Diabetes

Question 1

Rapid-Acting Insulin

Answer 1

Aspart, Lispro, glulisine

Onset: 5-15 min
Peak: 1-2 hrs
DOA: 2-4 hrs

Question 2

Short-Acting Insulin

Answer 2

Humulin R, Novolin R, Humalin R U-500

Onset: 30 min-1 hr
Peak: 2-4 hrs
DOA: 5-8 hrs

Question 3

Intermediate-Acting Insulin

Answer 3

Insulin NPH

Onset: 1-2 hrs
Peak: 6-10 hrs
DOA: 10-16 hrs

Question 4

Long-Acting Insulin

Answer 4

Lantus, Basaglar, Toujeo, Insulin detemir (Levemir)

Onset: 4-6 hrs
Peak: none
DOA: ~24 hrs

Question 5

Ultra Long-Acting Insulin

Answer 5

Insulin degludec (Tresiba)

Onset: ~ 1 hr
Peak: 9-12 hrs
DOA: up to 42 hrs

Question 6

Non-Insulin Antihyperglycemics

Answer 6

Biguaides
Sulfonylureas
Thiazolidinediones
Dipeptidyl pptidase 4 inhibitors (DPP-4)
Glucagon-like 1 peptide agonists (GLP-1)
GLP/GIP agonists
Sodium-glucose transporter 1 inhibitors (SGT-1)

Question 7

Biguanides

Answer 7

metformin (Glucophage)

• Inhibition of hepatic glucose production: may also improve peripheral insulin sensitivity

Question 8

Biguanides Adverse Effects

Answer 8

N/V/D
Macrocytic anemia secondary to b12 deficiency
lactic acidosis - avoid in poor renal function

does not cause hypoglycemia or weight gain

Question 9

Sulfonylureas

Answer 9

glipizide, glyburide, glimepiride

• Increase insulin secretion from the pancreas

Question 10

Sulfonylureas Adverse Effects

Answer 10

-Hypoglycemia- mostly with glyburide
-weight gain

Question 11

Thiazolidinediones

Answer 11

pioglitazone (Actos), rosiglitazone (Avandia)

• Increase insulin sensitivity in the peripheral tissues; secondarily acts by decreasing hepatic glucose production

Question 12

DPP-4 Inhibitors

Answer 12

sitagliptin (Januvia), saxagiptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina)

-Inhibit the enzyme responsible for the breakdown of endogenous glucagon-like peptide 1 and glucose dependent insulinotropic polypeptide resulting in increased endogenous incretin levels leading to:
1. glucose-dependent increases in insulin secretion
2. glucose dependent inhibition of glucagon secretion

Question 13

DPP-4 inhibitors Adverse Effects

Answer 13

Placebo like
small risk of pancreatitis

Question 14

GLP-1 agonists

Answer 14

exenatide (Byetta, Bydureon), liraglutide (Victoza), dulaglutide (Trulicity), semaaglutide (Ozempic, Rybelsus)

• Synthetic analogs of human glucagon-like 1 peptide, these agents work by increasing incretin levels resulting in:
  1. glucose-dependent increase in insulin secretion
  2. glucose-dependent decrease in glucagon secretion
  3. decreased gastric emptying
  4. increased satiety

Question 15

GLP-1 agonists Adverse Effects

Answer 15

-nausea/vomiting - can lead to wt loss
-headache
-pancreatits

*do not combine with DPP-4 inhibitors (considered duplicate therapy)

Question 16

Sodium-glucose co-transporter 2 (SGLT-2)

Answer 16

canaagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro)

• Reduces reabsorption of filtered glucose and lowers the renal threshold for glucose resulting in increased urinaryglucose excretion and lowering plasma glucose levels

Question 17

SGLT-2 Adverse Effects

Answer 17

-Genital fungal infections
-UTI
-Symptomatic hypotension

*can be helpful for other diseases such as CKD, HFrEF, and DM2