Pharm Exam 3 Diabetes

Kent State Pharmacology 1, exam 3, Diabetic chapter and drugs

Three P's of hyperglycemia

Polyuria, polyphagia, and polydipsia.

Glucosuria

Excess blood glucose in the urine.

Symptom of hypoglycemia

Shakiness, confusion, or diaphoresis.

Adverse effect of endogenous insulin deficiency

Hyperglycemia leading to long-term complications such as nephropathy or neuropathy.

Insulin's function at the cellular level

It acts as a 'gatekeeper' to allow glucose into the cells for energy production.

Insulin's role in glycogen storage

It promotes the conversion of excess glucose to glycogen, primarily in the liver.

Metabolic effect of insulin on lipids

It promotes fat storage by increasing lipid synthesis.

Difference in management between Type 1 and Type 2 diabetes

Type 1 requires insulin therapy from the start, while Type 2 may initially be managed with lifestyle modifications and oral medications.

Beta cells in Type 2 diabetes

Generally still functional, but the body is resistant to insulin.

Sign of long-term complications from diabetes

Neuropathy, which may cause numbness in the feet.

Actions of oral hypoglycemic agents

They may stimulate pancreatic insulin secretion, reduce hepatic glucose production, or increase insulin sensitivity.

Endogenous insulin release after a meal

The rise in blood glucose stimulates beta cells to release insulin.

Glucagon effect of blood sugar and action

Increases blood glucose

Stimulates the liver to convert stored glycogen into glucose

for release into the bloodstream (glycogenolysis).

Lipogenesis

The process by which excess glucose is converted into fat.

Unexplained weight loss in diabetes

Because the body cannot utilize glucose properly and may break down fat and muscle for energy.

Alcohol consumption effect on blood glucose

They can decrease blood glucose levels.

Impact of ACE inhibitors on blood glucose

They can decrease blood glucose levels.

Example of rapid-acting insulin

Insulin lispro.

Type of insulin for long-term basal coverage

Long-acting insulin - glargine

Short-acting insulin

Insulin that peaks within 30 minutes to an hour.

Diabetic ketoacidosis - DKA

A life-threatening complication due to severe insulin deficiency, leading to ketone buildup and metabolic acidosis.

Typical laboratory finding in hyperglycemia

Elevated blood glucose levels and possible ketonemia.

Effect of insulin on protein metabolism

It increases protein synthesis and inhibits protein breakdown.

Biguanides

An oral medication class used in Type 2 diabetes that increases insulin sensitivity - e.g., metformin

Beta cells in Type 1 diabetes

the immune system destroys the beta cells of the pancreas.

Diabetic nephropathy

A complication that is a leading cause of kidney failure in diabetes.

Neuropathy in diabetes

Can lead to unnoticed injuries or burns.

Symptoms of hyperglycemia

polyuria, polydipsia, and polyphagia.

Diabetic retinopathy

A long-term complication that involves damage to the eyes in diabetes.

Dietary advice for diabetes

Follow a balanced diet with consistent carbohydrate intake and monitor blood sugar regularly.

Glucagon location

A hormone secreted by alpha cells (pancreas)

Primary mechanism of action of insulin

facilitates the uptake of glucose into cells by binding to its receptor
allowing glucose to be used for energy, stored as glycogen, or converted to fat
lowering blood sugar levels.

Adverse effects of insulin therapy

The most common adverse effect is hypoglycemia. Weight gain may also occur.

Mechanism of action of glucagon

Stimulates glycogenolysis in the liver, converting glycogen into glucose, thereby increasing blood glucose levels during hypoglycemic events.

Adverse effects of glucagon

may cause nausea, vomiting, and in rare cases allergic reactions.

Patient education regarding glucagon use

Patients and caregivers should be taught how to administer in an emergency, and understand that it is a temporary rescue measure—not a substitute

Rapid‑Acting Insulins

given for mealtime glucose spikes.
Onset- 15-30 min, Peak- 30 min- 2.5 hr, Duration- 3-6 hours.

Patient education for rapid‑acting insulins

inject 15-30 minutes before meals, use proper injection technique, monitor blood glucose closely after meals, and recognize early symptoms of hypoglycemia.

Short‑Acting Insulin - Regular Insulin

The only insulin that can be given intravenously, used for mealtime coverage and IV therapy in emergencies. Its onset is 30-60 minutes, peaks from 1 to 5 hours, and it lasts 6-10 hours.

Patient education for regular insulin

inject 30-60 minutes before meals, carefully measure doses, rotate injection sites, and be aware of signs of hypoglycemia.

Intermediate‑Acting Insulin - NPH Insulin

Often used for basal coverage with a distinct peak effect. Its onset is 1-2 hours, peaks between 4 and 12 hours, and it has a duration of around 16 hours.

Adverse effects of NPH insulin

hypoglycemia - especially during the peak action, and potential injection site reactions.

Long‑Acting Insulins

These provide a steady, basal insulin level without a pronounced peak. Their onset is 3-4 hours, they have no significant peak, and they last approximately 24 hours.

Patient education for long‑acting insulin therapy

inject once daily at the same time,
understand that these insulins do not cover meal-related spikes,
monitor blood sugar levels to avoid nocturnal hypoglycemia.

Ultra-long-acting insulin

Releases slowly to provide a steady basal level with an onset that is gradual and a slow release over approximately 48 hours.

Rationale for combination insulin formulations

short-acting for meal coverage with intermediate-acting components for basal insulin levels.

Sulfonylureas

Pancreatic stimulators that stimulate beta cells to secrete more insulin, lowering blood glucose levels.

Adverse effects of sulfonylureas

High risk of hypoglycemia, potential for weight gain, and contraindicated in patients with severe renal impairment.

Metformin Action

Decreases hepatic gluconeogenesis, increases insulin sensitivity, and improves peripheral glucose uptake.

Adverse effects of metformin

gastrointestinal upset and the rare risk of lactic acidosis.

Contraindications for metformin

renal impairment or unstable heart failure and should not be used within 48 hours of iodinated contrast.

Patient education for metformin

Take with meals to reduce GI upset, have regular kidney function tests, and inform providers before imaging studies.

Acarbose

Inhibits the enzyme alpha-glucosidase in the small intestine, delaying carbohydrate absorption.

Adverse effects of acarbose

May cause gastrointestinal disturbances such as flatulence, abdominal cramps, and diarrhea.

Contraindications for acarbose

inflammatory bowel disease or other significant gastrointestinal disorders.

Patient education for acarbose

Take with the first bite of each meal and maintain adequate hydration.