Diabetes Types and Treatment Overview

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Questions and Answers

What is a characteristic side effect of Thiazolidinediones like Rosiglitazone?

Decreased appetite

Increased hematocrit

Hypoglycemia

Edema (correct)

Which mechanism is primarily associated with the action of Amylin?

Increasing gastric emptying

Inhibiting insulin secretion

Stimulating beta cell proliferation

Suppressing glucagon secretion (correct)

Which of the following is a contraindication for the use of Rosiglitazone?

Pregnancy

Stage 1 heart failure

Class 3 or 4 heart failure (correct)

Mild hepatic impairment

What effect does the incretin Exenatide have on the pancreas?

Augments glucose-dependent insulin secretion Signup and view all the answers

What is a primary action of Metformin in glycemic control?

Decreases hepatic glucose production Signup and view all the answers

Which statement accurately describes a feature of DPP-4 inhibitors like Sitagliptin and Vildagliptin?

They enhance incretin levels Signup and view all the answers

What is the primary mechanism of action of sulfonylureas?

Increase the secretion of insulin from pancreatic b cells Signup and view all the answers

Which of the following statements about the action of acarbose is true?

It prevents the cleavage of polysaccharides to monosaccharides in the intestine Signup and view all the answers

Which of the following may be a secondary effect of sulfonylurea therapy?

Improvement in hepatic insulin resistance Signup and view all the answers

What is a commonly noted gastrointestinal side effect of acarbose?

Flatulence Signup and view all the answers

At what plasma glucose levels do neuroglycopenic symptoms typically occur?

Below 60 mg/dl Signup and view all the answers

Which of the following inhibitors can be used in combination with sulfonylureas for an additive effect?

Acarbose Signup and view all the answers

Which mechanism is primarily associated with sulfonylureas in the treatment of diabetes?

Stimulate insulin secretion from pancreatic beta cells Signup and view all the answers

What is the primary action of biguanides, such as Metformin, in diabetes management?

Enhance insulin sensitivity and reduce hepatic glucose production Signup and view all the answers

How do insulin secretagogues function in diabetes treatment?

By stimulating the release of insulin from the pancreas Signup and view all the answers

What is a major contraindication for the use of Metformin?

Severe renal impairment Signup and view all the answers

Which strategy is most effective for glycemic control in type 2 diabetes?

Combination of oral hypoglycemics and lifestyle changes Signup and view all the answers

What is a common risk of insulin therapy without sufficient carbohydrate intake?

Hypoglycemia Signup and view all the answers

Which of the following medications primarily acts to enhance insulin sensitivity?

Biguanides Signup and view all the answers

Which factor is associated with the development of Type 2 diabetes?

Genetic predisposition Signup and view all the answers

What is a key characteristic that differentiates Type 1 diabetes from Type 2 diabetes?

Presence of islet antibodies Signup and view all the answers

What is the most common chronic complication of diabetes?

Retinopathy Signup and view all the answers

Study Notes

Types of Diabetes

Diabetes Mellitus Type 1: Insulin Dependent (IDDM); caused by destruction of pancreatic β cells.
Diabetes Mellitus Type 2: Non-insulin Dependent (NIDDM); characterized by insulin resistance.
Type I diabetes leads to low or absent insulin levels, while Type II diabetes typically exhibits high-normal to very high insulin levels.
Type I often presents between ages 1-20, whereas Type II onset is usually 12 years and older, commonly associated with obesity (60-90% of cases).
Gestational diabetes and family history are risk factors in Type II.
Both types can lead to serious complications, including the risk of diabetic coma and ketosis.

Consequences of Diabetes

Acute: Hyperglycemia, diabetic ketoacidosis, or diabetic coma.
Chronic Complications:
- Retinopathy: Leading cause of blindness in individuals of working age.
- Coronary and Cerebrovascular Disease: 2-4 fold increased risk of coronary heart disease and stroke; 75% have hypertension.
- Nephropathy: 16% of new patients require renal replacement therapy.
- Foot Problems: 15% risk of foot ulcers with a significant amputation requirement among those affected.
- Erectile Dysfunction: Affects up to 50% of men with long-standing diabetes.

Insulin

Insulin is a peptide hormone that reduces blood glucose levels, produced by β cells in the islets of Langerhans.
Insulin secretion is influenced by glucose levels leading to processes like glucokinase activation and ATP production.
Other hormones raising blood glucose include cortisol, glucagon, growth hormone, epinephrine, estrogen, and progesterone.

Treatment of Type 1 Diabetes

Treatment primarily involves insulin replacement therapy.
Various insulin preparations, categorized by onset, peak, and duration, are commonly used:
- Rapid: Lispro, Aspart, and Glulisine; onset 0.2-0.5 hrs, duration 3-4 hrs; used for meals and acute events.
- Short Acting: Regular insulin, onset 0.25-1 hr, duration 5-8 hrs; also for meals.
- Intermediate: NPH, onset 1.5-2 hrs, duration 18-24 hrs; used for basal coverage.
- Long-Acting: Glargine and Detimir; Glargine has up to 24 hrs coverage.

Insulin Delivery Systems

Inhaled Insulin: Example is Exubera; alternative to injections.

Adverse Effects of Insulin Therapy

Can cause severe hypoglycemia if insulin is administered without carbohydrate intake.
Additional side effects include edema and decreased hematocrit.

Thiazolidinediones: Rosiglitazone

Linked to hepatotoxicity and fatal ischemic heart disease.
Not recommended for patients with class 3 or 4 heart failure; may worsen heart failure and cause edema.

New Classes of Hypoglycemic Drugs

Amylin: A peptide that suppresses glucagon, delays gastric emptying, and suppresses appetite; Pramlintide is a modified form used with insulin.
Incretin: GLP-1 released from the gut increases glucose-dependent insulin secretion; quickly broken down by DPP-4.
- Exenatide: Incretin mimetic (injected).
- Sitagliptin & Vildagliptin: DPP-4 inhibitors (oral).

Symptoms of Hypoglycemia

Early symptoms include sweating, hunger, and tremors, typically at plasma glucose levels of 60-80 mg/dl.
At levels below 60 mg/dl, symptoms may escalate to confusion, weakness, and loss of consciousness.

Treatment of Type 2 Diabetes

Inhibitors of Intestinal Glucose Absorption: Acarbose and Miglitol act as α-glucosidase inhibitors, delaying carbohydrate absorption and reducing postprandial glucose.
- Side effects include significant gastrointestinal discomfort.
Sulfonylureas: Historically the first class of oral antidiabetic drugs; they promote insulin secretion from β cells, improving blood glucose levels and possibly enhancing insulin sensitivity.

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Description

This quiz covers essential information regarding the types of diabetes, including Type 1 (IDDM) and Type 2 (NIDDM), as well as their treatments involving insulin and oral hypoglycemic drugs. Enhance your understanding of the causes and characteristics of each diabetes type. Test your knowledge on this important health topic.