Pharm - Diabetes

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What is Diabetes Mellitus?: - a disorder of carbohydrate metabolism
- sustained hyperglycemia
- caused by no insulin production or resistance to action of insulin
What is Type 1 diabetes?: - no insulin production
- defect: pancreatic beta cells (genetic)
- autoimmune disorder
What is Type 2 diabetes?: - some insulin is produced
- defect: insulin resistance caused by number of receptors or impaired insulin secretion
- strong genetic factor
- obesity is a key risk
Long-term complications of diabetes?: Macrovascular disease and microvascular diseases:
1. Retinopathy
2. Nephropathy
3. Atherosclerosis (Htn, Stoke, IHD)
4. Amputations
5. Cataracts
6. Peripheral Neuropathy
7. Impotence
8. Gastroparesis (partial paralysis)

**cardiovascular disease is the leading cause of death among diabetic patients
Long-term treatment goals for diabetes?: - maintain normal physical and psychological functioning
- prevent complications by controlling blood glucose levels
- keep glycosylated hemoglobin (HbA1C) within normal limits
What is the source of insulin?: - human insulins
- beef & pork (discontinued - more prone to cause allergic reactions)
What affects the rate of absorption?: 1. blood flow
* lipodystrophy (can be caused by injecting insulin in the same spot; eventually reject the insulin)
2. additives such as:
* zinc
* isophane
*protamine
Where does insulin bind?: to insulin receptors on CMs of muscle & fat tissue
Where are carbohydrates stored?: - liver & muscle
- adipose tissue (lastly)
Insulin decreases oxidation of FFA to Ketoacids (liver). True or False.: True
What is the normal level of HbA1C?: less than 7%
What causes lipodystrophies?: Giving insulin in the same spot all the time (need to rotate locations)
What are the adverse effects of insulin?: related to MOA:
- hypoglycemia

not related to MOA:
- lipodystrophies
- allergic reactions
Which area produces the least amount of variation for absorption rate?: abdomen
What are the drug interactions of insulin that INCREASE blood glucose levels?: 1. Steroids
2. Sympathomimetics (dopamine, dobutamine, epinephrine)
3. Diuretics (hydrocholorothiazide)
4. Birth control pills (all increase insulin requirements)
What are the drug interactions of insulin that DECREASE blood glucose levels?: 1. Alcohol - inhibits enzyme
2. Beta-androgeneric blocking agents
3. Oral Hypoglycemics
What are doses guided by?: 1. blood glucose levels OR
2. grams of carbs eaten
Who requires more insulin?: Teenagers during growth spurts
Insulin is adjusted by how many units at a time?: 2 units (based on 2-5 days of glucose values)
What are 3 types of Insulin Therapy Regimens?: 1. BID Therapy (twice daily) - conventional - after surgery
2. Continuous subcut insulin infusion
(Insulin Pump) - programmable
3. Multiple daily insulin injections (MDII)
*Regular - before each meal
*Intermediate or long acting - daily or bid
What happens when diabetics become ill?: - insulin requirements MAY increase
- if patient is NPO or vomiting (still needs insulin but decrease insulin & give IV glucose)
Why do you draw up the regular first?: do not want to contaminate the long acting insulin
Why don't patients give their own insulin in hospitals?: to give them a break
What is the pathophysiology of Type 2 diabetes?: - BASAL insulin secretion is normal or increased
- GLUCOSE-STIMULATED insulin secretion is impaired relative to need
What are 3 different types of oral hypoglycemics?: 1. Sulphonylurea
2. Biguanides Metaformin
3. Thiazolidinediones (TZDs or Glitizides)
What are 2 types of Sulphonylureas?: 1.Tolbutamide (1st generation)
2.Glyburide (2nd generation)
What is the MOA of sulphonylurea?: - binds to ATPase-sensitive K+ channels in pancreatic CMs

- enhance insulin secretion in response to high blood glucose levels
- increase # and sensitivity of insulin receptors
What is the pharmacokinetics of sulphonylurea?: - rapidly absorbed from GI tract
- metabolized in the liver
- excreted in bile & urine
What are the contraindications of sulphonylurea?: - lack of endogenous insulin
- pregnancy (can cause problem with fetus)
- stressful conditions (infections or surgery)
- allergy to sulpha drugs
What are the side effects of sulphonylurea?: - water retention (ADH effect is increased)
- severe hypoglycemia
What are the drug interactions of sulphonylurea?: - beta blockers
- diuretics hyperglycemia
- alcohol (disulphiram-like reaction-Antabuse)
- hypoglycaemia from NSAIDs, sulpha drugs, ranitidine, & cimetidine
What is the MOA of Metformin?: - binds in the liver
- decreases production of glucose in liver
- enhances glucose uptake and use in muscles
What are the side effects of Metformin?: - decreased appetite
- nausea
- diarrhea
(subsides over time)
- weight loss
How can Metfomin be taken?: Alone or with sulphonylureas (***see steps from earlier)
What is the MOA of Thiazolidinedione (TZD)?: - decreases insulin resistance
- increases ability of target cells to respond to insulin

- may improve beta cell function (prevent complications)
- may also decrease lipids, BP and prevent atherosclerosis
How to manage DKA?: 1. H2O and Na+ replacement (first!)
2. Insulin
3. HCO3 for acidosis
4. K+ replacement (high in the blood but needs to be in the cell)
5. Normalization of glucose levels
What is the best IV solution for severe hypoglycemia?: IV glucose (D5W)
- route: IM, SC, or IV (must be reconstituted)
What are some signs and symptoms of DKA?: - polyuria
- polydipsia
- polyphagia
What type of oral hypoglycemic should you give someone who is lean?: Sulphonylurea
What type of oral hypoglycemic should you give someone who is obese?: Metformin
What type of oral hypoglycemic should you give someone who is hyperglycemic?: Acarbose
What 2 oral hypoglycemics can you give together?: - sulphonylurea + acarbose
- sulphonylurea + metformin
What are the 6 steps for managing type 2 diabetes?: Step 1: Diet & Exercise
Step 2: One oral hypoglycemic
Step 3: Two Drugs
Step 4: Oral hypoglycemic + insulin
Step 5: Insulin only
Step 6: Insulin + Thiazolidinedione (TZD)
What does NPH stand for?: Neutral Protamine Hagedorn

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Number of cards 44

Created By daisy497