Chapter 50: Antidiabetics Flashcards by Brina Quintanilla Reyes

What does diabetes mellitus mean?

Chronic disease results from deficient glucose metabolism

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What are the 3 major symptoms of diabetes mellitus?

Polyuria
Polydispisa
Polyphagia

Too much pee
Too much thrist
Too hungry

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What does insulin resistance mean?

Insulin receptors unresponsive or deficient in numbers

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There are 4 types of diabetes what are they?

Type 1
Type 2
Secondary
Gestational

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What is type 1 diabetes mellitus?

Insulin dependent DM

Normally known as childhood diabetes
Usually will need insulin for life because they simply are born without it

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What is type 2 diabetes ?

Insulin resistance
Decrease insulin production!

Mainly known as 25+
Non insulin dependent DM
So you kinda bring it upon yourself

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What is secondary diabetes mellitus?

Due to medications
Glucocorticoids
Thiazide
Diuretics
Epinephrine

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What is gestational diabetes mellitus?

Due to hormonal changes

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If you have gestational diabetes you have an increase what?

Increase risk for diabetes type 2

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Why do you get those 3 ps for diabetes?

Because you have too much sugar in your blood instead of in your cells

So sugar dehydrates you when it’s in your blood stream, so drink lots of water ( thristy )

And you pee it out so much
Because of how much water you end up drinking

And your cells are hungry for the sugar so that sends a signal to brain to “eat” more

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Type 1 diabetes comes on what?

Suddenly

Usually just out the blue

( most people are diagnosed with going to ER with diabetic ketoacidosis )

( a lot of weight loss typically )

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When you are diagnose with pre diabetes, can you reverse it?

Yes

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can you reverse diabetes type 2 and how?

Yes
Typically with exercise and good diet

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What is a really big factor of diabetes type 2?

It’s a progressive type of diabetes in which insulin can slowly stop being produced

( over time you lose ability to produce insulin, so 80% of your pancreas doesn’t even work when you get diagnosed with diabetes type 2 sadly )

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Why do patients with diabetes type 2 feel like failures ?

We have to remember that diabetes type 2 is progressive and the diagnose is usually really late, with already 80% of their pancreas already not producing insulin.

Patients can follow good exercise and diet and still again, it’s progressive that it just gets worse

So oral medication and insulin is usually increased and needed

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Notes
With type 2 diabetes, you are not making enough insulin
And your body is becoming resistance to the insulin that you make

Its important to note that the insulin isn’t going to be used in the same way was before

Usually late diagnoses

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Insulin is released from what?

Why are they secreted?

Beta cells of islets of langerhans in pancreas

In response to increase in blood glucose

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What are the 2 functions of insulin?

Promotes uptake of glucoses, amino acids and fatty acids

Coverts glucose to glycogen in liver and muscle for future needs

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What is normal blood glucose range?

70-99

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What is hemoglobin A1C?
Like why do we do it and what does it tell us?

A test where it tells us our blood glucose

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What is less than 5% in hemoglobin A1C tell us?

No diabetes

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What is pre diabetes hemoglobin A1c?

5.7-6.4

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What is hemoglobin A1C diabetes mellitus?

6.5 or more

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Notes
Hemoglobin A1C
So like 6.5 of your sugar is attached to your blood cell
( so this means you have Diabetes )

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Hemoglobin A1C looks at the average blood sugar for the past what?

3 months

For patients who have diabetes type 2 what is usually the goal for the their A1C levels?

Less than 7

Insulin is key that takes your ___ and __ from your bloodstream into your cells So if you don’t have insulin what happens?

Glucose and potassium The glucoses go out into the blood stream ( outside the cells )

What’s one thing we do to help patients with hyperkalemia and why?

Give people IV insulin & IV dextrose 5-10 Insulin will move that Potassium from their blood stream into your cells to get rid of that hyperkalemia

For someone who is getting a lot of insulin what do we have to worry about?

Hypokalemia Cause all of that potassium will be moving into the cells

What are the 2 human insulin? Usually this has low allergies and insulin resistance

Humilin R Novolin N

What are 2 human insulin analogs modified onset and duration?

Insulin lispro Insulin aspart

What are the 3 concentrations of insulin?

100 units / ML 500 units /ML rarely used Both come in 10ML vials

What are the 5 insulin types we are going to talk about?

Rapid acting Short acting Intermediate acting Long acting Combinations

What are the 3 rapid acting insulin?

Lispro (humalog) Aspart (novolog) Glulisine (apidra )

Rapid acting insulin type What is the onset? What is the peak? What is the duration?

10-30mins 30-90mind 1.5-5hours

What are the 2 short acting insulin?

