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NP2:DiabetesMellitus

Prof.Revak-Lutz; Test 3

QuestionAnswer
Diabetes is a chronic multisystem disease related to abnormal insulin production,and:or impaired insulin utilization
Diabetes is leading cause of heart disease, stroke, adult blindness, nontraumatic lower limb amputations
Glucagon hormone counterregulatory to insulin. Results in increased blood glucose by stimulating gluconeogenesis
Gluconeogenesis glucose production in the liver from precursors such as lactate and amino acids
Glycogen primary stotage form of glucose in liver and muscle
Glycogenolysis metabolic conversion of glycogen into glucose
Counterregulatory hormones glucagon, cortisol, growth hormone, and epinephrine. These hormones are released in response to hypglycemia, as a stimulus to effect gluconeogensis
Normal insulin metabolism produced by the beta cells in the islets of langherans of the pancreas
Normal glucose range 70-120 mg
An increase of insulin after a meal affects stimulate storage of glucose as glycogen, inhibits glucogenesis: tells the liver to stop releasing glucose, enhances fat deposition in adipose tissue, increases protien synthesis
Cause of Type 1 diabetes autoimmune attack on the beta cells of pancreas causing absolute deficiency of insulin secretion
Facts and numbers of Type 1 most often occurs in people under 30 years of age, ketosis prone (break down of fat), dependent on exogenous insulin, 10% of people with diabetes have type 1
Onset of symptoms of type 1 are rapid
Manifestations develope when pancreas can no longer produce insulin
Symptoms of type 1 include hx of recent, sudden, weight loss, polydipsia, polyuria, polyphagia
PWD Type 1 require exogenous insulin to live
Cause of type 2 diabetes include combination of insulin resistance at cellular level and live and inadequate insulin secrection
Facts and numbers for type 2 accounts for 90% of pts with diabetes, usually occurs in people over 35 years of age, 80-90% of patients are overweight
Symptoms of type 2 fatigue, recurrent infections (yeast), prolonged wound healing, visual changes
Type 2 incidence prevalance increases with age, genetic basis
Highest rate of diabetes in the world amoung ethnic populations are native americans and alaskan natives
in type 2 pancreas continues to produce some endogenous insulin but it is either insufficient or poorly utilized by tissues
Four major metaboli abnormalities of type 2 are body tissues do not respond to insulin (either unresponsive receptors or insufficient in #), pancreas decrease ability to produce insulin, inappropriate glucose production from liver, alteration in production of hormones and adipokines
Adipokines play a role in glucose and fat metabolism, contribute to pathophysiology of type 2
Main types of adipokines adiponectin and leptin
Onset of type 2 is gradual
Normal FPG <100
Normal 2-hr after postload glucose <140
Impaired fasting glucose FPG >or= 100-125
Impaired glucose tolerance (IGT): 2-hr postload glucose 140-199
Normal HbA1C 5.7-6.4%
prediabetes is not high enough diabetes diagnosis, if no preventive measure taken-usually develop type 2 within 10 years
Diabetes is present if fasting glucose level is greater than 126
Diabetes is present if symptoms plus random or casual plasma glucose is greater than or equal to 200
Diabetes is present if 2-hr OGTT level is greater than or equal to 200
Diabetes is present if HbA1C is greater than 6.5%
Risk factors for metabolic syndrome abdominal obesity, athrogenic dyslipidemia, raised bp, insulin resistance, prothrombic and proinflammatory states
Etiology of metabolic syndrome poor nutrition, inadequate physical activity, subsequent increases in body weight
Diagnostic criteria: 3 or more criteria met abdominal obesity, hypertriglyceridemia, low HDL-C, high bp, high fasting glucose
Goals of diabetes management reduce symptoms, promote well-being, prevent acute complications, prevent and delay onset and progression of long-term complications
Glycemic control goal of HbA1C <7%
Glycemic control goal of preprandial glucose 90-130
Glycemic control goal of postprandial glucose <180
Goal of treatment for bp <130;80
Goal of treatment for lipids <100
Goal of treatment for TG <150
Goal of treatment for HDL >40
HbA1C test is average of blood glucose over life span of RBC, in pwd ADA goal is 7%
Nutritional therapy for type 1 is based on the usual food intake and balanced with insulin and exercise patterns
Nutritional therapy for type2 is calorie reduction, and emphasis placed on achieving glucose, lipid, and bp goals
Alchohol high in calories, promotes hypertriglyceridemia and can cause severe hypoglycemia
Carbohydrate counting method incorporated into nutrional therapy for people with type 1 and 2
