PPP Learning Objectives for Final (1)

PPP Learning Objectives for Final (1) - PPP Learning...

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PPP Learning Objectives for Final Anti-diabetic Agents: 1. a. Glycation of the N-terminus of Hgb β chain i. Rate of formation of HbA1c is directly related to the ambient glucose concentration ii. Erythrocytes are freely permeable to glucose iii. HbA1c provides a glycemic history of the previous 90 days, the average erythrocyte lifespan iv. Current recommendations (ADA): 2-4 HbA1c measurements each year b. Life span of RBCs: 4 months c. A1C: average BG in the preceding 1.5 – 2 months d. e. For diagnosis (A1C > or = to 6.5) 2. Identify the symptoms DM a. Polyuria i. Osmotic dieresis: excessive urine output due to increased load of glucose or other osmotically active metabolites ii. When BG > 180 mg/dl: tubular reabsorption saturated 1. Glucose remains in the lumen 2. Fluid trapped in the lumen (osmosis) 3. b. Polydipsia i. Dehydration major component of acute, life-threatening conditions associated w/ diabetes c. Polyphagia d. Type 2: insulin resistance 3. Discuss the complications of DM a. Acute, life-threatening
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i. Hyperosmolar coma ii. Ketoacidosis b. Long-term i. Macrovascular (atherosclerosis): Heart attack, stroke, limbs, impotence ii. Microvascular: Retina, kidney, nerves iii. Non-vascular: Lens, joint, infection c. i. Fasting hyperglycemia in diabetic states - due to excessive gluconeopgenesis: inadequate suppression by fasting levels of insulin, hyper-glucagonemia 4. a. Mostly type 1: i. Insulin replacement: can overcome resistance in Type 2 1. Rapid-acting: Lispro (Lysine-B*28 & Proline-B29), Aspart (aspartic acid-B28), Glulisine (Lysine-B3 & Glutamine-B29) a. Can use Lispro w/ every meal 2. a. Can use glargine at night before bed 3. 4. Insulin pump therapy mostly Type I, > 100,000 Americans: only infuses rapid-acting insulin. Less hypoglycemia in Type I DM: it is the limiting factor ii. Amylin Replacement (Pramlintide) b. Type 2: i. Thiazolidinediones (enhance insulin sensitivity in adipocytes), biguanides (enhances insulin sensitivity in liver) 1. ii. Sulfonylureas, meglitinides, GLP-1 related agents (incretins)– increase insulin secretion (overcomes insulin resistance) 1. Incretin drugs a. GLP agonists: exenatide, liraglutide, CJC-1131, AVE-0010, Albugon, Glp-1-transferin, Exenatide Lar
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i. GLP-1-mimetics, unlike sulfonylureas, require the presence of glucose to stimulate insulin secretion ii. Exanatide: synthetic version of salivary protein found in Gila monster, Apprx. 50% identity w/ human GLP-1 1. Binds to known human GLP-1 receptors on β cells in vitro, resistant to DPP-IV
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PPP Learning Objectives for Final (1) - PPP Learning...

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