pancreatic hormones & diabetes (quiz 4)

endocrine gland of pancreas

secrete hormones such as insulin and glucagon to regulate blood sugar

exocrine gland of pancreas

produces pancreatic digestive juices

cell types of pancreas

- alpha: Glucagon

- beta: Insulin

fed state

- increase in glucose

- increase in insulin

- decrease in glucagon

fasting state

- decrease in glucose

- increase in glucagon

- decrease in insulin

glucagon

a hormone that triggers glycogen breakdown in the liver to increase blood glucose levels

after eating

- large rise in serum glucose ➜ insulin release

- tissue mostly resistant to glucose ➜ insulin facilitates transport intracellularly

- haptic tissue permeable

diabetes mellitus

insufficient insulin secretion or decrease effect of insulin

type 1 diabetes (T1DM)

- unable to synthesize any appreciable amounts of insulin ➜ beta cell destruction

- typically, childhood onset

- require insulin

- normal or slightly underweight

type 2 diabetes (T2DM)

- beta cell dysfunction and decreased insulin sensitivity

- typically, adults, more recently adolescents

- may progress to insulin requirements

- overweight or obese is common

diabetes complications

- blindness

- kidney failure

- heart disease

- stroke

- neuropathy

symptoms of high blood sugar

- extreme thirst

- frequent urination

- headache

- hunger

- abdominal pain

- blurry vision

- warm, flushed skin

- irritability

symptoms of VERY high blood sugar

- rapid, shallow breathing

- vomiting

- fruity breath

what is first line treatment of diabetes

non-pharmacologic ➜ diet & exercise

T1DM treatment

insulin

pre-diabetes treatment

non-pharmacologic interventions

T2DM treatment

diabetes meds (oral or injectable) +/- insulin

mechanism of action Metformin

- decrease glucose production from liver

- increase insulin sensitivity

side effects of Metformin

- diarrhea

- nausea/vomiting

- stomach cramping

- lactic acidosis ➜ rare, serious

Sulfonylureas: Glipizide, Glimepiride, Glyburide mechanism of action

increase insulin secretion from pancreas

side effects of Sulfonylureas

- hypoglycemia

- weight gain

GLP-1 Receptor Agonist: Exenatide (Byetta), Liraglutide (Victoza), Semaglutide (Ozempic) mechanism of action

- GLP-1 is an incretin hormone that is secreted from the gut in response to glucose to trigger the release of insulin from the pancreas

- GLP-1 receptor agonist increase these effects

side effects GLP-1 Receptor Agonist

- weight loss

- GI upset

- tachycardia (resting HR)

GLP-1 Receptor Agonist Indications

- type 2 diabetes

- overweight and obesity

- chronic kidney disease risk reduction

- cardiovascular risk reduction

- sleep apnea in obesity

- metabolic dysfunction associated steatohepatitis

Tirzepatide (Zepbound/Mounjaro) mechanism

GLP-1 receptor agonist + glucose-dependent insulinotropic polypeptide (GIP) agonist

what incretin hormones stimulates release of insulin in response to rise in glucose from meals

- GLP-1

- GIP

which drug has greatest weight loss effect due to dual mechanism of action

Tirzepatide (Zepbound/Mounjaro)

rare, serious ADE of GLP-1 agonist

- risk of thyroid cancer

- pancreatitis

- acute kidney failure

- increased HR

- diabetic retinopathy

- gallbladder disease

mechanism of action for DPP-4 inhibitor: Sitagliptin (Januvia_, Linagliptin (Tradjenta)

- inhibits the DPP-4 enzyme (DDP-4 destroys GLP-1)

- GLP-1 lowers blood glucose

side effects of DPP-4 Inhibitor

- well tolerated

- weight neutral

- pancreatitis

SGLT-2 Inhibitors mechanism of action

blocks glucose reabsorption in kidneys

side effects of SGLT-2 inhibitors

- UTI/Genital yeast infection/increased urine output

- weight loss

pioglitazone (actos) mechanism of action

increase insulin sensitivity

side effects of Pioglitazone (Actos)

- heart failure

- edema

- weight gain

- bone fracture

- increased liver function test

highest risk of hypoglycemia

- NovoLog

- Humalog

lowest risk of hypoglycemia

- lantus

- levemir

signs of hypoglycemia

- sweating

- hunger

- headache

- dizziness

- mood change

- trembling

- irritability

rescue therapies to increase blood glucose

- glucagon IM injection

- dextrose tablets

level 1 hypoglycemia

54-70 mg/dL

level 2 hypoglycemia

rule of 15

15 g carbs, check glucose in 15 min, repeat if

exercise

- promotes insulin like effect

- accelerates movement of glucose out of bloodstream and into peripheral tissues

exercise induced hypoglycemia

- depends on intensity, type and duration of exercise

- may require dose adjustment of rapid or short acting insulin prior to workout

- do not inject short acting insulin until at least 1 hour post workout

- inject insulin in stomach instead of arms or thighs to help slow absoprtion