Pt requiring insulin use the carbohydrate counting by carbohydrates eaten and pre-meal glucose determine amount of insulin taken
Exercise is an essential part of diabetes management bc increases insulin receptor sites, lowers blood glucose levels, decreases insulin resistance, and contributes to weight loss
Excercise is best done after meals
Self-monitoring of blood glucose (SMBG) allows pt to make self-managment decisions regarding diet, excercise, and medication
Oral agents work to improve the mechanisms in which insulin and glucose are produced and used by the body
Oral agents work on the three defects of type 2 by increasing insulin production, decreasing insulin resistance, and decreasing hepatic glucose production
Oral hypoglycemic agents include sulfonylureas and meglitinide
Oral insulin sensitizers include biguanides adn thiazolidendiones
Sulfonylureas are used to increase production from pancreas
Examples of Sulfonylureas are Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Diabeta, Micronase, Givnase)
Glipizide Glucotrol; Sulfonylureas (increase insulin production)
Glimepiride Amaryl; Sulfonylureas (increase insulin production)
Glyburide Diabeta, Micronase, Givnase; Sulfonylureas (increase insulin production)
Disadvantages of sulfonylureas weight gain, hypoglycemia
Meglitinides (oral) are used to increase insulin production from pancreas and is more rapid acting than sulfanylureas but has to be taken 30 minutes before each meal
If meal skipped should you take a meglitinide? no
Examples of meglitinides include Repaglinide (prandin), Nateglinide (starlix)
Repaglinide Prandin; meglitinide (increases insulin production)
Nateglinide Starlix; meglitinide (increases insulin production)
Biguanides (oral) are insulin senstizers used to reduce glucose production by liver, enhance sensitivity at tissues, improve glucose transport into cells
Example of biguanides is Metformin hydrochloride (glucophage)(insulin sensatizer)
Side effects of biguanides GI upset, risk of lactic acidosis
Biguanides are contraindicated for use with pts with renal dysfunction (serum creatine levels >1.5 in males; >1.4 in females), CHF, liver dysfunction
Oral thiazolidinediones (TZD) are used to improve insulin sensitivity, transport and utilization at target tissues
Metformin hydrochloride Glucophage; biguanide (insulin senstizer)
Examples of TZD's include Rosiglitazone maleate (Avadia, no longer on market), Pioglitazone HCl (Actos)
Rosiglitazone maleata Avadia, no longer on market; TZD (insulin sensitizer)
Pioglitazone HCl Actos; TZD (insulin sensitizer)
Advantages of TZD's (insulin sensitizer) no hypoglycemia when used alone, can be used in pts with decreased renal function
Disadvantages of TZD's (insulin sensitizers) weight gain (fluid), increased total and LDL cholesterol, not recommended in pts with heart failure, edema and anemia
Glucovance (combination) metformin and gliburide; risk for hypoglycemia
Metaglip (combination) metformin and glipizide; risk for hypoglycemia
Avandiament (combination) metformin and avandia
Alpha-glucosidase inhibitors "startch blockers" are used to slow down absorption of carbohydrate in small intestine
Exaples of alpha-glucosidase inhibitors include Acarbose (precose), Miglitol (Glyset)
Acarbose Precose; alpha-glucosidease inhibitor
Miglitol Glyset; alpha-glucosidase inhibitor
Disadvantages of alpha-glucosidase inhibitors GI side effects, dosed TID with first bite of meal (forget), in combination, hypoglycemia can only be treated with glucose
DDP-4 (other agaent)inhibitor is used to inhibit dipeptidyl pepidase-4, which inactivates incretin hormones (incretines regulate glucose by increasing insulin sythesis and pancreatic release), decrease hepatic glucose release
Disadvantages of "other" agaents only work when glucose present, mainly injectables, used for type 2 besides amylin
DDP-4 inhibitor is glucose dependent
Advantages of DDP-4 inhibitors is decreased risk of hypoglycemia, no weight gain
Examples of DDP-4 inhibitors are Januvia (sitagliptin), Galvus (vildaglipton)
Januvia Sitagliptin; DDP-4 inhibitor
Galvus Vildaglipton; DDP-4 inhibitor
Amylin analog is hormone secreted by beta cells of pancreas, cosecreted with insulin, indicated for type 1 and 2, administered subQ (thigh or abdomen)
Amylin acts to slow gastric empying, reduces postprandial glucagon secretion, increases satiety
Example of amylin is pramlintide (symlin)
Pramlintide Symlin; amylin
Incretin mimetic is a synthetic peptide used to stimulate release of insulin from beta cells and suppresses glucagon secretion, reduces food intake, slows gastric emptying; subcutaneous injection
An exmaple of an incretin mimetic is Byetta
Incretin mimetic such as Byetta are not to be used with insulin
Created by: stilsl
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