Diabetes (Insulin/Anti-diabetics)

Question 1

Rapid-Acting insulin

Answer 1

Lispro (humalog)
Aspart (novolog)
Inhaled insulin (afreeza)

Onset: 15-30min
Peak: 1-3hrs
Duration: 3-5hrs

Admin within 15min before a meal or immediately after

Question 2

Short acting

Answer 2

Humulin R
Novolin R

Onset: 30min
Peak: 3hrs
Durations: 8hrs

Administer 30min before a meal

ONLY insulin given IV

Question 3

Intermediate-Acting Insulin

Answer 3

Humulin N
Novolin N

Onset: 1-2 hrs
Peak effect: 6hrs
Range: 8-13hrs
Duration: up to 24 hrs

Admin once or twice daily
Only subQ
Do not mix w/ other insulin

Also NPH, regular before NPH (clear before cloudy)

Question 4

Long-Acting Insulin

Answer 4

glargine (lantus)
Detemir (levemir)

Onset:3-4 hrs
Peak: none
Duration: >24hrs

Admin once daily (or split and twice)
Only SubQ
Do not mix with other insulin

Question 5

Combination: Intermediate Acting/Rapid Acting

Answer 5

Humalog Mix 50/50
Humalog Mix 75/25
Novolog 70/30

Onset: 15-30min
Peak: 1-5hrs
Duration: 11-22hrs

Admin twice daily
15 min before a meal or immediately after
Only subQ

Question 6

Combination: Intermediate Acting/Short-Acting

Answer 6

Humulin 70/30
Novolin 70/30

Onset:30-90min
Peak: 1.5-6.5hrs
Duration: 18-24hrs

Admin twice daily
30-34 min before a meal
SubQ

Question 7

Sulfonylureas

Answer 7

Glipizide

Time with meals
Peak: 1-3hrs

MOA: stimulation of insulin secretion from beta cells

Question 8

Biguanide

Answer 8

Metformin

Contraindicated in renal and hepatic disease
Should be temp. discontinued in pts undergoing radiologic studies with contrast

MOA: decreases hepatic glucose production
decreases intestinal absorption of glucose
improves insulin sensitivity

Question 9

DPPV-IV inhibitor

Answer 9

Sitagliptin

Can be given with or without food

MOA: inhibitor of dipeptidyl peptidase-4 enzyme that slows the inactivation of incretin hormones involved in regulation of glucose homeostasis.

Question 10

SGLT-2 inhibitors

Answer 10

Canaglifozin (Inovkana)
Empaglifozin (Jardiance)

Peak: 1-2hrs
Give before meal

MOA: inhibits renal reabsorption of glucose and lowers renal threshold for glucose, resulting increased urinary excretion of glucose

Question 10

SGLT-2 inhibitors

Answer 10

Canaglifozin (Inovkana)
Empaglifozin (Jardiance)

Peak: 1-2hrs
Give before meal

MOA: inhibits renal reabsorption of glucose and lowers renal threshold for glucose, resulting increased urinary excretion of glucose