Pharm Part 11.1-11.2 - Diabetes

1

type __ diabetes has a juvenile onset with low insulin, and has a normal response to insulin. drug therapy: insulin

2

type __ diabetes has an adult onset, with normal/high insulin, with a decreased response to insulin. drug therapy: antihyperglycemics

insulin

__________ is a polypeptide that needs to be administered parenterally because of its large size

recombinant

insulin from ___________ human DNA has an identical amino acid sequence

insulin

regular synthetic, rapid acting, intermediate acting, and long acting are all types of ___________

rapid

aspart, glulisine, and lispro are ________ acting insulin

intermediate

isophane and NPH are ___________ acting insulin

long

glargine, determir, and degludec are __________ acting insulin

glucose

insulin increases _______ entry and storage in tissues (especially in muscle and liver), as well as increasing protein synthesis and lipid storage

GLU

when insulin binds to a receptor, it causes ______ transporters to pull glucose into the cell faster

2

in cases of type __ DM, the cell is not getting the message for GLU transporters to bring glucose in

increases, decreasing

insulin __________ the storage of glucose in skeletal muscle and other tissues, thereby _______ plasma glucose levels after a meal

acute

_______ problems with insulin insufficiency are hyperglycemia followed by hypoglycemia; shift to fat metabolism and ketones that can lead to ketoacidosis and acidic conditions

chronic

_______ problems with insulin insufficiency are repeated/prolonged hyperglycemia, small-vessel angiopathy, occlusion

angiopathy

chronic hyperglycemia can cause glucose to bind to proteins in vessel walls, occluding the lumen. this is called _________________

microangiopathy

____________________ in poorly controlled DM can lead to amputation, blindness, renal failure, and peripheral neuropathy

macroangiopathy

____________________ in poorly controlled DM can lead to hypertension, MI, and CVA (strok)

often

intensive insulin therapy monitors blood glucose (daily/often) and insulin dosage is adjusted accordingly

automatic, pumps

___________ glucose sensors and insulin ________ allow for easier monitoring and reduce finger pricks and/or shots

immunologic

adverse effects of insulin are __________________ reactions, more problematic with animal insulin sources

hypoglycemia

a very common and dangerous adverse effect of insulin is __________________ which occurs when the dose is too high, delayed or missed meals, and strenuous exercise

beta cells

pancreatic _____________ are what produce the insulin normally

high blood sugar

anti-hyperglycemics prevent _________________ and return blood glucose to normal levels

F; they are

T/F: beta cells are not functioning in type 2 DM

sulfonylureas

_________________ increase insulin release via direct effect and lower hepatic glucose production indirectly; variable efficacy effects tend to diminish with time, only effective in about 50% of people

sulfonylureas

examples of ________________ are acetohexamide, chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide

meglitinides

_________________ act like sulfonylureas and increase insulin release from pancreatic beta cells; current agents are repaglinide and nateglinide

incretin

__________-based therapies are peptides released in our own body and are released by the GI tract to help regulate glucose levels, keep the beta cells happier

glucagon

___________ is the antagonistic hormone to insulin

GLP-1 agonists, GLP-1

______________ are incretin therapies than mimic the action of _________ in the body, usually a sub-Q administration

DPP4 inhibitors

___________________ inhibit dipeptidyl peptidase 4, an enzyme that breaks down incretins and can prolong the effect of GLP-1, GLP

GLP-1 agonists

examples of __________________ are exenatide, liraglutide, albiglutide, and dulaglutide

DPP4 inhibitors

examples of _________________ are linagliptin, sitagliptin, saxagliptin, and alogliptin

increase, sensitizers,

type 2 diabetes is often treated with drugs that ________ insulin secretion and supply, insulin __________, or other methods like amylin analogs, decreased glucagon, or delayed gastric emptying

insulin sensitizers

metformin and glitazones are both ______________________

metformin

____________ is also called glucophage, and increases the tissue’s sensitivity to insulin while lowering hepatic glucose production; often a cornerstone of drug tx for type 2 DM

glitazones

_____________ act similar to metformin, and current agents are rosiglitazone and pioglitazone; increase tissue sensitivity to insulin and decrease hepatic glucose production

amylin

_______ is another substance produced by beta cells that decreases glucagon release, delays gastric emptying, and increases satiety

GI tract

alpha-glucosidase inhibitors inhibit glucose absorption from the ____________

kidneys

SGLT-2 inhibitors decrease glucose absorption in the ____________

SGLT-2

_________ inhibitors cause glucose to be lost in urine by reducing kidney reabsorption

bile acid

____________ sequestrants bind to bile and glucose in GI tract to decrease absorption

hypoglycemia

the primary problem with anti-hyperglycemics in type 2 DM medication is ________________

absorption

rehab concerns for both type 1 and type 2 DM include insulin ______________ which is affected by physical agents like heat and cold, massage, and exercise

exercise, diet

__________ and ______ management should always be combined with drug therapy in people with type 1 or type 2 DM