Lehne's Chapter 57 Drugs for DM

Early in disease process, symptoms of Type II DM results from

cellular resistance to insulin's actions, and from insulin deficiency.

Drugs for Type II diabetes such as Metformin, is often started:

immediately after diagnosis but, always in conjunction with diet modification and exercise.

Insulin deficiency promotes hyperglycemia by

increasing glycogenolysis and gluconeogenesis and decreasing glucose utilization.

Later in Type II DM the disease process progresses to:

insulin deficiency.

Sulfonylureas stimulate release of

insulin from the pancreas. They may also increase cellular sensitivity to insulin.

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors

lower blood sugar by increasing excretion of glucose via the urine.

The combination of _______________ plus insulin poses a risk of severe hypoglycemia. Nausea is common.

pramlintide

Type I is treated with

primarily with insulin replacement.

Symptoms of Type I DM results from a complete absence of insulin. The underlying cause is:

Autoimmune destruction of pancreatic beta cells.

Lispro, aspart, and glulisine have a _________________ and _________.

Very rapid onset and short duration.

Acarbose must

be taken with every meal in order to be effective.

Insulin deficiency puts the body into a

catabolic mode

Exenatide, incretin mimetic, for type IIDM is injected subq prior to meals. This drug

delays gastric emptying, suppresses glucagon release, and stimulates glucose dependent release of insulin.

Major adverse effect of sulfonylureas?

hypoglycemia

Hypoglycemia occurs when

insulin levels exceed insulin needs

SMBG is essential (self monitoring blood glucose )

is essential component of intensive insulin therapy.

All insulin in the United States are produced by

recombinant DNA technology.

Goal of treatment for Types I and II diabetes:

reduce long term complications including death.

Pioglitazone is a __________________ for diabetes Type II.

thiazolidinedione

Insulin has two basic effects:

1. stimulates cellular uptake of glucose, amino acids, and potassium 2. Promotes synthesis of complex organic molecules (glycogen, proteins, triglycerides).

Peak post meal target range is

180 or lower.

A1C should be measured every

3 to 6 months to assess long-term glycemic control.

Pre-meal monitoring of blood glucose target range:

70-130

Exenatide poses a risk of ____________________ in patients taking _______________, but not in those taking metformin. Nausea is common.

Exenatide poses a risk of hypoglycemia in patients taking sulfonylurea, but not in those taking metformin. Nausea is common.

Adverse effects of metformin

GI disturbances, decreased appetite, nausea, diarrhea. Does NOT cause hypoglycemia when used alone.

Major adverse effects of Acarbose

GI disturbances: flatulence, cramps, and abdominal distention.

Acarbose is an alpha glucosidase inhibitor for Type II DM

Inhibits digestion and absorption of carbohydrates, and thereby reduces the postprandial rise in blood glucose.

How do beta blockers mask signs and symptoms of hypoglycemia?

It masks hypoglycemia-induced signs that are caused by activation of the sympathetic nervous system (tachycardia and palpitations). Beta blockers inhibit the breakdown of glycogen to glucose, and can thereby impede glucose replenishment.

Which insulin can be administered IV as well as sub cutaneous?

Regular, aspart, lispro, and glulisine insulins

Exenatide is available as a short acting _____________ and Longer acting ___________________ formulation.

Short acting - Byetta Longer acting - bydureon

What are clear insulin preparations called?

Solutions they're clear and do not require agitation.

Hypoglycemia symptoms:

Tachycardia, palpitations, sweating, headache, confusion, drowsiness, and fatigue. If hypoglycemia is severe convulsions, coma, and death may follow.

Diabetes has two major forms:

Type 1- Insulin Dependent and Type II- Controlled by diet.

What type of hormone is insulin?

anabolic hormone

Metformin

decreases glucose production by the liver and increases glucose uptake by muscle and adipose tissue.

Anabolic hormones promotes conversation of:

energy and build up of energy stores.

Beta blockers can mask signs and symptoms of

hypoglycemia.

Pramlintide, (amylin mimetic), given subQ prior to meals to

enhance effects of mealtime insulin in patients with Types I and II DM. The drug delays gastric emptying and suppresses glucagon release, and thereby helps reduce postprandial hyperglycemia.

SGLT-2 inhibitors can increase the risk of

genitourinary infections.

Initial metabolic changes involve:

glucose and other carbohydrates. If the disease progresses, metabolism of fats and proteins changes as well

Hypoglycemia

glucose level below 70

Catabolic mode results in

glycogen converted to glucose, proteins are degraded to amino acids, and fats converted to glycerol (glycerin) and free fatty acids.

NPH

has intermediate duration of action.

Regular Insulin (native) when used sub cutaneous

has moderately rapid onset and short duration.

Diabetes is diagnosed by:

hemoglobin A1C is 6.5% or higher, fasting plasma glucose is 126 or higher, or casual blood glucose is 200 or higher, and patient has classic signs and symptoms of diabetes.

Type I and Type 2 diabetes share the same long term complications:

hypertension, heart disease, stroke, blindness, renal failure, neuropathy, lower limb amputations, erectile dysfunction, and gastroparesis, among others.

Gargine and detemir have a prolonged duration with

no definite peak in either blood levels or hypoglycemic effects.

Type II is treated with:

oral anti diabetic drugs or if needed, with insulin or non-insulin injectable drugs but, always in conjunction with diet modification and exercise.

DPP-4 Inhibitors (Dipeptidyl peptidase) are:

oral medications that lower A1C by 0.5%. These agents are generally well tolerated and augment the effects of natural incretin hormones.

Classic Signs and symptoms of DM:

polyuria, polydipsia, and sudden weight loss that cannot be attributed to other common causes.

What type of preparation is NPH insulin

suspension and requires agitation. (contents are cloudy)

Diabetes is characterized by:

sustained hyperglycemia

Pioglitazone increases insulin sensitivity of _____________ and thereby increases glucose uptake by ___________ and _____________; and decreases glucose production by the ______________.

target cells, muscle and adipose tissue, Liver.

Pioglitazone promotes

water retention which can increase risk of heart failure, liver damage, bladder cancer, and fractures. Also can cause ovulation in anovulatory pre-menopausal women; this poses a risk of unintended pregnancy.