days
    • -pt needs to fast for 8 hours before taking test
    • -normal FPG: 70-100
    • -pre DM: 101-125
    • -diabetic: >126
  5. DM 1 therapy vs DM 2 therapy
    DM 1: needs the insulin, mgmt of BP & lipids

    DM 2: maybe insulin & anti-diabetic drugs

    both need: diet and exercise
  6. How do you check the progress of treatment?
    • Hgb A1c: gets the avg sugar lvls of the past 2-3 months
    • Self-Monitoring of blood glucose (SMGB): finger prick at home
  7. Know the 4 types of insulin & what makes them different from another
    • Insulin Lispro (Humalog) - quick one, take with meals
    • Regular Insulin (Humulin R, Novolin R) - human insulin, take with meals to anticipate increased glucose OR take through out the day to maintain glucose levels. IV in ER
    • Neutral Protamine Hagedorn (NPR) Insulin suspension - its cloudy, mixable, sugar control between meals and at night (2 times a day) 
    • Insulin Glargine (Lantus) - 24 hour hold, only once a day, 
    • Premixed
  8. Rules of mixing insulin
    • Short acting & longer lasting insulin mix
    • -NPH the only long lasting insulin allowed to mix
    • -short acting drawn up, then long lasting drawn.
    • -in the syringe it looks like cloudy to clear
  9. Administration of insulin
    sub q: injection sites in upper arm, thigh and abs. abs most common. always move injection site 1 in away from the previous. 

    insulin pump: just replace the the meds in a couple of days. allows a steady flow of insulin then a bolus of insulin before meals
  10. Other uses for insulin
    • IV - for ER and ketoacidosis
    • hyperkalemia - increase cellular uptake of K = lower K levels
    • diagnosis of growth hormone (GH) deficiency
  11. dosage considerations of insulin
    • Exercising: Blood sugar is decreased = decrease insulin
    • stressed: causes an increase in blood sugar = increase insulin
    • diet: good diet lowers sugar intake = lower insulin
  12. 3 types of dosing schedules for insulin
    • Conventional therapy: mixed insulin at breakfast and dinner. only 2 shots
    • Intensive conventional therapy (sliding scale): One shot of Insulin Glargine at night, then a shot of regular insulin before every meal. flexible
    • Continuous subQ infusion: this is with the pump, same idea with sliding scale but with a pump.
  13. What is diabetic ketoacidosis?
    • It is more common in DM 1 pts.
    • There is an extreme low of insulin 
    • presents as: hyperglycemia, waterloss, appears to be drunk, fruity breath, production of ketoacids
  14. How do you treat diabetic ketoacidosis?
    correct the glucose level, insulin replacement, bicarbonate to correct pH, H2O and Na replacement,K replacement
  15. What is Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?
    • Hyperglycemia caused by insulin deficiency
    • more common in DM2
    • No fruity breath, no change in pH, no ketoacids
    • happens during stress, s/s are slow to appear 
    • presents as: dehydration, thickened blood,
  16. Metformin (Glucophage)
    - Uses, MOA, AE, Toxicity, Memory Trick
    • uses: DM for pts who skip meals, prevention of DM2, gestational DM, 
    • MOA: lowers glucose levels by decreasing the absorption and stopping glucose production in liver, increases sensitivity of insulin receptors in fat and muscle cells
    • AE: nausea, diarrhea, appetite suppression (wt loss), decrease absorption of B12 & folic acid
    • Toxicity: lactic acidosis (brings the pH lvl low)
    • Memory trick: Glucophage - eat up the glucose. reduces glucose lvls
  17. Sulfonylureas (Micronase)
    MOA, AE, D2D, Memory trick
    • MOA: stimulates the pancreas to produce more insulin. "squeezes to get the insulin"
    • AE: hypoglycemia - if you forget to eat
    • teratogenicity - no prego
    • D2D: alcohol - decrease BS
    • beta blockers - hides the effect of hypoglycemia
    • Memory trick: sulfonylureas = squeeze
  18. Repaglinide (Prandin)
    MOA, AE, Memory Trick
    • MOA: promotes insulin release
    • AE: Hypoglycemia, Teratogenicity
    • must eat a meal within 30 mins, or else hypo
    • Memory trick: prandin = brandin...has DM2 and eats every 30 mins
  19. Pioglitazone (Actos)
    MOA, AE, D2D, Memory Trick
    • MOA: makes receptors more sensitive to insulin, lowers glucose production
    • AE: common- respiratory tract infection, headache, myalagia, heart failure, fluid retention, hypoglycemia, ovulation in postmenopausal women, bladder CA, fractures in women
    • D2D: insulin
    • Memory: pioGLITAzone, glitter like jems, jems are rare, this is the only one with crazy AE
  20. Acarbose (Precose)
    MOA, AE, D2D, Memory Trick
    • MOA: delays the absorbtion of dietary carbs (carbs are made up of glucose)
    • AE: GI effects, anemia - because cant absorb iron, hepatoxicity
    • D2D: metformin - more GI effects, and acarbose lowers the absorption of metformin (acarbose dominates)
    • Memory: aCARbose, in the car someone always farts, or delayed car ride
  21. Sitagliptin (Januvia)
    MOA, AE, Memory Trick
    • MOA: stimulates incretin hormones = ↥ insulin release and suppresses release of glucagon
    • AE: upper respiratory tract infection, headache, pancreatitis
    • Memory: sitaglipTIN - stimulates increaTIN
  22. Exenatide (Byetta)
    MOA, AE, D2D, Memory
    • MOA: mimics increatin - slows gastic emptying, stimulates glucose dependent release, slows release of glucagon, suppresses appitite
    • AE: hypoglycemia, reducing effects of med eventually, pancreatitis, fetal harm
    • D2D: slows absorption of oral drugs, OCP, give dx 1hr before
    • Memory: byetta - BYE appitite

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