Diabetes

released by the beta cells in the pancreatic islets of Langerhans in response to blood glucose levels. 

Effect- lower blood glucose concentration

secreted with insulin from the beta cells in the pancreatic islets of langerhans in response to meals

Effect- lower blood glucose concentration

released from the alpha cells in the islets of Langerhans in response to blood glucose levels. 

Effect- raise blood glucose concentration

two hormones that are secreted from cells located in the epithelium of the small intestine. Glucose dependent isulinotropic peptide (GIP) and Glucagon like peptide (GLP-1). 

Effect- lower blood glucose.

• 1. Binds to plamsa membrane receptors on skeletal, heart muscle and adipose tissue. Causes the movement of a carrier protein from inside the cell to the plasma membrane where it acts as a channel to allow glucose into a cell. Result: as glucose moves into cells- the blood glucose concentration decreases. 
• 2) Stimulates gluconeogenesis in the liver to store glucose for use between meals or during a fast. 
• 3) Inhibits the liver from releaseing more glucose into the bloodstream and inhibits the breakdown of protein and fat for energy 
• 4) Facilitates entry of amino acids into cell for protein synthesis.

1)Raises blood glucose through action at the liver (activates enzymes that break down glucogen) 

2) Stimulates formation of glucose from amino acids

3) stimulates breakdown of triglycerides to fatty acids to use for fuel

• "Juvenille"
• sudden onset
• can occur after viral infection
• stops forming insulin 
• 10% of diabetes cases

insulin injection

• older onset
• insulin resistance
• overweight
• hereditary
• slower onset
• 90% of diabetes cases

• Polyurea- urine
• Polydipsia- hunger
• Polyphasia- thirst

• Retinopathy
• Neuropathy
• Nephropathy 
• CVD/Artherosclerosis

126 mg/dl

random

blood test of blood sugar over 3 months

>6.5

All individals with diabetes are treated with diet and exercise. Most individuals also require the use of medicine

• Sweating
• Urine glucose -
• Sudden onset
• Rapid shallow respiration 
• Hyperactive reflex
• Normal to high BP

• Gradual onset
• Hypotension 
• Rapid deep respiration 
• Hyperactive reflex 
• Urine glucose +

facilitates rate of glucose uptake into cels and stimulates gluconeogenesis

100

• 24 hour/long acting 
• no peak

• pre meal insulin
• fast acting
• 2-5 hours
• peak 30-90 min

no peak

"big stick"

Cause the release of insulin. bind to receptors in beta cell membrane which closes potassium channels. Cell depolaries, influc of calcium, and insulin release from cell. 

Adverse effect: can cause hypoglycemia

MOA: decreases liver glucose production and intestinal glucose absorption. Also increases glucose utilization by other tissues. Does not affect insulin secretion. Does not cause hypoglycemia when used alone. 

Adverse effects: Diahrea, upset stomach. 

LACTIC ACIDOSIS

• fatal 50% of the time
• as an adverse effect of therapy with metformin it is extremely rare 
• The onset of lactic acidosis is sublte with malaise, myalgias (muscle pain), respiratory changes, sleepiness, and gastrointestinal issues.