Diabetes Mellitus (Ch 60)

Question 1

Adverse effects of Sulphonylureas: glyburide? When is it taken?

Answer 1

Hypoglycemia is most common adverse effect usually mild but can be severe (because it is forcing the pancreas to produce insulin)

Taken with breakfast (usually one/day)

Question 2

Example of an insulin Sulphonylureas?

Answer 2

glyburide

Question 3

What is very important when administering Human-Based insulins?

Answer 3

time frames of insulins are essential to know

Question 4

If hypoglycemia occurs what should we do?

Answer 4

-Give glucagon
-Have the client et 120 - 200mL of clear fruit juice, glucose tablets or gel

-After the liquid snacks have the client eat their meal soon or give a small snack such as crackers (carbohydrates and protein)

Monitor blood glucose levels

Question 5

Example of Alpha-glucosidase inhibitors? What do they cause?

Answer 5

-acarbose
-miglitol

Cause a delayed absorption of glucose

Question 6

What drug interactions do we need to bear in mind with insulins? (increase hypoglycemic effects)

Answer 6

-Increase hypoglycemic effect so will lower blood glucose levels

-B-Blockers (eg propranolol)
reduce glycogenolysis (glycogen to glucose) and sings of hypoglycaemia

-Also can mask signs of SNS activation (tachycardia, palpitations)

Question 7

When are short acting insulins administered? Onset? peak? duration?

Answer 7

Short (fast) acting
onset 30-60 minutes
peak 2 -3 hours
duration 6-7 hours

given with meals

Question 8

Boxed warning for TZD (rosiglitazone)?

Answer 8

Boxed Warning for rosiglitazone (Avandia)
Increased risk of angina, MI and heart failure (plasma volume)

Question 9

Example of Medication Interactions with oral/non-insulin agents? What do they do?

Answer 9

Glucocorticoids:
decrease the effect of hypoglycemic medication

Cortisol-like drugs cause an increase in blood glucose

Question 10

What do TZDs decrease?

Answer 10

-rosiglitazone (Avandia), other glitazones
-Decrease insulin resistance
-“Insulin sensitizing agents”

Question 11

Incretins mechanism of action? What do they stimulate and break down?

Answer 11

-Intestinal contents release incretins (GLP-1 and GIP)
Stimulate insulin release
Inhibit glucagon release

-Incretins broke down by the enzyme DPP- 4
dipeptidyl-peptidase 4

Question 12

SGLT2 Inhibitors – Adverse Effect

Answer 12

Increased urination
possible hypotension/dizziness

UTIs
not surprising

Question 13

What do we measure for Diabetes Mellitus?

Answer 13

-Measure HbA1C

-Measure of the average blood glucose over the past 3 months

Question 14

Example of a Amylin Mimetic? What does it inhibit?

Answer 14

Pramlintide

-delays gastric emptying and inhibits glucagon secretion
-reduce postparandial glucose

-Given as an injectable

Question 15

Adverse effects of insulin?

Answer 15

Life threatening hypoglycemia can occur with insulin

Early signs of hypoglycemia: rapid onset
agitation, irritable
headache
sweating
shaky and tremors
pale

Others: tachycardia, flushing, hunger

Question 16

What interactions of agents reduces the effect of insulin?

Answer 16

Reduce effect of insulin: so will increase blood glucose levels

Glucocorticoids

Question 17

When are Rapid-insulins administerd? onset? peak of action? Ex?

Answer 17

-Given with meals

-Onest: 10-15min
-Duration: 3-5 hours
-Peak of action: 60-90min

-Insulin lispro

Question 18

How does long-acting insulin work? onset? Peak? Duration? What kind of therapy is it used for? Ex?

Answer 18

Long acting:
onset 90 minutes
NO pronounced PEAK
duration 24 hours

Ex.) Insulin glargine (Lantus)
Clear, colourless solution

Basal therapy

Question 19

What is Sitagliptin? how is it administered? What does it inhibit? When is it given?

Answer 19

-DPP-4 enzyme inhibitors reduce incretin metabolism (reduced glucose
“gliptins”) (breaks down incretin)

-Given oral once daily with or without food ‘

*Used for type 2 only

Question 20

Ex of incretin mimetic? SC administered administration

Answer 20

Exenatide (GLP1) administered IM (needle pen)

Question 21

How do Insulins function as?

Answer 21

Function as a substitute for endogenous hormone

(Effects are the same as normal endogenous insulin)

Question 22

Mecanism of action for Sulphonylureas: glyburide? (oral) What do they improve? What do they decrease?

Answer 22

Stimulate insulin secretion from pancreatic beta cells = increasing insulin levels
Beta cell function must be present

Improves sensitivity to insulin in muscles, liver and fat
tissues take up and store glucose more easily

liver by decreasing the rate of insulin metabolism and breakdown

*Forces insulin to produce insulin)

Question 23

Diabetes drugs that interact with the incretin pathway?What do they inhibit?

Answer 23

-sitagliptin (given oral)

-excenatide

SGLT-2 inhibitors

Question 24

What do Alpha-glucosidase inhibitors (oral) inhibit? What is the result? what must it be taken with?

Answer 24

Reversibly inhibit the enzyme alpha-glucosidase in the brush border of the small intestine:
-acarbose
-miglitol

Inhibits digestion of oligo- and disaccharides

Result: delayed absorption of glucose

Must be taken with meals to prevent excessive postprandial blood glucose elevations

Question 25

Newest Ex of type 2 DM drugs are? Sodium-Glucose Transporter(SGLT2) WHat do they inhibit?

Answer 25

Canagliflozin

-inhibit glucose transporter in nephron (PT)

Question 26

What kind of therapy is intermediae-acting insulin used for? onset? peak? duration? Ex?

Answer 26

onset 1-3 hours
peak 5-8 hours
duration 10-18 hours

Basal therapy (not focused on spikes of insulin, focused on the spaces after the peak?

-cloudy appearance

*NPH (neutral protamine Hagedorn)

Question 27

Type 1 diabetes you must use/inject?

Answer 27

Insulin
Production of defective insulin

Question 28

Ex of a Thiazolidinediones (TZDs) (insulin stabilizers)

Answer 28

rosiglitazone

Question 29

Ex of biguanides?

Answer 29

metformin

Question 30

Mechanism of actions for Biguanides- metformin? (oral) What does it not increase?

Answer 30

1.) Decrease hepatic production of glucose

2.) Increase tissue sensitivity to insulin = increase uptake of glucose

-does not increase insulin secretion from the pancreas

Question 31

What occurs with to much insulin in the body?

Answer 31

Hyperglycemia (irritability and confusion, SNS activation)