Diabetes Flashcards
GLP-1 Stimulates
Insulin secretion
Somatostatin secretion
Beta cell proliferation
Gastric Acid secretion
GLP-1 Inhibits
Gastric emptying
Appetite
Beta cell death
Insulin Stimulates
Glycogenesis Glycolysis Pentose Shunt FA Synth Indirect: TG synth
Insulin Inhibits
Glycogenolysis Gluconeogenesis Lipolysis FA Beta Ox Indirect: Ketogenesis
Glucagon Stimulates
Glycogenolysis Proteolysis Gluconeogenesis Lipolysis FA Beta Ox Indirect: Ketogenesis
Glucagon Inhibits:
Glycogenesis
Glycolysis
FA Synth
Normal Fasting Plasma Glucose
<100
Pre-Diabetes Fasting Plasma Glucose
100-125
Diabetic Fasting Plasma Glucose
> = 126
75g Oral Glucose tolerance test (OGTT), Normal
<140
75g Oral Glucose tolerance test (OGTT), Pre-Diabetic
140-199
75g Oral Glucose tolerance test (OGTT), Diabetic
> = 200
Hgb A1c, Normal
<5.7
Hgb A1c, Pre-Diabetic
5.7-6.4
Hgb A1c, Diabetic
> = 6.5
Random Plasma Glucose diabetes diagnosis
> 200 + symptoms
Insulin half life and metab
3-5 minutes
Insulases in liver (50%), kidney, placenta
C-peptide half life and metab
3-4x insulin
Degraded by kidney
Benefit of short insulin half life
permits rapid changes in circulating levels
Benefit of long C-peptide half life
ideal marker of endogenous insulin produx and secretion
Basal insulin purpose
COntrol plasma glucose during fasting/between meals to prevent liver from making too much glucose
prevent ketosis
T1DM insulin dosing
Basal 24hrs + rapid w meals
T2DM insulin dosing
start basal and progress to meals if needed
NPH dosing
Humulin-N
Novolin-N
QHS or BID
DOA 12-16 hrs
Levemir dosing
Detemir
QD or BID
DOA ~18 hrs
Glargine 100 dosing
Lantus
Basaglar
QD
DOA 24 hrs
Glargine 300 (Toujeo) Degludec U100 or U200 (Tresiba) dosing
QD, but flex dosing for degludec
DOA >24 hrs
Humalog U100 or U200, Apidra, Fiasp dosing
Lispro Aspart Glulisine Onset 5-15 min Peak 1 hr DOA 3-4 hrs
Regular dosing
Novolin R Humulin R Onset ~30 min Peak 2-4 hrs DOA 6-8 hrs
Insulin to grams of carb
1 unit insulin:15 g carbs
Insulin to correct hyper-g
<150 - no insulin
for every 50 above, 1 unit insulin to a max of 5 units (350 glucose)
With food: start with 5 units, use increments up to 10 units
Pre-mixed insulin admin
BID before meals
70/30 of basal/bolus
Type 1 dose
0.4-0.7 units/kg/day
Type 2 dose
0.5-2.0 units/kg/day, sometimes need much more
Initiation of basal insulin in T2DM
• Start 10 units daily or ~0.2u/kg/day
• Measure daily fasting am glucose
• Titrate basal insulin to fasting glucose goal
(e.g. 80 - 140mg/dL)
How to adjust basal insulin
around FASTING glucose levels
How to adjust bolus insulin
glucose levels 2 hrs before or after meal
How to adjust premixed insulin for a.m.
prelunch and predinner glucose
How to adjust premixed insulin for p.m.
post dinner, bedtime, &/or morning fasting
Insulin Pump
constant low basal infusion
Bolus manually direted
Artificial pancreas
No patient input
Senses glucose and transmits info to pump to determine insulin/glucagon secretion
