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Diabetes, Lower Blood Glucose - Coggle Diagram

- - - - lispro
      - glulisine
      - aspart
    - - control postprandial glucose
        
        not eating immediately after = hypoglycemia
        
        15 min before eating a meal or immediately after
      - emergency DKA
  - - - IV in emergency situatinos
      - SC for maintenance
      - control postprandial glucose
        
        1 hr before meal
  - - - onset 3-4 hrs, peak at 4-9 hrs, duration 15 hrs
      - combine w faster acting to allow more accurate dosing and better blood sugar control
  - - - glargine
      - detemir
    - - peakless, basal level of insulin
      - control basal glucose levels w/o producing hypoglycemia
  - - - syringe/needle
      - insulin pen injector
- - - - autonomic hyperactivity
        
        sym
        
        tachycardia
        
        palpitations
        
        chills
        
        sweating
        
        tremor
        
        para
        
        nausea
        
        hunger
    - - delay in eating
      - unusual exertion
      - inappropriate insulin dosage for need
    - - glucose tablet/gel
      - quick glucose source
    - - pt unconscious
      - give IV glucose
        
        glucagon (IM/IV)
  - - - esp in times of stress
        
        greater counter-regulatroy hormones
  - - - brain starved
    - - insulinoma
      - consequence of insulin resistance w 2DM
  - - - hyperglycemia
      - metabolic acidosis
      - ketosis
        
        insulin deficiency = cells can't get glucose
        
        break down fat as fuel source
        
        ketone buildup in blood/urine
    - - give insulin IV, fluid, electrolytes
- - - - relative deficiency of insulin secretion
        
        unable to overcome resistance
  - - - require insulin replacement for life
- - - - decr in gluconeogenesis
  - - - metformin
  - - - may decr risk of DM in high risk
      - doesn't cause
        
        hypoglycemia
        
        wt gain
      - allows for combintation therapy
      - reduce fasting/postprandial glucose levels
  - - - renal insufficiency
      - liver failure
      - HF/edema
- - - - bind to intestinal diasccharides to break down complex carbs for absorption
        
        delays carb absorption of starches, dextrins, maltose, sucrose
  - - - BUT minimal effect on fasting glucose
  - - - gas
      - diarrhea
      - stomach upset
- - - - nuclear TFs that regulate genes
      - normally activated by FFAs and eicosanoids
  - - - in muscle/adipose tissues
      - lower liver glucose production
      - affect lipid metabolism/body fat distribution
  - - - risk of bladder cancer
    - - cardiac issues
- - - - promots insulin release
  - - - glyburide
      - glimepride
      - glipizide
    - - lower fasting/postprandial glucose
    - - wt gain
      - hypoglycemia
      - CI
        
        sulfa drug
        
        pregnancy
        
        liver/kidney failure
  - - - repaglinide
      - nateglinide
    - - promotes insulin release from pancreas
        
        lower postprandial glucose
      - short acting
    - - less risk of hypoglycemia compared to suflonylureas
      - wt gain
      - caution in liver/kidney prblems
      - CI in pregnancy
- - - - extended half life
        
        modified DPP-4 cleavage
        
        addition of components to reduce renal clearance
      - actions
        
        improve glycemic control in T2DM
        
        lowers fasting glucose
        
        wt loss
      - adverse effects
        
        GI efffects
        
        injection site rxns
        
        incr HR
        
        serious/fatal acute pancreatitis
    - - actions
        
        promotes insulin release
        
        inhibits glucagon secretion
        
        delay gastric emptying
        
        anorexic effect
      - inhibits peptidase (DDP-IV) that breaks down GLP-1
      - adverse effects
      - don't take w meal
  - - - indirect insulin release stimulation
- - - - decr glucagon and glucose uptake
      - help with wt loss
- - - - act independent of insulin