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Pharmacology
Diabetes
| Question | Answer |
|---|---|
| New evidence shows that _in _ Americans born in 2000 will develop diabetes sometime during their lifetime. | 1 in 3 |
| Type 2 prevalence by ethnicity.. which population is hit the hardest? | coushatta indian tribe, %80 |
| what was the estimated economic cost of diabetes in 2007? | $174 billion |
| ______ ______ is a group of metabolicdiseases characterized by hyperglycemia resulting from defects in insulin secretion,insulin action, or both. | Diabetes mellitus |
| Which type of diabetes involves....(ß-cell destruction, absolute insulin deficiency) | Type 1 |
| Which type of diabetes involves.... (Progressive insulin secretory defect + insulin resistance) | Type 2 |
| Impaired Fasting Glucose,Impaired Glucose Tolerance, Gestational Diabetes are all grouped into the category of _______? | pre-diabetes |
| intrinsic and extrinsic risk factors of diabetes all lead to ________ - a condition of excess blood glucose | hyperglycemia |
| normal fasting blood glucose = | 70 - 100 mg/dl |
| diagnostic lab values for diabetes; 8hr fasting plasma glucose (FPG)= | > or = to 126 mg/dl |
| diagnostic lab values for diabetes; casual plasma glucose .. done anytime = | > or = to 200 mg/dl with symptoms |
| diagnostic lab values for diabetes; 2 hour plasma glucose.. no exercise before taking = | > or = to 200 mg/dl during Oral Glucose Tolerance Test (OGTT) |
| patients with a casual plasma glucose test > 200 mg/dl may have diabetes symptoms such as... | polyuria - urination, polydipsia - thirst, polyphagia - hunger, blurred vision,and unexplained weight loss |
| Additional signs & symptoms of Type 2 Diabetes | Fatigue, Dry skin, Slow wound healing, and may be asymptomatic |
| Impaired Glucose Metabolism Insulin Resistance(Pre-Diabetes).. what scores would you expect for 1) impaired fasting glucose? and 2) impaired oral glucose tolerance testing? | 1) FPG > 110 mg/dl ... but... < 126 mg/dl 2) OGTT > 140 mg/dl…but ... < 200 mg/dl |
| Type _ diabetes in adolescents is one of the most rapidly growing forms of diabetes in US | Type 2 |
| Risk factors of diabetes for children | Obesity, Ethnic minorities,Positive family history, Puberty, Gender (female > male,Signs of insulin resistance, acanthosis nigricans, hypertension |
| What presents with a light-brown-to-black,pigmentation on the back & sides of the neck,axilla & groin? | Acanthosis Nigricans |
| what are the Pancreas functions 1)of the exocrine? & 2)of the endocrine? | 1) secretion of pancreatic juice that aids indigestion of all foods in the small intestine(99%) & 2)secretion of hormones, from islets of Langerhans, that control various body processes (1%) |
| Endocrine Function Islets of Langerhans contain: 1) ____ cells 2) ____ cells and 3) _____ cells | 1) alpha 2) beta 3) delta |
| Alpha cells make _____ which increase blood glucose | glucagon |
| Beta cells make ____ and ____ which decrease blood glucose | amylin and insulin |
| Delta cells make ________ which inhibits the secretion of insulin, glucagon, & growth hormone | somatostatin |
| What is the pathophysiology of Type 1 diabetes? ( 3 things ) | 1)Autoimmune destruction of islets of langerhans beta cells2) Absolute deficiency in plasma insulin levels3) patient must take insulin to survive |
| Etiologic factors of diabetes type 1... 1) 2) & 3)? | 1)Genetic (thrift gene theory)2) Environmental 3) Immune |
| What percentage of diabetes cases are Type 2? | 90 - 95% |
| What percentage of Type 2 diabetics require inuslin? | 30 - 40% |
| What is the pathophysiology of Type 2 diabetes? (2 things ) | 1) insulin resistance 2) hepatic glucose overproduction |
| How are the liver, pancreas, and peripheral tissues affected by Type 2 diabetes? | Liver - increase glucose productionPancreas - impaired insulin secretionPeripheral tissues - receptors defected |
| What is the action of sulfonylureas? | stimulate pancreas to secrete insulin |
| What is the action of biguanides? | decrease the amount of glucose from the liver and increase muscle sensitivity to insulin |
| What is the action of meglitinides? | stimulate the pancreas to secret insulin |
| What is the action of alphaglucosidase inhibitors? | slow breakdown of starches & glucose in the intestine |
