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Pharm 2 > Diabetes and Insulin > Flashcards

Diabetes and Insulin Flashcards

1
Q
A
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2
Q

What substance is released from the intestine in response to eating that goes up to brain and provides satiety?

A

GLP-1 (Glucagon Like Peptide

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3
Q

What substance sends signals to pancreas that starts the release of insulin in response to elevated glucose after eating?

A

GLP-1

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4
Q

What cells in the pancreas release insulin?

A

Beta islet cells

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5
Q

GLP cause the liver to slow down ____ and start storing ____

A
  • gluconeogenesis
  • glycogen
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6
Q

3 P’s of DM

A
  • Polydyspia
  • Polyuria
  • Polyphagia
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7
Q

Difference in body habitus b/w DM I and DM II

A

DM I are thin, DM II are obese

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8
Q

DM Type I is a genetically predisposed disease that causes an alteration on which chromosome?

A

Altered Human Lymphocyte Antigen on the short arm of chromosome 6

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9
Q

At time of diagnoses of DM type II, ___% of beta islet cells are destroyed

A

90%

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10
Q

What meds can induced hyperglycemia?

A
  • Glucocorticoids (Long term prednisone)
  • Antipsychotics (esp Risperadal, Haldol, Zyprexa)
  • HIV medications
  • Octreotide
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11
Q

What 3 conditions can cause stress-induced hyperglycemia

A
  1. Illness
  2. Trauma
  3. Pregnancy

All increase release of epi and cortisol

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12
Q

What two ways is DM diagnosed?

A
  1. Fasting BG > 126 x 2 occasions
  2. Random BG > 200mg/dl
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13
Q

4 ways glucose is monitored

A
  • Blood Glucose (BG) Monitor
  • Blood or Plasma Glucose
  • Glycosylated Hgb (HgA1C)
  • Urinary Ketones
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14
Q

For BG monitoring levels <75 mg/dl, a meter should read within ___ mg/dl

A

15

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15
Q

For BG monitoring levels >70 mg/dl, a meter should read within ___%

A

20%

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16
Q

What is the advantage and disadvantage of blood plasma glucose levels?

A
  • more accurate
  • takes longer and requires more blood
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17
Q

Normal HgA1C?

A

4-6%

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18
Q

ADA recommended HgA1C level?

A

<7-8.5% (depends on age of diabetic patient)

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19
Q

HgA1C provides a average reading based on BG over the past __ months

A

3

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20
Q

What happens if you aggressively try to drive down BG levels?

A

PONV, feel worse after

outcomes will be actually worse

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21
Q

BG level of ___ is ok to go to OR and under ___ for most procedures

A

175 180

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22
Q

T/F Only Type II DM will show urinary ketones

A

FALSE only type I

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23
Q

Type II DM will start on oral hyperglycemic meds, but most will require insulin esp if their first HgA1C is > __

A

10

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24
Q

Pro-insulin (storage) molecule is small amino acids chained together with cleavages between ___ and ___

A

31-32 and 64-65

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25
Q

What type of reaction takes place after insulin bind to alpha and beta receptors?

A

Phosphorylates, and then different types of cascades begin

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26
Q

Besides glucose, What substances are pulled into the cell by insulin through the GLUT-4 molecule?

A

Amino acids Phosphate Potassium Magnesium

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27
Q

What insulin-stimulated intracellular pathway causes cell growth, proliferation, and gene expression?

A

MAP Kinase signaling pathway

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28
Q

What insulin-stimulated intracellular pathway causes synthesis of lipids, proteins, glcogen, along with cell survival/proliferation and GLTU-4 molecule activation?

A

PI-3K signaling pathway

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29
Q

To prevent refeeding syndrome, what % of normal caloric intake should they start at

A

25%

Too much results in massive release of insulin, leads to massive drops in phos, K, mag –> arrhythmias, respiratory failure, death

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30
Q

MOA of insulin

A
  • Binds to plasma membrane insulin receptors
  • Phosphorylated receptor substrates then activate or inactivate numerous enzymes and other mediating molecules.
  • Translocation of glucose transporters (GLUT’s) to plasma membranes
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31
Q

What do Glucose transport molecules (GLUT-4) do?

