What is the basis of treatment of diabetes mellitus type 1?
Low-sugar diet and insulin replacement
What is the basis of treatment for diabetes mellitus type 2?
Dietary modification and exercise for weight loss, oral hypoglycemics, insulin replacement (late)
Name three short-acting insulins.
Lispro, aspart, regular
Is neutral protamine Hagedorn (NPH) insulin considered a short-, intermediate-, or long-acting insulin?
Name two long-acting insulins.
Insulin binds insulin receptors which have ______ _____ signaling pathways.
For what electrolyte disturbance can insulin be used as a treatment?
A patient is in the intensive care unit and noted to have a blood glucose of 225 mg/dL; what medication is appropriate for this condition?
Insulin is effective in treating stress-induced hyperglycemia
What is the most common adverse effect of insulin treatment?
Hypoglycemia; very rarely, one may see a hypersensitivity reaction
Name two first generation sulfonylureas.
Name three second generation sulfonylureas.
Glyburide, glimepiride, glipizide
Which diabetes drugs can cause a disulfiram-like reaction?
To which class of diabetes drugs does metformin belong?
To which class of diabetes drugs do pioglitazone and rosiglitazone belong?
Name two -glucosidase inhibitors.
Describe the mechanism of action of sulfonylureas.
Sulfonylureas close the K+ channel on the -cell membrane leading to cell depolarization and causing insulin release by increased calcium influx
Will sulfonylureas work in type 1 diabetes mellitus?
No; these drugs require islet cell function and the ability to secrete endogenous insulin (defective in type 1 diabetes)
What is an adverse effect of second-generation sulfonylureas?
What is the mechanism of action of metformin?
Unknown; may decrease gluconeogenesis, increase glycolysis, thereby decreasing serum glucose levels; overall, it acts as an insulin sensitizer
True or False: Metformin can be used in patients without islet function.
Before prescribing metformin, it is important to assess the function of what organ?
Kidney; if metformin cannot be excreted it may build up leading to lactic acidosis
How do glitazones work?
They increase target cell response to insulin via the peroxisome proliferator-activated receptor-γ pathway
What are the side effects of glitazones?
Glitazones can cause weight gain, edema, hepatotoxicity, and cardiovascular toxicity
Acarbose and miglitol work by inhibiting what enzyme?
-Glucosidase, an intestinal brush border enzyme; this results in decreased postprandial hyperglycemia
What is the principal toxicity of -glucosidase inhibitors?
What is the mechanism of action of pramlintide?
Pramlintide is a mimetic of an endogenous hormone and acts by inhibiting glucagon
What are some toxicities of pramlintide?
Hypoglycemia, nausea, diarrhea
Give an example of a glucagon-like peptide-1 mimetic drug.
Exenatide; this drug was discovered in the saliva of the gila monster
What is the mechanism of action of the GLP-1 mimetics?
Increases insulin and decreases glucagon
What are toxicities of exenatide use?
Nausea, vomiting and possibly pancreatitis