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Pharmacology > Diabetes 2 > Flashcards

Diabetes 2 Flashcards

1
Q

If DM2 pt doesn’t respond to non-insulin therapy in 3-6 months, what do you do?

A

add another drug or insulin, can use PO and insulin together

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2
Q

If DM2 pt is very symptomatic, what can you do?

A

start with insulin, skip PO

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3
Q

What is recommended for DM2 pt w/ dec renal function?

A

glipizide, glimepiride, insulin, TZDs, not glyburide or metformin

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4
Q

What is recommended for DM2 pt w/ dec hepatic function?

A

insulin, miglitol, sitagliptin, not TZDs, metformin, or glyburide

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5
Q

What is recommended for obese DM2 pts?

A

metformin, acarbose, not sulfonylureas, TZDs

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6
Q

what is recommended in DM2 pt when hypoglycemia is a concern?

A

metformin, not insuling, sulfonylureas

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7
Q

When to use short term insulin in DM2 pt?

A

acute illness, surgery, stress, er, preg, breast-feeding, severe metabolic decompensation aka diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, severe hypertriglyceridemia

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8
Q

when to use long term insulin in DM2 pt

A

if target is not reached after optimal dose of combo therapy, consider change to multi-dose insulin therapy, when initiating, insulin secretagogues should be stopped and insulin sensitizers should con’t

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9
Q

Short acting insulin drugs

A

Insulin aspart (Novolog), insulin lispro (Humalog), regular insulin (humulin R, novolin R), insulin glulisine (Apidera), insulin inhalation (Afrezza)

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10
Q

Intermediate acting insulin

A

NPH (Humulin N)

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11
Q

Long acting insulin

A

Insulin detemir (Levemir), insulin glargine (Lantus)

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12
Q

Clinical uses of insulin

A

DM1, DM2, hyperkalemia, short term hospitalized pts that are insulin naive

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13
Q

What is the onset, peak of action and duration of short acting insulin? Dosing schedule?

A

.5-1 hr, 2-4 hrs, and 5-8 hrs, take 30 mins before eating

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14
Q

What is the onset, peak of action and duration of intermediate acting insulin, Dosing schedule?

A

1-3 hrs, 5-8 hrs, up to 18 hrs, taken at bedtime or twice a day

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15
Q

What is the onset, peak of action and duration of fast acting insulin, Dosing schedule?

A

90 mins, no peak, 24 hr duration, usually taken once or twice a day

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16
Q

Factors that alter insulin action

A

route of admin (IV fastest), site of injection (stomach fastest), heat can increase rate of absorption and action, low doses are absorbed more rapidly, pt errors, irregular diet/exss, renal function, stress, drugs

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17
Q

at what conditions is insulin stable?

A

stable at room temp for 28 days once the vial is open, prefilled syringes are stable 28 days when refrigerated, otherwise 10-28 days

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18
Q

What are advantages of short acting insulin?

A

decreases post prandial hyperglycemia because of shorter duration, flexibility of schedule (can be given right after meals

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19
Q

What are disadvantages of short acting insulin?

A

risk of hypoglycemia if planned meal not consumed, needs combined with long acting for optimal BG control, $$

20
Q

What are advantages of long acting insulin

A

closely mimics normal physiologic basal pancreatic insulin release, provides 24 hr coverage with a constant absorption and no pronounced peak, good for pts suffering from nocturnal hypoglycemia

21
Q

What are disadvantages of long acting insulin?

A

longer hypoglycemia episode in event of too much dose or dec caloric intake, $$$$$

22
Q

What is insulin glargine (Toujeo)

A

insulin that is available as 300 units/ml, confusing because there is also insulin glargine (Lantus) which is 100 units

23
Q

what is a good starting point for insulin dosing?

A

.1-.2 units/kg/day, or about 10 units daily, always start low and be pt specific

24
Q

What is once daily injection of long acting insulin good for?

A

DM2 pts or short term for newly diagnosed DM1 pts

25
Q

What is considered to be the most efficacious dosing of insulin?

A

once daily injection of long acting and TID short acting, it mirrors pancreatic funciton

26
Q

How often can doses by titrated?

A

every 2-3 days, IF pt understands dosing

27
Q

What do you do for fasting glucose hyperglycemia in pt on insulin therapy?

A

eat bedtime snack? need to increase insulin at HS or move to HS dosing

28
Q

What do you do for pre lunch hyperglycemia in pt on insulin therapy?

A

add/inc short acting morning dose

29
Q

What do you do for bedtime hyperglycemia in pt on insulin therapy?

A

add/inc short acting pre-dinner dose

30
Q

What do you do for fasting glucose hypoglycemia in pt on insulin therapy?

A

dec evening dose, check timing of AM test and HS dose

31
Q

What do you do for pre-lunch hypoglycemia in pt on insulin therapy?

A

dec/omit short acting am dose

32
Q

What do you do for bedtime hypoglycemia in pt on insulin therapy?

A

add HS snack (piece of toast), dec pre-dinner dose of short acting

33
Q

What is the difference in DM1/DM2 with increased insulin dose?

A

2 units dec BG by ~50 in DM1, 4 units dec BG by 50 in DM2

34
Q

What time of insulin is usually used for pumps?

A

humulin R, 100units or 500 units

35
Q

What should self care management include?

A

BG monitoring, wt monitoring, foot care, hygiene, healthy lifestyle?diet or physical activity, identify targets for control, stop smoking

36
Q

Complications of diabetes?

A

CV disease, HTN, ACS, hyperlipidemia, nephropathy, retinopathy, neuropathy, poor wound healing

37
Q

Diabetic ketoacidosis

A

absolute insulin deficiency results in severe hyperglycemia, ketone body production and systemic acidosis as cell starvation flips metabolism from aerobic to anaerobic

38
Q

Who does DKA present in?

A

young, female, Type 1

39
Q

What is the onset and symptoms of DKA?

A
40
Q

what are the causes of DKA?

A

infection, non-compliance, new onset DM, MI, stroke, meds

41
Q

Mild DKA?

A

pH 7.25-7.3, HCO3 15-18, mental status alert

42
Q

Moderate DKA?

A

pH 7-7.24, HCO3 10-15, mental status alert/drowsy

43
Q

Severe DKA

A

pH

44
Q

How to treat DKA?

A

correct hypovolemia, hyperglycemia, acidosis, electrolyte abnormalities, initiate fluids, give IV insulin, correct hypokalemia first, correct metabolic acidosis

45
Q

When to switch IV fluids in DKA?

A

switch to dextrose containing fluids when BG is 200-300

Pharmacology (61 decks)

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