Regular ( humulin R and novolin R)

Short acting insulin type What is the onset? (2) What is the peak?(2) What is the duration?(2)

Sub Q-30mins IV 15min Subq 1.5-3.5hours iv 15-30mins Subq 4-12hours IV 2-6 hours

What is the intermediate acting insulin ? (2)

NPH ( humulin N and novolin N )

Intermediate acting insulin type What is the onset? What is the peak? What is the duration?

1.5H 4-12H 14-24H

What are your 3 long acting insulin?

Glargine (Lantus) Detemir (Levemir) Degludec (Tresiba)

Long acting insulin type What is onset? What is peak? (3) What is duration?(2)

1-2H Glargine-none Determir (6-8H) Degludec (12H) Glargine & determir (24H) Degludec (42H)

What is inhaled insulin ?

Afrezza

Notes Old insulin used to come from pigs and cows A lot of people had allergic reactions to Now we manipulate insulin so it can last us longer for us Usually last all morning until lunch time

All insulin come in what? ML of what? Concentration is what?

Vials 10ML 100units

Why would we have 500units concentrations?

Usually ICU When patients blood sugar is like 1500 or whatever

Make sure to always read the labels!!!!

With rapid acting insulin, we know that the onset is 10mins. What’s important about this? (2)

Do not give until food is there because it works really fast Can cause quick hypoglycemia effects!

Rapid and short acting usually do the same thing How many meals do you think they can handle or help?

First meal ; just one meal really

Intermediate acting They have what letter?!!

N!!! Remember the N NPH!!

Intermediate acting is from breakfest and ends usually until when?

Dinner time really

Notes Long acting insulin Works in the background typically !!!!

Why would we use an inhaled insulin? ( afrezza )

Very resistant to subq insulin

If you take a Intermediate acting When is it going to work? ( take it at breakers ) What if you take during dinner time?

Lunch time Take a bed night snack is needed

Long acting usually is taken how many times a day?

One pill or maybe even two

If you have a patient who has a hard trouble complying to insulin We usually do combination insulins What are they? (2)

Composed of short & intermediate Rapid & intermediate acting

What are 2 numbers of combinations?

NPH 70 & regular 30 NPH 50 & regular 50

Now onto insulin resistance and storage

What does insulin resistance mean?

Antibodies develop over time to animal insulin Antibodies cause insulin resistance and insulin allergy Obesity can lead to insulin resistance

How do we store insulin? (3)

Keep unopened bottles in refrigerator until open Avoid storing insulin in direct sunlight or at high temperatures Open vitals are good at room temperature for 1 month or refrigeration for 3 months

Who needs more insulin typically? 1 or 2?

2 because they are resistant and not making enough

What if a patient still has insulin when they have an open vial, what do we tell them?

Throw them out after a month ( usually tell them pick a day, 15th of month or first ) Or keep refrigerated for 3 months ( insulin is not stable for longer than a month ! )

What is the action of insulin?

Promote use of glucose by body cells, store glucose as glycogen in muscles

What is the usage or purpose of insulins?

Reduce blood glucose Control diabetes mellitus

What is the only insulin given IV?

Regular insulin

What 2 diabetes increasing glucose medications? They usually decrease the effectiveness of it so we need to amp up diabetes meds

Thyroid Steroids

Insulin Decrease glucose with tricyclic antidepressants, MAOIS, aspirin and oral anticoagulant ( decrease blood sugar, may need to lower the amount of insulin )

What are your two side effects of insulin?

Hypoglycemia Lipodystrophy

What are side effects of hypoglycemia?

Can be emergency Nervousness, trembling Lack of coordination Sweating, tachycardia Headache, confusion Can become combative and incoherent

What is lipodystrophy? How do we fix? What may be presented ?

Injecting insulin in the same spot over and over again Rotate sites Abnormal fat disposers and scaring

There is something called somogyi effect, what is it?

Rebound effect in which an overdose of insulin causes morning hypoglycemia ( too much insulin at night/day, and wake up in the morning with hypoglycemia )

When do we check or diagnose this somogyi effect?

2-4am checking sugars

What is the treatment for somogyi effect?

Have a snack or decrease insulin dose ( if predawn glucose less than 60 )

What is the side effects of somogyi effect? (3)

AM headache Night sweats Nightmares

What is the dawn phenomenon?

Morning hyperglycemia present on awakening

What are the side effects of dawn phenomenon?

Headaches Night sweats Nightmare

What is the main cause of sawn phenomenon?

Growth spurts

What is the treatment of dawn phenomenon?

Increasing the insulin dose

What is the biggest concern for diabetes? What side effects ?

Hypoglycemia!! ( neuro problems )

If you find a patient who is unconscious and is on insulin what is the first thing we do?

