Antidiabetics Flashcards
Types of diabetes mellitus
Type 1, type 2, secondary, gestational
Normal range for blood glucose
fasting
70-99 mg/dL
What is A1c?
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)
Difference between human insulin and human insulin analogs?
both duplicate effects of pancreatic insulin, but analogs have various available changes to onset and duration
Humalin, Novolin vs. lispro, aspart
Types of insulin
rapid, short, intermediate, long, combination
rapid and short are “clears”, intermediates are “cloudy”, longs are analogs, combos are NPH/regular (short)
What is the antidote to insulin?
Sugar
Rapid-acting insulin
- Clear, subQ
- lispro, aspart, glulisine, and oral inhalation
see individual cards for o/p/d of each
Insulin lispro
Onset 15-30 min, peak 30-90 min, duration 3-5 hr
Insulin aspart
Onset 10-20 min, peak 40-50 min, duration 3-5 hr
Insulin glulisine
Onset 20-30 min, peak 55 min, duration 1.5 hr
Oral inhalation insulin
Onset 12-15 min, peak 53 min, duration 2.5 hr
Short-acting insulin
- Clear, subQ or IV
- insulin regular
see individual card for o/p/d
only insulin that can be given IV
Insulin regular
- 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
Intermediate-acting insulin
- Cloudy, subQ
- Insulin isophane NPH
see individual card for o/p/d
Cloudiness due to protamine (protein) additive to prolong action of insulin
Insulin isophane NPH
Onset 1.5 hr, peak 4-12 hr, duration 14-24 hr
Long-acting insulin
- analogs, continuous, subQ, cannot be combined with any other type
- glargine, detemir, degludec
often given at bedtime
Insulin glargine
Onset 1-1.5 hr, peak none, duration 24 hr
Insulin detemir
Onset 1-2 hr, peak 6-8 hr, duration 24 hr
Insulin degludec
Onset 1 hr, peak 12 hr, duration 42 hr
Combination insulin
- Combo of short/intermediate or rapid/intermediate, subQ
- NPH 70/regular 30, NPH 50/regular 50
Sliding-scale insulin
- 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
Hypoglycemia (insulin shock)
- Symptoms: nervousness, tremors, lack of coordination, cold and clammy skin, headache, confusion
- Treatment: oral sugar or D5 injection if airway is non-maintainable
Somogyi effect
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
Lipodystrophy
tissue changes caused by repeated injections at the same site
lipoatrophy (dimple), lipohypertrophy (lump)
prevented by rotating injection sites
Dawn phenomenon
- hyperglycemia upon awakening
- symptoms: headache, night sweats, nightmares
Managed by increasing HS insulin
Diabetic ketoacidosis
hyperglycemia and inability to metabolize sugars leads to catabolism of fatty acids subsequent accumulation of ketones
potassium unable to penetrate cells d/t increased sugar on cells, accumulation occurs and leads to cardiovascular issues
What is the criteria for oral hypoglycemics?
- 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
8 for class
What are the classes of oral antidiabetics?
Sulfonylureas (1st & 2nd gen), biguanides, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, incretin modifiers, incretin mimetics, amylin analogues
see individual cards for specifics
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Meglitinides
Incretin modifiers
Incretin mimetics
Amylin analogues
Hyperglycemic drugs
used to raise blood sugar
Glucagon
- 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
Diazoxide
- 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
Which complementary/alternative therapy can lower insulin requirements?
Chromium
Which complementary/alternative therapies can cause increased insulin levels and/or hypoglycemia?
w/ insulin and/or oral antibiotic drugs
9
Black cohosh, garlic, bitter melon, aloe, gymnema, ginseng, bilberry, hawthorn, ginko (if taken w/ glipizide)
Which complementary/alternative therapies decrease the therapeutic effect of insulin and oral antidiabetics?
Cause hyperglycemia
Rosemary, stinging nettle
Which complementary/alternative therapy may improve insulin sensitivity?
Milk thistle
Which complementary/alternative therapy may enhance the effectiveness of metformin, increase pioglitazone levels, and decrease the effectiveness of tolbutamide?
Ginko
Which complementary/alternative therapy may alter the metabolism of repaglinide and affect BG when taken with tolbutamide?
St. John’s wort
