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Amylin
- a hormone formed by beta cells in the pancreas. hormone co-secreted with insulin (made in beta cells). This hormone helps in 3 ways:
- 1. slows (normalizes) gastric emptying
- 2. suppresses glycogen from the liver
- 3. regulates food intake by centrally mediated
first phase response
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Does the hormone amlyin help with pre or post prandial blood glucose?
POST PRANDIAL GLUCOSE
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Incretin (gastrointestinal hormone)
aka GLP-1 receptors that are secreted upon the ingestion of food from the GI tract. Increases insulin response from beta cells.
first phase response
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what is the synthetic drug to mimic amylin?
PRAMLINTIDE (SYMLIN)
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what meds try to mimic GLP-1 receptors?
Exenatide (Byetta)
liraglutide (victoza)
bydureon
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what does GLP-1 stand for?
Glucagon like peptide-1
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Functions of GLP-1?
- -increase insulin secretion in pancreas
- -decreases glucagon secretion
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Alpha cell
Alpha cells make and release a hormone called glucagon. The body sends a signal to the alpha cells to make glucagon when blood glucose falls too low. Then glucagon reaches the liver where it tells it to release glucose into the blood for energy. (MAKES SUGAR!)
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beta cell
a cell that makes insulin. Beta cells are located in the islets of the pancreas.-
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What hormones does beta cells release?
insulin, C-peptide, and amylin
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What does C-peptide do?
Helps to prevent neuropathy and other vascular deterioration
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DPP-4 Inhibitor (gut hormone)
Blocks the action of DPP-4 enzyme which destroys incretin
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Basal rate
a steady trickle of low levels of longer-acting insulin
- (second phase insulin release)
- Baseline insulin
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Bolus rate
Insulin poured into bloodstream rapidly with a meal or snack to cover glucose entering blood (first phase insulin release)
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Pre-diabetes diagnosis
- A1c= 5.7-6.4
- FPG= 100-126
- OGTT= 140-199
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Diabetes diagnosis
- FPG= >126
- A1c= >6.5%
- OGTT= >200
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Signs/Symptoms of DKA?
N/V/D,poluria,polydypsia,polyphagia,weight loss,high BS,lethargy,+ketones,fruit breath,dehydration,blurred vision
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Honeymoon phase
When 10% of pancreas may produce insulin. Must be careful to avoid too much insulin dosing in beginning to prevent hypoglycemia. may last few weeks up to 1 year
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Target A1c?
<7% ADA, <6.5% AACE
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Fasting pre-prandial glucose?
70-130 ADA, <110 AACE
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Post prandial target?
<180 ADA, <140 AACE
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HS glucose
100-140 ADA, 100-140 AACE
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What is target BP for pt w/ dm?
<130/<80
- *start behavior therapy if 130-139 and 80-89
- *start behavior + meds if >140/>90
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What are microvascular side affects of diabetes complications?
Nephropathy (kidneys), retinopathy (eyes), neuropathy (nerves)
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Macrovascular dm complications?
CAD, STroke, PVD
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Gluconeogenesis
Formation of new glucose from protein or fat
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Glycolysis
breakdown of glucose for energy
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glycogen
main form of carbohydrates storage in liver and muscle, readily converted to glucose to satisfy energy needs
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glycogenesis
when glucose turns into glycogen for storage to use as energy later
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glycogenolysis
the breakdown of glycogen to glucose in order to use the stored energy
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lipogenesis
formation of lipids to store energy
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lipolysis
breakdown of lipids to produce energy
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Why does insulin become ineffective in most type 2 diabetes patients?
It starts with insulin resistance where body doesn't use insulin effectively which causes body to overcompensate and produce more than necessary which tires out the B cells and causes damage to proper function
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