Diabetes Flashcards
What method is used to give insulin and where is insulin derived from?
Given parenterally (not absorbed PO) Derived from human insulin–more rapidly absorbed and less immunogenic than animal sources
What is the standard preparation of insulin
100 units per milliliter
List examples of immediate, short, intermediate, and long insulin drugs
Immediate –lispro, aspart, glulisine
Short – regular insulin
Intermediate – NPH
Long – Detemir, Glargine
Which type of insulin lasts for 12 hours but peaks at four hours?
Intermediate (NPH)
Which type of insulin most closely mimics human insulin?
Immediate (lispro)
Which type of insulin requires the most frequent administrations?
Immediate (lispro)
What is a conventional insulin prescription?
Two biphasic (70/30) injections daily with short acting agents PRN
List six drugs that cause hyperglycemia
Glucagon, steroids, epinephrine, thyroid hormones, oral contraceptives, diuretics
Describe how an all day insulin dose works
Long acting insulin agent (Glargine or detemir) covered by lispro
What is added to insulin to make it long-acting?
Zinc and protamine
What type of insulin is in an insulin pump?
Lispro (immediate)
Who is more likely to be insulin dependent, patient under 30 with diabetes or a patient over 30 with diabetes?
Under 30 with diabetes always require insulin
Over 30 with diabetes can manage with diet, insulin, and PO agents
Which types of insulin maybe mixed?
Shorter acting agents maybe mixed in one syringe and immediately used
long-acting insulin should never be mixed
What happens to long acting insulin agents administered by IV?
They separate and precipitate (as all suspensions do) when administered IV
Only non-suspension insolent products should be administered via IV drip
Why should insulin never be shaken?
Shaking denatures the protein (indicated by foam)
Instead, roll between hands to warm
When should insulin be refrigerated?
If prepared more than 30 days in advance
What size syringe should be used for insulin administration?
1 mL (or smaller, never larger)
What are the four signs of hypoglycemia?
Tremor, headache, malaise, tachycardia
How are pregnant patients with DM usually treated?
Switch to insulin – does not cross placenta
Why should patients on beta blockers be careful when taking insulin?
Beta blockers can mask signs of hypoglycemia (decrease headache, treat tremor, prevent tachycardia)
Describe a proper insulin injection
Subcutaneously in hip/flank at 45° angle
Summarize the mechanism of sulfonylureas in treatment of DM
Increase insulin release and sensitivity
Which type of oral diabetic agents require a 30% pancreatic function?
Sulfonylureas
Which kind of sulfonylurea should be avoided in the elderly?
Long acting agents (chlorpropamide, tolbutamide)-can bottom out their blood sugar
How are sulfonylureas excreted?
Renally, highly plasma protein bound
What is the most common adverse effect of sulfonylureas?
Rash
Which type of sulfonylurea may be coadministered with insulin?
Second or third generation (glimepiride, glyburide)
Describe how biguanides work
They reduce hepatic glucose production (ineffective in absence of insulin)
Why was phenformin removed from the market in 1970s?
It caused fatal lactic acidosis
What is the only kind of biguanide agent still used?
Metformin (Glucophage)
What is one added bonus of Exenatide (Byetta)?
Weight-loss
Which patients should be extra cautious of taking biguanides (Metformin)?
Those with renal dysfunction – metformin can cause lactic acidosis, increased serum creatinine
Also, patients with hepatic dysfunction, cardiogenic shock, and pregnancy
How is metformin dosing altered with the use of contrast dye?
Hold for 24 to 48 hours before use of dye
What is another name for thiazolidinediones?
Glitazones
How do Glitazones work?
They reduce peripheral insulin resistance (stimulate PPAR gamma resulting in adipose tissue differentiation)
Which of these three tend to be least effective in diabetes treatment – sulfonylureas, biguanide’s, Glitazones ?
Glitazones are less effective
List two common side effects of Glitazones
Weight gain and peripheral edema
Which patients should avoid taking Glitazones?
Those with heart or hepatic failure
How do Meglitinides work to treat diabetes?
Short acting secretagogues that release stored insulin (similar to sulfonylureas)
List examples of two Meglitinides and when you should take them
Repaglinide (take QID 30 minutes before meal) and Nateglinide (TID)
How does Exenatide work?
Functional analog of GLP-1 that enhances insulin secretion and delays gastric emptying, used as adjunct therapy with insulin or other oral
What is an added bonus side effect of using Exenatide?
Weight loss
List three major side effects of Exenatide
Nausea, vomiting, pancreatitis
Why do long acting GLP-1 agonists come with a black box warning?
They can cause thyroid C cell tumors
Explain the dosing of Exenatide
Take 5 to 10 µg b.i.d. one hour before morning and evening meals
Explain how dipeptidylpeptidase-4 (DDP-4) inhibitors improve glucose control
They prevent metabolism of GLP-1 thereby enhancing insulin secretion and delaying gastric emptying
List an example of a DPP-4 inhibitor
Januvia
Explain how Acarbose and Miglitol work to control diabetes
Alpha–glucosidase inhibitor that reduces digestion of complex carbohydrates in the gut causing increased sugar excretion in stool (used as adjuncts with other diabetes meds)
What are potential side effects of Acarbose and Miglitol?
Diarrhea, flatulence – bacteria in gut feed on undigested sugar
Which 3 diabetes medications are given subcutaneously?
Insulin, Byetta, Symlin
Describe how Pramlinitide (Symlin) works to control diabetes
Amylin analogue with longer half-life that reduces postprandial glucagon secretion, slows gastric emptying, reduces caloric intake and enhances effects of insulin
What are 2 side effects of pramlintide (Symlin)?
Weight loss, nausea
How is Symlin dosed?
15 µg subcutaneously just prior to large meals, titrate to 120 µg as tolerated
How does Canaglifozin (Invokana) work to control diabetes?
Inhibits sodium–glucose cotransporter 2 (SGPT-2) in kidney to waste urinary glucose
What are common side effects of Invokana?
Yeast infections, UTI, balanitis due to increased sugar in urine
Also osteoporosis and osteopenia due to potential calcium excretion (?)
How is Invokana usually dosed?
100 mg QD before first daily meal for type two diabetes only
What two tests must be monitored for patients on Invokana?
CrCl and serum K levels
