Diabetes and Insulin

Question 1

Insulin concentration

Answer 1

100U/ml

Question 2

very rapid acting insulin

Answer 2

lisper, insulin aspart, glulisine

Question 3

rapid acting insulin

Answer 3

regular

Question 4

intermediate acting insulin

Answer 4

NPH

Question 5

long acting insulin

Answer 5

detemir, glargine

Question 6

ultra long acting

Answer 6

degludec

Question 7

lispro

Answer 7

onset within 15 minutes, peak of action 45-75 minutes, duration 2-4h.

Question 8

insulin aspart and glulisine

Answer 8

onset 10-15 minutes, peak 45-75 minutes, duration 2-4h

Question 9

aspart (fiasp)

Answer 9

vitamin B3 added which may increase speed of absorption. onset 15-20 minutes, time to peak plasma concentration 1 hour, DOA 5-7h

Question 10

regular insulin

Answer 10

onset 30 minutes, peak 2-4h after SQ injection because of insulin hexamers. duration 6-8h. periop single dose 1-5U or infusion .5-2U/h

Question 11

Five Main SE:

Answer 11

1. hypoglycemia
2. allergic reactions
3. lipodystrophy
4. insulin resistance
5. drug interactions

Question 12

Oral Antidiabetic Drugs

Answer 12

1. secretagogues
2. biguanides
3. thiazolidinediones or glitazones
4. alpha glucosidase inhibitors

Question 13

Metformin drug class and contraindications

Answer 13

oral biguanide, can be used in combination with insulin and sulfonylureas. contraindications: lactic acidosis, AKI, GI intolerance, acute hepatic disease

Question 14

Metformin MOA

Answer 14

blood glucose lowering effect is not mediated through stimulation of endogenous insulin secretion

Question 15

Metformin and Lactic Acidosis

Answer 15

• possible SE of metformin therapy
• discontinue 48h before elective surgery
• monitor for lactic acidosis, ABG, lactate, RFP
• anaerobic metabolism results in pyruvate–>reduced to lactate
• do not administer in patients with hepatic metabolism, renal insufficiency (creatinine >1.5mg/dL), IV contrast dye, acute MI, CHF, arterial hypoxemia, sepsis
• treatment: hemodialysis, bicarbonate administration

Question 16

Sulfonylureas

Answer 16

• can lower glucose levels to hypoglycemic levels
• improved BG control, decreased hepatic production of very low density lipoproteins, improved hypertriglyceridemia
• up to 20% of patients do not have adequate hypoglycemic response to maximal doses (primary failures), and another 10-15% of patients who initially respond will fail to respond to therapy each year (secondary failure).
• successful treatment requires beta cell function
• do not administer to patients with sulfa allergy

Question 17

Sulfonylureas MOA

Answer 17

act on sulfonylurea receptors on pancreatic and cardiac cells: inhibit adenosine triphosphate sensitive K channels on pancreatic beta cells resulting in calcium influx and stimulation of insulin release

Question 18

How does sulfonylurea affect cardiovascular mortality

Answer 18

close potassium-ATPase channels and inhibit ischemic preconditioning aka the cardioprotective mechanism

Question 19

Glyburide MOA

Answer 19

stimulates insulin secretion over 24 hour period. increases insulin sensitivity and inhibits liver production of glucose

Question 20

glipizide MOA

Answer 20

increases glucose uptake and suppresses liver glucose output- effects persist for prolonged periods without tolerance. rapid plasma clearance minimizes risk for hypoglycemia

Question 21

glimepiride MOA

Answer 21

decreases blood glucose by stimulating release of insulin from pancreas and may decrease hepatic glucose production. combined with insulin therapy when sulfonylureas are not effective

Question 22

metglinide

Answer 22

exert effects on beta cells (similar to sulfonylureas). repaglinide, nateglinide.

Question 23

repaglinide

Answer 23

stimulates release of insulin from beta islet cells of pancreas

Question 24

nateglinide

Answer 24

lowers blood glucose by stimulating release of insulin from pancreas. accumulation of active metabolites may cause hypoglycemia

Question 25

alpha glucosidase inhibitors

Answer 25

acarbose and miglitol

Question 26

thiazolidinesiones (TZD’s)

Answer 26

rosiglitazone and pioglitazone. act at skeletal muscle, liver and adipose tissue via peroxisome proliferator activator receptor-gamma to decrease insulin resistance and hepatic glucose production, and to increase use of glucose by liver.

Question 27

glucagon like peptide 1 receptor agonists

Answer 27

exenatide and lireglutide. injectable agents that bind to receptors in pancreas, GI tract and brain to increase insulin secretion from beta cells, (glucose dependent), decrease glucagon production from alpha cells and reduce gastric emptying