Give them sugar. ( glucagon Typically )

If a patient is conscious and is taking insulin what do we do?

Check their blood sugar and correlate their symptoms

What are the methods of insulin administration? Dont over think?

Arm Stomach Thighs

Notes Super skinny 45 degree Padding ( fat ) 90 degree

Now onto insulin regimens!

What are the 2 insulin regimens?

Bolus Basal Basal-Bolus

What is Bolus insulin regimens?

Shorter acting insulin Used to control blood glucose during and immediately after meals Rapid & short acting

What is basal insulin regimen?

Longer duration of action Used to control glucose levels between meals and overnight NPH and long acting insulin’s

Bolus is right before you eat What type of insulin? Basal is usually in the background ( snack ) What type of insulin?

Rapid & short ( intermediate ) NPH and long acting

People with type 2 diabetes when they go insulin what is the normal regimen do they get?

Basal insulin

Notes Basal Bolus regimen - long acting insulin ( once a day ) - then you do a Bolus for every meal Check your blood sugar and sliding scale Or calculate the insulin

Can you mix your long insulin?

NO!!

What is sliding scale insulin dosing?

Reacting to a blood sugar that’s high Usually used in the hospital We check blood sugar before Meal, then we calculate the blood sugar and based on that, how much unit we give

Can we use rapid and short in the same syringe? Can we mix it with intermediate?

Yes

NPH is cloudy!! Needs to be rolled ( only insulin that’s cloudy!) Long acting is by itself Rapid food need to be present Short acting gives great risk of hypoglycemia NPH can be mixed with rapid or short acting

15 grams of carbs 5 pieces of hard candy 4 cans of soda With signs of hypoglycemia

If someone has type 1 diabetes typically they are usually insulin Type 2 diabetes usually do oral

Oral antidiabtes drugs

Notes Oral anti diabetic drugs For type 2 DM Can be used in combination Insulin maybe added to OA medications do better control

Oral anti diabetic drugs Work in some combination (3) Either does one thing

Decrease insulin resistance Increase insulin production Decrease hepatic glucose production

What are the 5 oral medications for oral anti diabetic drugs?

Sulfonylureas Biguandie: metformin Thiazolondinediones DDP-4 Glucagon

What is the side effect of sulfonylureas? They do all 3 BTW!

Hypoglycemia !!

If you take a sulfonylrueas And they don’t eat what happens?

Hypoglycemia!!

What medication for biguandie?

Metformin

What are the 4 side effects of metformin?

Metallic taste Lactic acidosis GI upset !!!! Pancreatitis

What is usually the first choice of oral anti diabriecs? And does all 3 things?

Metformin

How do you get rid of the GI upset for diabetic oral medication?

Usually start at a low dose

If a patient is having a test for IV contrast, why do we withhold metformin? And how long is the holding? Before and after?

Because they both are excreted through the kidneys They cause renal failure 48aftee and 48 before

Test question A patient is schedule to do a test with IV contrast, but they took meformin this morning, what do we do? Or metformin is ordered do we still give it?

Call the doctor and reschedule No hold it for the 48 hours

Thiazoldinoediones What is it heavily contrainicated for? Actos and Avandia

Class 3 and class 4 heart problems Edema and weight gain

DDP-4 inhibitor What does it do? - increase the level of incretin hormones - increase insulin secretion Take it with metformin Not taken first time - usually it’s an add on for metformin or sulf What are the 3 examples? Sitagliptin ( januvia) Saxagliptin (onglyza) Lingaliptin (tradjenta )

Guidelines for oral anti diabetic Therapy for type 2 diabetes Onset of diabetes mellitus at age 40 years or older Diagnosis of diabetes for less than 5 years Normal weight or over right Fasting blood glucose 200MG Less than 40 units of insulin Normalcrenal and hepatic function

Glucagon like peptide Agonists What are the 3 medications? Think of tides!

Exenatide ( byetta) Liraglutide ( victoza) Semgalutide ( ozempic & wegovy ) ( weight loss ^ )

What are the 6 side effects of the glucagon like peptide agonist?

Nausea Vomit Diarrhea Constipation Dyspepsia ( lost of appetite) Restlessness

Glucagon like peptide agonists Action Is what?

Slow gastric emptying, reduce food intake Sugar is at a steady state

Take with food for oral medication To help with GI upset

What is glucagon???

Help with hypoglycemia!! Increase blood glucose by stimulating Last resort !!! Where medical alert bracelet ( we give this if your unconscious) Then call 911

In the hospital for help with hypoglycemia?

Dextrose 50%

What is diazoxide used for?

Hypoglycemia caused by hyperinsulinsm ( so too much insulin and we use this and they need to eat a shit ton of sugar )