A
  • Facilitate glucose diffusion into cells
  • Shift intracellular glucose metabolism toward storage (Glycogenesis)
  • Stimulate cellular uptake of amino acids, phosphate, potassium and magnesium
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32
Q

When does insulin resistance occur?

A

Occurs when there is an impaired intracellular insulin signal that results in decreased recruitment of glucose transport proteins to the plasma membrane and subsequent decrease glucose uptake.

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33
Q

What is the body’s response to insulin resistance ?

A

Compensatory hyperinsulinemia

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34
Q

T/F Insulin can regulate the population of receptors

A

True

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35
Q

What is the relationship between insulin and the number of insulin receptors

A

Inversely related

The more circulating insulin, the less number of insulin receptors on the cell

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36
Q

What is the t1/2 of IV insulin?

A

5-10 mins but the duration of effect is longer

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37
Q

What is the DOA of insulin?

A

30-90 mins

38
Q

Where is insulin metabolized?

A

liver and kidneys

39
Q

How much insulin that reaches the liver is metabolized on a single pass?

A

50%

40
Q

What prolongs the half life of insulin more, liver or renal disease?

A

Renal disease

41
Q

Insulin administered SQ is released ____ into the circulation

A

slowly

42
Q

Basal rate of insulin secretion by the pancreas is _ unit/hr.

A

1

43
Q

Food prompts a _ - _ fold increase in secretion

A

5-10x

44
Q

Total daily secretion of insulin is approx. __ units/day

A

40

45
Q

T/F Insulin response to glucose is greater for oral ingestion than for I.V. infusion

A

True eat a sandwich - better insulin response than glucose

46
Q

What is the peak of long acting insulins?

A

There is no peak

47
Q

Regarding insulin types, there duration of action correlates with ___

A

onset of action

48
Q

Long acting insulins are also known as ____

A

glargine

49
Q

What is the longest acting insulin?

A

Degludec (Tresiba), up to 42 hrs good for people that aren’t good at remembering to take insulin

50
Q

What is the only time you would give lantus BID?

A

If the volume is too much to handle in one dose. Otherwise its pointless

51
Q

Onset, peak, and duration of regular insulin

A

30mins 2-4 hrs 6-8 hrs

52
Q

what is the DOA of Levemir?

A

6-23 hours

It’s intermediate like NPH

53
Q

What types of insulin are considered “basal rate insulins”?

A

Long and intermediate acting (long is given once daily, intermediate BID)

54
Q

In premixed insulin, which number is the longer acting one?

A

First number

ex. humulin 70/30 (70% is NPH, 30% is regular

55
Q

T/F Insulin is one of the top 5 drugs that send people to ER

A

True

56
Q

Whats a drawback to rapid acting insulins?

A

With the rapid acting - Wild swings in glucose can make people feel sick, dizzy

57
Q

Newer insulin agents are produced from ___ Older agents were produced from ___

A

recombinant technology

animal (beef and pork)

58
Q

What is the benefit of recombinant technology insulins?

A

Allergy or immunoresistance that could accompany administration of animal insulins is no longer a significant problem

59
Q

Only ___ acting insulin may be given IV/ via pump

A

short

no NPH or long acting

60
Q

T/F All insulins can be given SQ

A

True

61
Q

Side effects of insulin

A
  • Hypoglycemia
  • Hypokalemia (also hypo phos and mag)
  • Allergic Reactions
  • Lipodystrophy
  • Insulin Resistance
  • Drug Interactions
62
Q

What is the most severe side effect of insulin?

A

hypoglycemia

63
Q

what is lipodystrophy?

A

injecting in same site over and over again results in atrophy of fat at site of SQ injection, get hard bumps.

64
Q

How can lipodystrophy be minimized?

A

Minimized by rotating the site of injection every 3 days

65
Q

Signs and symptoms of hypoglycemia

A

Diaphoresis Tachycardia Hypertension

66
Q

Hypoglycemia symptoms reflect the compensatory effects of increased ____

A

epinephrine

67
Q

What is Somogyi effect?

