Diabetes

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Author:
Christyna
ID:
45223
Filename:
Diabetes
Updated:
2010-10-26 18:10:14
Tags:
pharmacology
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Description:
diabetes part of exam
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  1. Beta cells of islet of langerhans in pancreas
    • normally produce insulin which is necessary for cellular utiliation of glucose by most body cells
    • enhances use of glucose
    • lowers blood sugar
    • increases converstion of glucose to glycogen for storage
  2. alpha cells of pancreas
    • produce glucagon which ^ blood sugar
    • work together to maintain a normal blood sugar of 70-110 mg/dL
    • A1C of <7%
  3. "pre-diabetes"
    • fasting BG 120-125
    • need to LOOSE WEIGHT!
    • may be started on metformin
  4. type 1
    • requires exogenous insulin replacement therapy
    • destroyed pancreatic cells (autoimmune disorder)
  5. type 2
    • usually sufficient insulin produced but may require insulin if needed
    • genetic predisposition
  6. primary sx
    • hyperglycemia
    • classic triad of polyuria, polydipsia, polyphagia
  7. polyuria
    blood becomes hypertonic: Pulls water in-now gotta pee!
  8. polydipsia
    tissue (cell) dehydrated bc water is being pulled to vessels, so therefore become thirsty
  9. polyphagia
    swallowing (eating) a lot bc body thinks it needs more glucose bc pt keeps peeing it out
  10. "sliding scale"
    • usually done ac & hs for pt who is eating & q6h for pt who is NPO
    • most commonly "regular insulin" (short acting)
  11. insulin
    • lowers BG
    • primary SE: hypoglycemia (diaphoresis, weakness, pale and cool, etc.)
    • s/sx masked in pt on beta blockers
    • rotate sites to prevent lipodystrophy
  12. somogyi effect
    rebound hyperglycemia
  13. rapid acting (insulin)
    • Onset: 15 min.
    • Duration: 3-6 hrs
    • Humalog, Novalog, Apidra
    • given immediately before or after meals
  14. short-acting
    • Regular insulin (Humulin R, Novolin R0
    • CLEAR
    • ONLY insulin that can be given IV
    • most common for "sliding scale"
    • SQ onset: 30 min.
    • peak: 2-3 hrs
    • duration 5-7 hrs.
    • IV: onset & peak: 10-30 min.
    • Duration: 1/2-1 hr
  15. Intermediate
    • NPH (Humalin N, Novalin N)
    • (only) CLOUDY insulin
    • commonly ordered for daily injection
    • Onset: 1-2 hr
    • Peak: 4-8 hr
    • Duration: 10-18 hr
  16. Long Acting
    • Glargne (Lantus) & (Levemir)
    • given 1X day usually but can be given q12h
    • lasts 24 hrs
    • CLEAR
  17. Combination insulin
    • intermediate w/ rapid or intermediate w/ short
    • Humulin 70/30
  18. s/sx of hypoglycemia
    • need immediate simple sugar and complex CHO & protein
    • anything that raises BG-increase the need for insulin
    • most common reason diabetic gets sick: ^ glucose
  19. oral hypoglycemic agents
    • ARE NOT oral insulin
    • help pancreas make insulin or make insulin receptors
    • primary SE: if drug works on pancreas, is hypoglycemia
  20. Biguanide
    • metformin
    • first line drug & most commonly ordered oral agent
    • works by lowering glucose production by liver, decrease GI absorption, ^ receptor sensitivity
    • risk for lactic acidosis
    • serious diarrhea is short-term
  21. Sulfonylureas
    • work on pancreas to increase secretion of insulin
    • SE: hypoglycemia
    • "ide" family
    • glipizide, etc.
  22. Alpha-Glucosidase Inhibitors
    • inhibit enzymes in GI tract
    • SE: GI distress
  23. Glitazones
    • Avandia off market soon
    • ^risk heart attactks & HF
  24. Meglitinide
    • "glinide" drugs
    • short acting
    • good for post prandial (after eating)
    • hyperglycemia-stimulate pancreatic secretion of insulin-->risk for hypoglycemia
  25. Amylin & Incretin mimetics
    response to food-suppress glucagon, slow gastric emptying, increase satiety, controls weight loss
  26. 1. Gliptins
    2. Byetta
    • 1. ^incretin levels
    • 2. "lizard spit" medicine SQ. type 2 only. pancreatitis is risk
  27. Raise BG
    • Glucagon-parental injection
    • D50W: given IV push

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