Diabetes Management

Question 1

Regular insulin

Answer 1

Short acting (2-3hr peak)
Give SC or IV
AE: SNS/PNS up: coma, convulsion, give glucose, wt gain, insulin antibodies

Question 2

NPH

Answer 2

Intermediate acting insulin (2-5hr)
Give SC
AE: SNS/PNS up: coma, convulsion, give glucose, wt gain, insulin antibodies

Question 3

Lispro, aspart, glulisine

Answer 3

Rapid acting insulin (5-15mins)
All made with slightly modified insulin
AE: SNS/PNS up: coma, convulsion, give glucose, wt gain, insulin antibodies

Question 4

Glargine, detemir, degludec

Answer 4

Slow onset, long acting
Mimic basal insulin
AE: SNS/PNS up: coma, convulsion, give glucose, wt gain, insulin antibodies

Question 5

Metformin

Answer 5

A biguanide
Lowers HbA1C without hypoglycemia
Targets liver to acheive euglycemia
Renal excretion
AE: GI, don't give in CKD

Question 6

Chlorpropramide, tolbutamide

Answer 6

1st gen. sulfonylureas: Close ATP sensative K channel
Acutely raise insulin and chronically lower glucagon
Tolerance can develop
Ptn bound
AE: wt gain, hypoglycemia, don’t give with barbituates, rifampin, CYP3A4 activator

Question 7

Glyburide, glypizide, glimeperide

Answer 7

2nd gen. sulfonylureas: Close ATP sensative K channel
Acutely raise insulin and chronically lower glucagon
Tolerance can develop
Ptn bound
Longer half-life the greater risk of hypoglycemia
Risk: Glimeperide, glyburide then glypizide
AE: wt gain, hypoglycemia, don’t give with barbituates, rifampin, CYP3A4 activator
Dont give glyburide or glypizide if renal or liver hx.
Don’t give glimeperide in liver hx.

Question 8

Repaglinide

Answer 8

Meglitinide

Same as sulfonylureas but must give with meals

Question 9

Nateglinide

Answer 9

D-phenylalanine analogue
Fast onset meglitinide
AE: wt gain, no in liver issues

Question 10

Gliflozins

Answer 10

SGLT-2 inhibitors
Increase glucose excretion, reduced CVD risk
Only for T2 and no in CKD
AE: DKA, candidiasis, UTI, hypotension

Question 11

Exenatide, lixisenatide, dulaglutide, albiglutide, semigluide

Answer 11

DPP-4 resistant GLP-1 analogues

AE: gi and neprotox

Question 12

Sitagliptin, saxagliptin, linagliptin, alogliptin

Answer 12

DPP-4 inhibitors

AE: sitagliptin: renal:: saxagliptin: CYP3A4

Question 13

Proglitazone, rosiglitazone

Answer 13

Target adipocytes for fat redistribution and decreased insulin resistance
PPARG agonist??? a TF
Increase glucose uptake
AE: wt gain, edema, fat dystrophy, liver (CYP3A4)

Question 14

Acarbose, miglitol

Answer 14

alpha-glucosidase inhib
prevents glucose absorption from intestines
AE: Gi with bad gas

Question 15

Pramlinitide

Answer 15

Amylin agonist
Amylin- islet polypeptide, slows emptying and decreases glucagon (adjunct tx)
AE:nausea, hypoglycemia, GI dz