Diabetes Basics, Insulin/Glucagon

Question 1

Pathophysiology of Type 1 diabetes

Answer 1

auto immune disease that causes destruction of B cells in the pancreas

Question 2

Pathophysiology of Type 2 diabetes

Answer 2

insulin resistance - related to skeletal muscles and adipose tissue

decreased production of endogenous insulin

Increased hepatic gluconeogenesis

Question 3

Insulin MOA

Answer 3

• Tissues primarily affected by insulin: muscle, adipose, and liver
• stimulate glucose entry into cells
• increase storage of glucose as glycogen in muscle and liver cells
• inhibits glucose production in liver and muscle cells
• promotes protein synthesis by increasing amino acid transport into cells
• enhances fat storage and prevents mobilization of fat for energy

Question 4

Onset/duration/how to use Rapid acting Insulin:

[lispro (Humalog) - Aspart (NovoLog) “Logs” - glulisine (Apidra)]

Answer 4

• Bolus insulin (Prandial, mealtime)
• onset in 5 minutes - peaks in 1 hour - duration 4-5 hours
• take 5-15 minutes before a meal

Question 5

Onset/duration/how to use Short acting insulin:

“regular” (Humulin R - Novilin R)

Answer 5

• Bolus insulin
• take about 30 to 45 minutes before eating
• peaks in 3 to 4 hours, duration 4 to 10 hours

Question 6

Onset/duration/how to use Intermediate acting insulin:

NPH insulin - Humalin N/ Novalin N

Answer 6

• Basal insulin
• onset: 1/2 to 1 hour; peak 4 to 10 hours; duration 12 to 24 hours
• looks cloudy - has to be mixed before injecting

- Take twice daily - do not have to take before eating - can be given before or after the meal - can be mixed with regular insulin

Question 7

Onset/duration/how to use Long acting insulin:

glargine (Lantus); detemir (Levemir); degludec (Tresiba)

Answer 7

• Basal insulin
• onset 2-4 hours; duration 24 hours with little or no peak

Lantus - ideally taken in the PM unless dose of 100u or more daily (divide into 2 doses and take BID)

Levemir - usually taken BID

Tresiba - ultralong acting - works for 48 hours - taken daily at the same time of day - good for people with erratic work schedule

Question 8

Insulin patient education

Answer 8

• How to measure and inject - Consider insulin pen
• Insulin dose and timing
• Insulin storage
• Blood glucose monitoring
• s/s and tx of hypo/hyperglycemia

Question 9

Glucagon MOA

Answer 9

• accelerates liver gluconeogenosis, which increases the breakdown of glycogen to glucose and inhibits glycogen synthesis - leads to elevated blood glucose levels
• given for hypoglycemia

**important to keep on hand for someone taking insulin**

Question 10

Glucagon adverse effects

Answer 10

• nausea
• increased BP
• hypersensitivity rx
• anaphyalxis and skin rase (rare)

Question 11

Insulin - adverse effects

Answer 11

Lipodystrophy/weight gain

Hypoglycemia

Generally very minimal adverse effects

Question 12

Which insulin has no peak effect?

Answer 12

Insulin glargine

Question 13

Inhaled insulin can replace which group of insulins?

Answer 13

Alternative to short- or rapid-acting insulins

Question 14

Inhaled insulin - indications

Answer 14

Injection site reactions

Needle aversion

Difficulty injecting

Question 15

How to initiate basal insulin

Answer 15

• Start with long-acting at hs
• 0.2u/kg at bedtime
• 100kg pt = 220lbs = 20units at hs
• Once above 50units per day may find 2x daily dosing works best