Diabetes

Question 1

List the rapid insulins

Answer 1

Lispro (HumaLog)
Aspart (NovoLog)
Glulisine (Apidra)

Question 2

List the long acting insulins

Answer 2

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

Question 3

Onset for rapid insulins

Answer 3

10-30 min

Question 4

Peak for rapid insulins

Answer 4

30 min - 3 hr

Question 5

Duration of rapid insulins

Answer 5

3-5 hrs

Question 6

Onset of long acting insulins

Answer 6

0.8-4 hr

Question 7

Peak of long acting insulins

Answer 7

No peak

Question 8

Duration of long acting insulins

Answer 8

16-24 hrs

Question 9

List the types of agents used for T2DM

Answer 9

Biguanides
Sulfonylureas
Dipeptidyl peptidase-4 (DDP-4) inhibitors
GLP-1 Receptor Agonists (Incretin Mimetics)

Question 10

Example of a Biguanide

Answer 10

Metformin (Glucophage)

Question 11

How does metformin work?

Answer 11

• Increase uptake/use of glucose and decrease insulin resistance (in skeletal muscle; fat tissue)
• Enhances insulin sensitivity
• Reduces liver glucose production

Question 12

Examples of Sulfonylureas

Answer 12

Glipizide (Glucotrol)
Glyburide (Glynase)
Glimepiride (Amaryl)

Question 13

How do sulfonylureas work?

Answer 13

Increases insulin production (*from the pancreas)

Question 14

Example of DPP-4 inhibitors

Answer 14

Sitagliptin (Januvia)

Question 15

How do DPP-4 inhibitors work?

Answer 15

Increase incretin hormone levels (in small intestine)
Increases insulin synthesis and release of insulin from *pancreas
Decreases *liver glucose production

Question 16

Examples of GLP-1 Receptor Agonists (Incretin mimetics)

Answer 16

*Exenetide (Byetta) (with meals)
*Liraglutide (Victoza) (with or without food)
Dulaglutide (Trulicity)

Question 17

Major side effect of sulfonylureas

Answer 17

*Hypoglycemia (need to keep source of oral glucose)

Question 18

How is metformin administered?

Answer 18

PO

Question 19

How is Amaryl administered?

Answer 19

PO
With food

Question 20

How is Januvia administered?

Answer 20

PO

Question 21

How is Byetta administered?

Answer 21

SubQ with meals
Alone or with Metformin in T2DM

Question 22

How is Victoza administered?

Answer 22

SubQ, with or without meals
Alone or with Metformin in T2DM

Question 23

How is Trulicity administered?

Answer 23

SubQ
Alone or with Metformin in T2DM

Question 24

How do GLP-1 Receptor Agonists (Incretin Mimetics) work?

Answer 24

Works in stomach and pancreas
- Delays gastric emptying
- Stimulates insulin secretion from pancreas

Question 25

Side effects of Incretin mimetics

Answer 25

Nausea/vomiting
Diarrhea
Pancreatitis

Question 26

Should metformin be given with our without food

Answer 26

With meals to decrease GI upset

Question 27

Contraindications for metformin

Answer 27

*Hold for 48 hours pre/post surgery or procedure using contrast

Renal, liver, or cardiac disease (*lactic acidosis)
Iodine based contract medium (can cause AKI)
Excessive alcohol intake

Question 28

Side effects of metformin

Answer 28

Nausea/vomiting
Diarrhea
Lactic acidosis (BBW)

Question 29

Most effective 1st like tx for T2DM

Answer 29

Metformin

Question 30

What forms does metformin come in?

Answer 30

Immediate release
Extended release
Liquid forms

Question 31

Contraindications of sulfonylureas

Answer 31

Avoid alcohol because it drops blood sugar

Question 32

How is Glucotrol administered?

Answer 32

Within 30 min of food

Question 33

Side effects of DDP-4 Inhibitors

Answer 33

HA
URI
Pancreatitis
CHF
(Do not usually cause hypoglycemia)