DM management part 2

Question 1

what are the possible injection site reactions of insulin injections

Answer 1

inflammation
fibrosis
pain
lpohypertrophy
lipoatrophy

Question 2

what are the rapid acting insulins

Answer 2

lispro (humalog)
aspart (novolog)
glulisine (apidra)
technosphere (afrezza)

Question 3

what is the inhaled insulin

Answer 3

technosphere (afrezza)

Question 4

what is the short acting insulin

Answer 4

human regular (humulin R, novolin R)

Question 5

what is the intermediate acting insulin

Answer 5

human NPH (HUmulin, novolin)

Question 6

what are the long acting insulins

Answer 6

detemir (levemir)
glargine U100 (lantus)
glargine U300 (toujeo)
degludec

Question 7

low insulin in the morning resulting in hyperglycemia due to the nocturnal release of glucagon

Answer 7

dawn phenomenon
treated by taking more insulin at night

Question 8

treated by taking more insulin at night

Answer 8

dawn phenomenon

Question 9

what is a treatment practice used to help with portion control and insulin bolus doings? what are common starting guidelines?

Answer 9

carb counting
males - 60g per meal 30 g per snack
females - 45g per meal 15g per snack

Question 10

hyperglycemia in the morning as a result of excess exogenous insulin at night. often a result of hypoglycemia at night, which is regulated and then converted to rebound hyperglycemia in the morning

Answer 10

somogyi effect
treated by decreasing insulin at night

Question 11

treated by decreasing insulin at night

Answer 11

somogyi efect

Question 12

3AM check shows BG of 39

Answer 12

somogyi effect

Question 13

3AM check shows BG of 94

Answer 13

dawn effect

Question 14

decreased insulin at bedtime causes improvement in morning hyperglycemia

Answer 14

somogyi effect

Question 15

decreased insulin at bedtime results in worse or persisting hyperglycemia

Answer 15

dawn phenomenon

Question 16

what is the alternate dosing for the physiologic dosing regimen

Answer 16

can use carb counting:
1 U per 15g of carb PLUS
1 U for every 50mg/dL of BG at pre meal screening above a set goal

Question 17

what insulin is preferred for basal dosing, why?

Answer 17

long acting insulins preferred over NPH
because long acting:
* more predictable absorption
* closer to endogenous insulin release pattern
* QD dosing
* less hypoglycemia

Question 18

what even is this slide, just flip it

Answer 18

Question 19

fixes a leaky liver

Answer 19

metformin (biguinides)

• inhibits hepatic gluconeogenesis
• decreases intestinal absorption of glucose
• slightly improves insulin sensitivity

Question 20

BBW for lactic acidosis

Answer 20

metformin

Question 21

what are the locksmiths

Answer 21

TZD (thiazolinediones) - rosiglitazone and pioglitazone
* “unlock” muscle and fat cells to help utilize glucose.
* improves insulin sensitivity and increases peripheral tissue glucose uptake
* decreased gluconeogenesis
* increased adipogenesis

Question 22

what medications bind to PRAR-gamma

Answer 22

TZDs

Question 23

weight gain, edema, anemia, fracture risk

Answer 23

TZDs

Question 24

bladder cancer risk

Answer 24

pioglitazone

Question 25

BBW for CHF

Answer 25

TZDs

Question 26

BBW for MI

Answer 26

rosiglitazone

Question 27

worsens TC, LDL, increases HDL

Answer 27

rosiglitazone

Question 28

CI in CHF, caution with liver disease and osteoporosis risk

Answer 28

TZDs

Question 29

who are the electricians

Answer 29

sulfonylureas and meglitinides zap the pancreas to stimulate increased production of insulin (bind to a site on K+ channel which leads to release of insulin)