A

Rebound hyperglycemia caused by sympathetic nervous system activity in response to hypoglycemia may mask the correct diagnosis

68
Q

What is the most significant risk factor for developing insulin resistance?

A

If the diabetic patient doesn’t change their lifestyle and diet

“ex. I took my insulin, so now I can eat a whole cake”

69
Q

At what level would you begin to worry about hypoglycemia intra-op?

A

80 Diagnosis under GA is difficult

70
Q

Chronic NPH administration may lead to the development of antibodies to _____

A

protamine

71
Q

what type of currently available type of insulin is most likely to cause an allergic reaction?

A

NPH (due to protamine)

72
Q

A patient is considered to be insulin resistant if they require > ___ units/day

A

100 Battling DOWN REGULATIOn of insulin receptors

73
Q

Acute insulin resistance is associated with what 3 things?

A

trauma

surgery

infection

74
Q

What meds can counter the effects of insulin?

A

Epinephrine

ACTH/glucocortocoids

Estrogen

Glucagon

75
Q

How does epinephrine counter insulin?

A
  • Inhibits the secretion of insulin
  • Stimulates glycogenolysis
76
Q

What does epinephrine stimulate ?

A

Glycogenolysis

77
Q

With multiple SQ injection insulin management, what percent is given at intermediate or long acting? Versus how much is given in additional dosages with meals and sugar checks?

A

70% as intermediate or long acting at bedtime. 30% as additional doses with rapid acting

78
Q

How often should insulin pump injection site be changed?

A

every 2-4 days

79
Q

What type of insulin is typically used in insulin pumps?

A

Regular or Lispro

80
Q

What is afreeza?

A

Rapid acting Inhaled Insulin with onset 10-15 min and duration 3 hours.

“a hot steaming pile of garbage” per Emily

81
Q

In what situation would insulin sliding scale be used as sole treatment method?

A

When someone is on a steroid that is causing hyperglycemia.

Otherwise SS’s should e NOT be used alone, need some sort of basal coverage as well

82
Q

What are the four main long term complications of diabetes mellitus?

A
  1. Atherosclerosis
  2. Neuropathy
  3. Nephropathy
  4. Retinopathy
83
Q

Diabetes is the number one cause of….?

A

1 cause of:

  1. Dialysis
  2. Blindness
  3. Amputation

due to large size of a glucose molecule that destroy tiny capillaries/nephrons

84
Q

What electrolyte abnormality can have an increased risk with perioperative hyperglycemia?

A

Hyponatremia

As glucose goes up, Na+ begins to come down

85
Q

T/F: High rather than low blood glucose is desired under general anesthesia?

A

True; because GA can mask signs of low blood glucose

86
Q

What is optimal blood glucose levels perioperatively? Total joints?

A

80-180mg/dl

Total joints 80-150mg/dl

87
Q

What is included in “non-tight control regimen”?

A

1/4 to 1/2 dose intermediate or long acting prior to surgery.

Coverage based on BG concentrations.

Initiate IV insulin infusion based on continued need for correction.

88
Q

1 unit of regular insulin will decrease BG by how many mg/dl?

A

50-60mg/dl per 1 unit regular insulin

89
Q

What is included in “Tight Control regimen”?

A
  1. Maintenance D5W at 50ml/hr/70kg body weight
  2. Insulin at 0.05u/kg/hr (0.5-1u/hr)
  3. Check BG Q1-2hrs
  4. Adjust drip as needed to obtain targeted goal
90
Q

If “tight control regimen” being used and 4 hours into a case the BG is 300mg/dl, should you bolus regular insulin?

A

No; bolusing regular insulin can create dangerous swings of glucose levels. Better to titrate gtt accordingly

91
Q

What is perioperative management of patients with insulin pumps?

A
  1. Prior to surgery= clear liquids with or without sugar 2. Maintain basal infusion rate
  2. Turn off preprandial boluses
  3. Measure BG Q1hr
  4. Question patient how much insulin is typically required to decrease BG by 50mg/dl
92
Q

What substance is released from the intestine in response to eating that goes up to brain and provides satiety?

A

GLP-1 (Glucagon Like Peptide

Pharm 2 (19 decks)

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