DM lecture 2

Question 1

What is Diabetes Mellitus (DM)?

Answer 1

a disorder characterized by hyperglycemia, due to altered metabolism of carbohydrates, fats and proteins.

Question 2

What is Type-1 diabetes?

Answer 2

insulin-dependent

Question 3

What is Type-2 diabetes?

Answer 3

non-insulin-dependent

Question 4

Classical symptoms of DM?

Answer 4

Hyperglycemia
Polydipsia (dry mouth and itchy skin)
Polyphagia
Glucosuria
Polyuria

Question 5

What are other symptoms of DM?

Answer 5

Blurred vision (if progressed retinopathy)
Peripheral neuropathy, leading to amputation
Fatigue
Weight loss
Poor wound healing (cuts, scrapes, etc)
Recurrent infections such as vaginal yeast infections, groin rash, or external ear infections (swimmers’ ear)
impotence (male)

Question 6

Diagnosis of DM?

Answer 6

Fast blood glucose test
Oral glucose tolerance test
Random glucose level measurement
hemoglobin A1C test

Question 7

Type 1 DM

Answer 7

-most common age 10-16
-resulting from destruction of pancreatic beta cells
-catabolic disorder (no insulin, high glucagon, no beta cell response to insulin releasing stimuli)
-most severe from of diabetes (untreated leads to ketosis/ketoacidosis)
-exogenous insulin needed!!!!!!!

Question 8

What are the 4 different types of insulin preps?

Answer 8

1. rapid-acting (very fast onset within 5-10 min, short duration)
2. short-acting (with fast onset action within 30 min)
3. intermediate acting
4. long acting (slow onset and very long duration of action)

Question 9

Ayo what is insulin?

Answer 9

-it is derived from pro-insulin, a long single-chain protein, which is cleaved to insulin (51AA) and C-peptide (31AA)
-pro insulin has a mild hypoglycemic action

Question 10

Sources of Insulin?

Answer 10

-human insulin (less expensive, less immunogenic meaning causing allergy and insulin resistance), is produced by recombinant DNA tech
- Human pro-insulin gene is inseted into E. coli (Humulin) and yeasts (Novolin)

Question 11

What is ultra-short acting?

Answer 11

-insulin lispro
-rapidly acts in 5-15 min and peaks in 1 hr
-duration of action is 4-5 hr
-does not caused delayed hypoglycemia bc has lowest variability of abs 5%
-preferred for continuous sc infusion devices

Question 12

Other rapid acting insulins?

Answer 12

-insulin aspart (aspartic acid instead of proline at B28)
- insulin glulisine (glutamic acid instead of lysine at B29 and asparagine instead of lysine at B3)

Question 13

characteristics of short-acting insulin prep?

Answer 13

-soluble crystalline zinc insulin
-onset of action is within 30 min
-peaks between 2-3 hr and last for 5-8 hr (risk of postprandial hyperglycemia and delayed hypoglycemia exists)
-only form of insulin to be administered to IV (VERY useful in treatment of ketoacidosis or other conditions that insulin requirements change rapidly)
-less costly than lispro

Question 14

Characteristics of intermediate-acting?

Answer 14

-NPH
-onset is delayed by combining app amts of protamine and insulin (1:10)
-onset of action 2-5 hr and duration of 4-12 hr
-mixed with rapid acting or short acting insulin and given 2–4 times daily for insulin replacement
-action is unpredictable due to its erratic abs leading to significant decline in use

Question 15

Characteristics of long acting?

Answer 15

-insulin glargine (long acting, soluble peakless insulin analog)
-produced by adding two arginine molecules at the C-Terminus and substitution of a glycine for asparagine at the A21.
-slow onset of action (60-90 min) and max within 4-6 hrs and maintained for 11-24 hr or longer

Question 16

What is Insulin Detemir?

Answer 16

-another long acting insulin analog
-the terminal threonine B30 is removed and a myristic acid is attached to lysine at B29

Question 17

_____ of insulins provides a better glycemic control

Answer 17

mixture

Question 18

which one of these insulin prep will have most variability in abs? (Dr L question)

Answer 18

NPH (highest variability at 50%)

Question 19

NPH peaks within several hours and thus addition of a rapid- or short-acting insulin provides a better postprandial glycemic control compared to NPH alone

Question 20

why use mix of insulin? (Dr L question )

Answer 20

peak, onset, duration is different so when combine, provide better glycemic control

Question 21

Mixtures of insulin preps

Answer 21

some long acting must be given seperate bc they are not miscible

Question 22

Concentration

Answer 22

U-100 common in pharmacy

Question 23

Insulin delivery systems

Answer 23

-main one is SC injection (standard mode)
-portable pen injectors
-infusion
-inhaled
- Afrezza (inhaled) introduced in 2014

Question 24

Treatment with insulin

Answer 24

-used in type 1 pts with DM

Question 25

insulin therapy

Question 26

The goal of conventional SC therapy is to replicate normal physiological insulin secretion

Question 27

Intensive therapy attempts to restore near normal glucose patterns throughout the day while minimizing the risk of _________?

Answer 27

hypoglycemia
monitor especially elders and kids <7 yr old
frequent monitor needed

Question 28

Hypoglycemia could be due to

Answer 28

-delay in eating a meal
-physical exertion
-large doses of insulin
-tight control without frequent monitoring\

Question 29

Signs of hypoglycemia

Answer 29

-hyperactivity of both sympathetic (tachycardia, palpitation, sweating, tremulousness) and parasympathetic (nausea, hunger) systems is observed that may progress to convulsions and coma

Question 30

How do you treat Mild Hypoglycemia (pt conscious and able to swallow)

Answer 30

-orange juice or any sugar containing bev

Question 31

Hypoglycemia (unconscious) treatment?

Answer 31

-2–50 mL of 50% glucose solution IV
-if IV glucose not available, 1 mg of glucagon (sc or IM)
-if glucagon not available, small amount of honey or syrup in buccal pouch (oral feeding contraindicated in unconsciousness)

Question 32

What are complications of therapy?

Answer 32

antibodies are produced (IgA, IgD, IgE, igG, IgM) which could lead to
-insulin allergy
-insulin resistance

Question 33

Insulin allergy?

Answer 33

-is an intermediate hypersensitivity and is a rare case in which local or systemic urticaria will develop (due to histamine release from the mast cells in response to an anti-insulin IgE Ab)
-the use of human insulin or insulin analogs obtained by the recombinant tehcnology from the onset of therapy should eliminate the risk of allergy

Question 34

Insulin resistance?

Answer 34

low titer of circulating IgG anti-insulin Abs develop in pts with some degress of tissue insensitivity to insulin, leading to extremely high insulin requirement

Question 35

complicaitons of therapy

Answer 35

-lipodystrophy at injection sites