DM

Question 1

Hormones that counter insulin

Answer 1

Cortisol
Epinephrine
Growth hormone

Question 2

Insulin effects

Answer 2

-Stimulate lipogenesis
-Stimulate protein synthesis
-Promotes passage of potassium and magnesium into cells

Question 3

DM signs and symptoms

Answer 3

BG > 126
A1C > 6.5%
Polyuria
Polydipsia
Polyphagia
Glycosuria
Unexplained weight loss
Fatigue
Blurred via

Question 4

T1 DM complications

Answer 4

Diabetic ketoacidosis
Hyperosmolar hyperglycemic syndrome

Question 5

T2 DM cause

Answer 5

Insulin deficiency and insulin resistance
- decreased number of insulin receptors
- insulin receptors less responsive

Question 6

Metabolic syndrome

Answer 6

Obesity
Coronary heart disease
Dyslipidemia
Hypertension
Microalbuminemia (protein in urine)
Increased risk for thrombotic clot event

Question 7

A1C levels

Answer 7

Goal is <7% for diabetic patients
<5.7 % is normal
5.7 - 6.4 % prediabetes
> 6.5% type 2 diabetes

Question 8

BG goal for T2 DM patient

Answer 8

80 to 130 fasting BG

Question 9

Insulin effects

Answer 9

Metabolism of carbs, fats, proteins
Store glucose in liver
Convert glycogen to fat stores

Question 10

Rapid acting insulin

Answer 10

Insulin Lispro (Similar action to body’s own insulin)
Insulin aspart

Given subq or via continuous subq pumping

Question 11

Afrezza

Answer 11

Rapid acting insulin that is inhaled
Peak 12-15 min
Duration 2-3 hours
Admin 20 minutes before meal
Must be given with long acting insulin or oral diabetes medication
SE: hypoglycemia, cough, throat pain
Contra: smokers, chronic lung disease
Black box: risk of acute bronchospasms

Question 12

Short acting insulins

Answer 12

Regular insulin
Route: iv bolus, iv infusion, IM, subq
Subq route: onset 30-60 min, peak 2.5 hours, duration 6-10 hrs
IV route: immediate onset, duration 2-6 hours

Question 13

Intermediate acting insulin

Answer 13

Insulin isophane (NPH)
-cloudy appearance
-often comb w/ regular insulin
-onset 1-2 hours
- peak 4–8 hours
-duration 10-18

Question 14

Long acting insulin

Answer 14

Insulin glargine aka basal insulin
-clear solution
-constant level of insulin in body
-usually given daily, can be 2x day
-onset 1-2 hours
-Peak none
-Duration 24 hours
Toujeo: more concentrated U-300 form

Question 15

Other long acting insulin

Answer 15

Insulin detemir: duration dose dependent ; lower dose needs to be 2x/day;
Insulin glargine: biosimilar insulin using U100 syringe
Insulin degludec: ultra long acting; give once day using U100 or U200

Question 16

Dulaglutide

Answer 16

Injectable GLP-1 given weekly
Enhances glucose dependent insulin secretion, suppresses elevated glucagon secretion
Slow gastric emptying
Increase first and second phase insulin secretion
For t2 DM patients who haven’t controlled BG with metformin, sulfonylurea, or glitazone
Risk of developing thyroid cancer-cells
Nausea, vomiting
Pancreatitis
5-10 lbs of weight loss

Question 17

Before giving glucose altering drugs

Answer 17

Get thorough hx
Vs
BG, A1C
Potential complications and drug interactions
Assess pt ability to eat
Assess for n/v
If NPO, consult HCP about antidiabetics

Question 18

Insulin mixing

Answer 18

Always withdraw regular or rapid acting insulin first