| What is the action of DPP-4 inhibitors? | prevent breakdown of GLP-1, lowering blood glucose only when elevated |
| Glucovan is a combination of what two oral agents and affects what? | Metformin & Glyburide/ pancreas, liver, fat cells, muscle cells |
| Metaglip is a combination of what two oral agents and affects what? | Metformin & Glipizide/ pancreas, liver, fat cells, muscle cells |
| Avandamet is a combination of what two oral agents and affects what organ? | Metformin & Rosiglitazone/ liver, fat cells, muscle cells |
| What is the action of thiazolidindiones? | increase muscle sensitivity to insulin |
| What is frequently associated with insulin resistance? | Obesity |
| 90% of individuals with diabetes in the US are classified as having type 2.. what percentage of that population is obese? | 90% |
| The national standards for diabetes care includes? 6 things to check | HbA1c testing,neuropathy screening, lipid control, dilated eye exam, blood pressure, and foot exams |
| how is hypergylcemia caused in Type 1 diabetes? | absence of insulin production |
| how is hypergylcemia caused in Type 2 diabetes? | insulin resistance + impaired insulin secretion |
| what are some treatment strategies for type 2 diabetes? | Medical Nutrition,Physical Activity,Oral Hypoglycemic agents, Insulin therapy, Lipid control, Blood pressure control, Stress reduction |
| What is special about protein and type 2 diabetes? | protein does not increase the plasma glucose concentrations |
| What mineral does Pam Scarborough say works the best to help insulin work more efficiently? | Chromium |
| What antioxidant does Pam Scarborough say works the best for lowering blood glucose? | Alpha-lipoic acid |
| Things to do to avoid hypoglycemia during/after exercise: | have CHO(carbs) available, check blood glucose prior to exercise, inject insulin over less active or inactive muscle sites,avoid exercise during peak insulin times |
| Insulin is produced where? | Pancreas |
| Insulin is made by the Islets of Langerhans by ____ cells? | Beta |
| Insulin can be taken orally, true or false? | FALSE! |
| ___ % of insulin used in the US is by type 2 patients? | 80 |
| Insulin injection sites.. which site is the fastest to absorb? | Abdomen.. 50% faster than thigh |
| Combination therapy in type 2... what is the rationale? | different mechanisms of action, may be safer |
| what 2 drugs are taken for BIDS therapy? | daytime - Sulfonylurea + bedtime Insulin |
| who benefits the most from BIDS therapy? | patient early in course of dz |
| what 2 drugs taken together improve insulin sensitivity? | Metformin + Insulin |
| what 2 drugs taken together decrease postprandial(after a meal) hypoglycemia? | Alpha glucosidase inhibitor (acarbose) + Insulin |
| what 2 drugs taken together improves insulin resistance and improves insulin action inperipheral tissues? | Thiazolidinediones + Insulin |
| what are some drugs that enhance hyperglycemia? | corticosteriods, beta blockers, and Niacin-vitamin B |
| The HgbA1c (glycoslated hemoglobin assay) test gives the average bloodglucose over a ____ period of time? | 2 - 3 month |
| targets for glycemic control by the ADA say a AC1 score of what range is normal? preprandial in mg/dl(plasma equivalent)? postprandial (2 hour test) in mg/dl? | <7%, 80 - 120, <180 |
| what are some complications of patients with acute diabetes? | high glucose (hyperglycemia), low glucose (hypoglycemia) |
| what are some complications of patients with acute diabetes with hyperglycemia? | Diabetic ketoacidosis (DKA)only occurs in Type 1 patients... and Hyperosmolar,hyperglycemic,nonketotic syndrome (HHNS)seen in elderly undiagnosed Type 2 patients |
| what are some complications of patients with chronic diabetes? | macrovascular disease, infections, difficulty with wound healing, |
| what are some Macrovascular Complication ofDiabetes? | Cerebrovascular Disease (CVD),Coronary Artery Disease (CAD),Peripheral Vascular Disease (PVD), and herosclerosis/Arteriosclerosis -hyperinsulemia contributes to placformation |
| what ___% of patients diagnosed with Type 2diabetes have some complications at time ofdiagnosis? | 50 |
Created by:
txst spr 2009
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