Antidiabetics

Question 1

Types of diabetes mellitus

Answer 1

Type 1, type 2, secondary, gestational

Question 2

Normal range for blood glucose

fasting

Answer 2

70-99 mg/dL

Question 3

What is A1c?

Answer 3

representation of blood glucose levels over past three months

measures amount of glucose bound to RBC Hb

below 5.7% –> normal
5.7% - 6.4% –> prediabetic
≥ 6.5% –> diabetic (7.0% @ VA)

Question 4

Difference between human insulin and human insulin analogs?

Answer 4

both duplicate effects of pancreatic insulin, but analogs have various available changes to onset and duration

Humalin, Novolin vs. lispro, aspart

Question 5

Types of insulin

Answer 5

rapid, short, intermediate, long, combination

rapid and short are “clears”, intermediates are “cloudy”, longs are analogs, combos are NPH/regular (short)

Question 6

What is the antidote to insulin?

Answer 6

Sugar

Question 7

Rapid-acting insulin

Answer 7

• Clear, subQ
• lispro, aspart, glulisine, and oral inhalation

see individual cards for o/p/d of each

Question 8

Insulin lispro

Answer 8

Onset 15-30 min, peak 30-90 min, duration 3-5 hr

Question 9

Insulin aspart

Answer 9

Onset 10-20 min, peak 40-50 min, duration 3-5 hr

Question 10

Insulin glulisine

Answer 10

Onset 20-30 min, peak 55 min, duration 1.5 hr

Question 11

Oral inhalation insulin

Answer 11

Onset 12-15 min, peak 53 min, duration 2.5 hr

Question 12

Short-acting insulin

Answer 12

• Clear, subQ or IV
• insulin regular

see individual card for o/p/d

only insulin that can be given IV

Question 13

Insulin regular

Answer 13

• SubQ: onset 30 min, peak 1.5-3.5 hr, duration 4-12 hr
• IV: onset 15 min, peak 15-30 min, duration 2-6 hr

Question 14

Intermediate-acting insulin

Answer 14

• Cloudy, subQ
• Insulin isophane NPH

see individual card for o/p/d

Cloudiness due to protamine (protein) additive to prolong action of insulin

Question 15

Insulin isophane NPH

Answer 15

Onset 1.5 hr, peak 4-12 hr, duration 14-24 hr

Question 16

Long-acting insulin

Answer 16

• analogs, continuous, subQ, cannot be combined with any other type
• glargine, detemir, degludec

often given at bedtime

Question 17

Insulin glargine

Answer 17

Onset 1-1.5 hr, peak none, duration 24 hr

Question 18

Insulin detemir

Answer 18

Onset 1-2 hr, peak 6-8 hr, duration 24 hr

Question 19

Insulin degludec

Answer 19

Onset 1 hr, peak 12 hr, duration 42 hr

Question 20

Combination insulin

Answer 20

• Combo of short/intermediate or rapid/intermediate, subQ
• NPH 70/regular 30, NPH 50/regular 50

Question 21

Sliding-scale insulin

Answer 21

• scale based on individual’s blood sugars, gives correlating insulin dose
• allows for more coverage in times of stress/illness/meds/etc.
• involves rapid or short acting insulin

Question 22

Hypoglycemia (insulin shock)

Answer 22

• Symptoms: nervousness, tremors, lack of coordination, cold and clammy skin, headache, confusion
• Treatment: oral sugar or D5 injection if airway is non-maintainable

Question 23

Somogyi effect

Answer 23

Rapid decrease in blood sugar in the predawn hours (2-4am) that stimulates a large hormonal surge to increase blood sugar, causing a rebound high

Managed by monitoring BG during those hours and reducing HS insulin

Question 24

Lipodystrophy

Answer 24

tissue changes caused by repeated injections at the same site

lipoatrophy (dimple), lipohypertrophy (lump)

prevented by rotating injection sites

Question 25

Dawn phenomenon

Answer 25

- hyperglycemia upon awakening - symptoms: headache, night sweats, nightmares ## Footnote Managed by increasing HS insulin

Question 26

Diabetic ketoacidosis

Answer 26

hyperglycemia and inability to metabolize sugars leads to catabolism of fatty acids subsequent accumulation of ketones ## Footnote potassium unable to penetrate cells d/t increased sugar on cells, accumulation occurs and leads to cardiovascular issues

Question 27

What is the criteria for oral hypoglycemics?

Answer 27

- Type 2 (must have a pancreas that makes some insulin) - onset at ≥40 years old - diagnosis <5 years - normal to overweight - fasting BG ≤200mg/dL - <40 units of insulin required today - normal renal and hepatic function

Question 28

# 8 for class What are the classes of oral antidiabetics?

Answer 28

Sulfonylureas (1st & 2nd gen), biguanides, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, incretin modifiers, incretin mimetics, amylin analogues | see individual cards for specifics

Question 29

Sulfonylureas

Answer 29

Question 30

Biguanides

Answer 30

Question 31

Alpha-glucosidase inhibitors

Answer 31

Question 32

Thiazolidinediones

Answer 32

Question 33

Meglitinides

Answer 33

Question 34

Incretin modifiers

Answer 34

Question 35

Incretin mimetics

Answer 35

Question 36

Amylin analogues

Answer 36

Question 37

Hyperglycemic drugs

Answer 37

used to raise blood sugar

Question 38

Glucagon

Answer 38

- hormone secreted by alpha cells in pancreas - increase BG by stimulating glycogenolysis and gluconeogenesis - used after insulin-induced hypoglycemia when other methods not available | takes 10 minutes for onset

Question 39

Diazoxide

Answer 39

- increase BG by inhibiting insulin release from beta cells - stimulate release of epinephrine from adrenal medulla - used for chronic hypoglycemia caused by hyperinsulinism - not indicated for hypoglycemic reaction

Question 40

Which complementary/alternative therapy can lower insulin requirements?

Answer 40

Chromium

Question 41

Which complementary/alternative therapies can cause increased insulin levels and/or hypoglycemia? | w/ insulin and/or oral antibiotic drugs ## Footnote 9

Answer 41

Black cohosh, garlic, bitter melon, aloe, gymnema, ginseng, bilberry, hawthorn, ginko (if taken w/ glipizide)

Question 42

Which complementary/alternative therapies decrease the therapeutic effect of insulin and oral antidiabetics? | Cause hyperglycemia

Answer 42

Rosemary, stinging nettle

Question 43

Which complementary/alternative therapy may improve insulin sensitivity?

Answer 43

Milk thistle

Question 44

Which complementary/alternative therapy may enhance the effectiveness of metformin, increase pioglitazone levels, and decrease the effectiveness of tolbutamide?

Answer 44

Ginko

Question 45

Which complementary/alternative therapy may alter the metabolism of repaglinide and affect BG when taken with tolbutamide?

Answer 45

St. John's wort