Diabetes Flashcards
Mixed insulin drug names
Novolog 70/30 (70% Intermediate; 30% Rapid);
Novolin 70/30 (70% Intermediate; 30% Short);
Humulin 70/30 (70% Intermediate; 30% Short);
Humalog Mix 75/25 (75% Intermediate; 25% rapid);
Humulin 50/50 (50% Intermediate; 50% Short)
Long-acting insulin drug names
Glargine (Lantus); Detemir (Levemir)
Intermediate-acting insulin drug names
NPH (Humulin N; Novolin N)
Short acting insulin drug names
Regular Insulin (Humulin R; Novolin R)
Ultra-short acting insulin drug names
Lispro (Humalog); Aspart (Novolog); Glulisine (Apidra)
Role of pancreas in diabetes
Endocrine function - secretion of insulin (beta cells); glucagon (alpha cells); Somatostatin (delta cells)
Role of liver in diabetes
Conversion of excess glucose into glycogen for storage; (This glycogen can later be converted back to glucose for energy.)
Type 1 Diabetes
Onset usually in childhood or puberty; Frequently undernourished at time of onset; 5-10% of DM diagnoses; moderate genetic predisposition; Defect - beta cells are destroyed, eliminating the production of insulin. INSULIN-DEPENDENT!
Drug classes involved treatment of Type 1 Diabetes
Basal Insulins = Intermediate-acting (NPH); Long-acting
Bolus Insulins = Ultra-short acting; Short-acting (Regular Insulin)
Ultra-short acting insulin use
Bolus; More rapid onset & shorter duration than regular insulin; Should be given within 15 minutes before a meal or within 20 minutes after starting a meal
Ultra-short acting insulin onset, peak, and duration
Onset ~ 0.25 hr; Peak ~ 1-2 hr; Duration ~3-4 hr
Short-Acting Insulin Use
Bolus insulin regulation; Regular insulin
Short-Acting Insulin onset, peak, and duration
Onset ~ 0.5-1.0 hr; Peak ~2-3 hr; Duration ~3-6 hr
Intermediate-acting insulin (NPH) use
Basal insulin regulation
Intermediate-acting insulin onset, peak, and duration
Onset ~2-4 hr; Peak ~6-10 hr; Duration ~10-16 hr
Long-Acting insulin use
Basal
Long-acting insulin onset, peak, and duration
Onset ~4 hr; Peak = NONE; Duration up to 24 hr
Mixing Insulins
Never mix any insulin in the same syringe with long-acting insulin (insulin glargine or insulin detemir)
General adverse effects related to insulin
Most common side effect of insulin therapy is hypoglycemia; others include Weight gain, Lipodystrophy (degeneration of adipose tissue), Allergic reactions, Local injection site reactions
Guidelines for Injecting Insulin
Areas of “loose skin”: abdomen, thighs, upper arms, upper buttocks; Rotation of injection sites to help prevent fibrosis or lipohypertrophy; Use the same region & rotate injection sites to have less variability in insulin absorption, but also minimize lipodystrophy
Type 2 Diabetes
Onset frequently over 35 (although becoming more prevalent in kids due to childhood obesity); usually obese at onset; 90-95% of DM diagnoses; VERY STRONG genetic predisposition; Defect - inability of beta cells to produce appropriate quantities of insulin, insulin resistance, and/or other defects
Drug classes involved treatment of Type 2 Diabetes
Oral
Non-Insulin Injectables
Basal Insulin
Bolus Insulin
Oral Agent Pharmacologic Mechanisms
- Increase production of insulin
- Decrease glucose output
- Increase sensitivity to insulin
- Delay digestion of carbohydrates
- Inhibition of enzymes
Oral Agents
- Sulfonylureas
- Meglitinides
- Biguanides
- Glitazones
- Alpha-glucosidase inhibitors
- DPP4 Inhibitors
Sulfonylureas Action
Binds to sulfonylurea receptors on B-cells & stimulates pancreatic secretion of insulin
Sulfonylureas Side Effects
Hypoglycemia, weight gain, hemolytic anemia, GI upset
Sulfonylureas Dosing
Twice daily dosing before meals; Start at lower doses in elderly and compromised renal or hepatic function
Advantages of 2nd Gen Sulfonylureas
more potent, fewer adverse effects & drug interactions
Action of Meglitinides
Bind to receptors on βcells & lowers glucose by stimulating pancreatic isulin secretion; Produces more physiologic insulin release after a meal & better postprandial BG lowering
Side Effects of Meglitinides
hypoglycemia, weight gain
Cautions of Meglitinides
Hepatic Impairment
Biguanides Actions
Decrease hepatic glucose production; Increase peripheral glucose utilization
Biguanides Side Effects
N/V/D, & metallic taste are the most common SE Lactic acidosis: minimize use in renal insufficiency, CHF Avoid if SCr > 1.5 in males & 1.4 in females Does NOT induce hypoglycemia when used as monotherapy GI SE can be minimized by taking with food & titrate
Biguanides Medications
METFORMIN (Glucophage)
Glitazone Actions
Sensitize muscle & fat to effects of insuline (thru activation of PPAR gamma receptor)
Insulin must be present for medication to work!
May take 3 months for full effect
Glitazone Side Effects
Edema and weight gain (caution in CHF and edema) Monitor LFTs closely due to potential Liver dysfunction (trioglitazone) Mixed effects on lipids (DecreaseTG, IncreaseHDL, but negative effect on LDL)
Glitazone Medications
Pioglitazone (Actos); Rosiglitazone (Avandia)
Alpha-glucosidase inhibitor Actions
Prolongs the absorption of carbohydrates (by preventing breakdown of sucrose & complex carbohydrates in the small intestine)
Net effect: Decrease postprandial glucose; fasting BG is relatively unchanged
Alpha-glucosidase inhibitor Side Effects
GI Side effects: diarrhea, abdominal cramps
DPP4 Inhibitor
Dipeptidyl Peptidase 4-Inhibitors
DPP4 Inhibitor Action
- Increases insulin release
- decreases glucagon levels in the circulation
DPP4 Inhibitor Use
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
DPP4 Inhibitor Side Effects
URI, nasopharyngitis and headache, hypoglycemia
Incretins
Group of GI hormones that:
- increase postprandial insulin secretion
- slow the rate of absorption of nutrients from GI tract
- inhibit glucagon release
Amylins
Group of GI Hormones that: Slows the absorption of nutrients (slows gastric emptying time
Incretin Mimetic Actions
- Glucose-dependent stimulation of insulin release
- suppression of glucagon
- slows gastric emptying
- May preserve B-cell function (useful in early disease)
Incretin Mimetic Side Effects
Nausea, vomiting, weight loss, injection site irritation
Amylin Analog Drug
Pramlintide (Symlin)
Amylin Analog Action
Suppresses glucagon secretion;
Delays gastric emptying;
Decreases postprandial hyperglycemia;
Promotes satiety;
Amylin Analog Uses
type 1 and type 2 diabetes (on insulin)
Amylin Analog Side Effects
nausea& vomiting, weight loss
Non-insulin Injectables
Incretin Mimetics; Amylin Analogs
