-
ultrashort acting insulin
- lispro, aspart
- onset .25h
- duration 5h
-
short acting insulin
onset .5-1hr
duration 5-8h
regular
-
shor acting insulin
onset 1h
duratoin 12-16h
semilente
-
intermediate acting insulin
onset 1-3h
duration 18-24h
lente
-
long acting insulin
onset 4-8h
duration 20-36h
ultralente
-
unique feature of ultralente compared with other insulins
metabolized only renally
-
4 clinical signs of DM
- polyuria
- polydypsia
- polyphagia
- weight loss
-
-
secondary DM
- islet destruction
- infectious
- pancreatitis/tumors
- drugs - corticosteroids,endocrinopathy
-
8 risk factors of DM
- family history (parent, sibling increase70%)
- obesity
- race/ethnicity
- age >45yo
- previous insufficient glucose tolerance
- HDL <35mg/dl
- history of GDM or >9lb baby
- HTN (140/90)
-
5 points to remember for TI
- autoimmune
- absolute insulin deficiency
- children
- acute metabolic complications
- ketoacidosis - cardiovascular
-
4 points to remember for TII
- relative insulin deficiency
- peripheral resistance
- chronic vascular complication
- microangiopathy - kidney,brain,retina,CV
-
4 diseases that are increased risk for developing due to diabetes
- nephropathy
- retinopathy
- neuropathy
- cardiovascular disease
-
leading cause of death in diabetic patients
heart disease
-
3 complications developed from DM
- atherosclerosis
- fibrosis
- cardiomyopathy
-
New guideline levels of fasting plasma glucose (FPG) for diagnosing diabetes
126mg/dl
-
hypoglycemic
increase insulin secretion
- insulin secretagogues
- sulfonylureas
- benzoic acid derivatives
-
antihyperglycemic
increase tissue glucose uptake
- biguanides
- thiazolidinediones
-
antihyperglycemics
decrease glucose production
biguanides
-
antihyperglycemic
decrease GI glucose absorption
- alpha glucosidase inhibitors
- biguanides
-
moa of sulfonylureas
- 1. increase insulin release from the B cells by binding to the K/ATP channel, increasing intracellular Ca.
- 2. reduction of glucagon levels by inhibiting A cells
- 3. extrahepatic indirect effect of increasing insulin sensitivity by increasing: the number of receptors or affinity
-
efficacy and safety concern of sulfonylureas
- increased CV risk
- failure to maintain a good response over long term therapy - induces a refreactoriness in B cell response
- allow drug free window to decrease tolerance
-
first gen sulfonylureal - time to peak effects and duration of action
- chlorpropamide
- peak - 2-7h
- duration - 60h
-
2 second gen - time to peak and duration
- glipizide XR
- peak 6-12h
- duration 24h
- glyburide
- peak 2-6h
- duration 12-24
-
meglitinde: MOA, time to peak and duration, when useful
- repaglinide
- modulate B cell insulin release through K channels, overlap with sulfonylurea action site
- peak < 1h
- duration T1/2 1h
- useful in sulfa allergies
-
biguanide: 2 moa, when useful
- metformin
- 1. decrease hepatic glucose output
- 2. increase insulin/glucose uptake
- decrease fatty acid oxidation
- decrease GI carbohydrate absorption
- #1 choice for glycemic shock
-
2 thiazolidinedione: MOA, CI
- rosiglitizone - avandia
- pioglitizone - actos
- increase tissue glucose uptake- receptor affinity
- CI - liver disease
-
2 alpha-glucosidase inhibitors: moa, 2 side effects
- acarbose
- miglitol
- competitive inhibitor of the intestinal alpha-glucosidase and modulates the postprandial digestion and absorption of starch and disaccharides.
- GI upset & hepatic injury w/ chronic use
-
glucagon: metablolic effect, downside, clinical uses
- recruits glycogen and induces gluconeogenesis
- stimulates insulin release
- clinical - unconsciousness
- significant hypoglycemia
- beta block poisoning
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