DM part 2

Question 1

what do all people with type 1 diabetes need

Answer 1

insulin to survive

Question 2

which country is highest for type 1 diabetes

Answer 2

finland

Question 3

what are the types of insulin

Answer 3

humalog (lispro), novalog (aspart)
regular insulin
NPH, Humulin N
lantus (glargine), levemir (detemir)

Question 4

what are rapid acting insulin

Answer 4

lispro (humalog)

aspart (novalog)

Question 5

what is the onset, peak and duration of rapid acting insulin

Answer 5

onset: 10-30 min
peak: 30 min to 3 hr
duration: 3-5 hours

Question 6

what are short acting insulin

Answer 6

regular (humulin R or novolin R)

Question 7

what is the onset, peak and duration of short acting insulin

Answer 7

onset: 30 min-1hr
peak: 2-5 hr
duration 5-8 hr

Question 8

what are intermediating acting insulin

Answer 8

NPH (Humulin N or novolin N)

Question 9

what is the onset, peakk and duration of intermediate acting insulin

Answer 9

onset 1.5-4 hr
peak 4-12 hr
duration 12-18 hour

Question 10

what are long acting insulin

Answer 10

glargine (lantus)
Detemir (levemir)
degludec (tresiba)

Question 11

what is the onset,peak and duration for long acting linsulin

Answer 11

onset 0.8 -4 hours
peak no pronounced peak
duration 18-24 hours

Question 12

what is inhaled insulin

Answer 12

really fast
ex: afrezza
can't use if you have pulmonary problems 
onset 12-15 min
peak 60 min
duration 2.5-3 hr

Question 13

can long acting be mixed

Answer 13

no, pH will inactive each other

you can take at the same time just in different syringes

Question 14

how is insulin stored

Answer 14

can be kept room temp for a month once open
can mix leave in fridge for 1 week
if unopened leave in fridge

Question 15

which insulin is the longest

Answer 15

degludec last up to 42 hours

can’t be mixed

Question 16

what are premixed insulins

Answer 16

NPH/regular 70/30 MOST COMMON
aspart 0/30
lispro 50/50
lispro 75/25

Question 17

how do type 1 base insulin dosage on

Answer 17

how many carbs
what BG is
how much physical activity

Question 18

what are the new insulins

Answer 18

degludec (tresibu) 200 units/mL (the longest acting, long insulin that can be mixed with others, comes in a pen and twice as concentrated)

glargine (toujeo) 300 units/ ml

insulin R 500 untils/mL (type 2 b/c insulin resistance)

inhaled insulin- afrezza, technosphere

lispro U -200

Question 19

what are insulin therapy for type 1

Answer 19

rapid before meals

long acting either morning or night for background

Question 20

what are insulin therapy for type 2

Answer 20

basal at first, long acting

might need rapd

Question 21

what is the most common mistake with insulin

Answer 21

not giving the right type

Question 22

what do you do first with the pen

Answer 22

go to 2 to prime to get the air out

Question 23

what are problems with insulin therapy

Answer 23

hypoglycemia - limiting facor for type 1
allergic reaction
lipodystrophy- using same spot, skin gets thicker, absorption slower, so move spots
smoggy effect- wake up with high BG from too much insulin

Question 24

which insulin is used for PRN

Answer 24

rapid because we want BG down

Question 25

what are oral agents

Answer 25

sulfonylureas (glipizide, glimepriide)
meglitinides (repaglinide)
a-glucosidase inhibitors (acarbose)
biguanides (metformin)
thiazolidinediones (pioglitazone)
dipeptidyl peptidase 4 inhibitor (sitagliptin)
sodium glucose co transporter 2 (canaglifozin)

Question 26

what is sulfonylureas (glipizide, glimepiride)

Answer 26

this is the older oral agent
lowers A1C about 1% 
effective medication only for 8-9 years cannot fix by increasing dosage 
causes pacers to secrete insulin
can cause hypoglycemia an gain weight

Question 27

what is meglitinides (repaglinide)

Answer 27

shorter acting, must be giver 30 mins before food, causes pancreas to secrete insulin, causes hypoglycemia
on liver

Question 28

what is a-glucosidase inhibitors (acarbose)

Answer 28

on gut

slow down carbohydrate metabolism in gut

Question 29

what is thiazolidinediones (pioglitazone)

Answer 29

work on insulin resistance cause people to hold onto fluid

Question 30

what is biuanides (metformin)

Answer 30

approved for pre diabetes works on liver, slows down breakdown of glycogen does not causes hypoglycemia don’t gain or lose weight
if on for a long time can be vitamin b deficient

Question 31

what is dipeptide peptidase 4 inhibitor (sitagliptin)

Answer 31

slows down gastric
extend normal incretins that are there
dont cause hypoglycemia

Question 32

what is sodium glucose co transporter 2 (canaglifozin)

Answer 32

flow out of kidneys
work on kidney so we don’t hold on to glucose
UTI yeast infection decrease in weigh loss decrease in BP

Question 33

what is uncertain based therapies

Answer 33

liraglutide (GLP 1 agonist) subcut
promotes weight loss
lowers BP
works on gut
extended life with people with cardiovascular disease
highly recommend for type 2, CV disease, high A1C on metaformin

nausea and vomitting

Question 34

drugs associated with hyperglycemia

Answer 34

loop diuretics, thiazide diuretics (larger doses)

presdnisone (corticosteroids)

Question 35

drugs associated with hypoglycemia

Answer 35

alcohol

beta blockers can prolong hypoglycemia and mask symptoms

Question 36

what are causes of hypoglycemia (BS is less than 70 mg/dl

Answer 36

insulin excess
oral hypglycemic meds
inadequate nutrients
physical activity
alcohol intake in fasting state

Question 37

what are adrenergic s/s of hypoglycemia

Answer 37

cold sweats
weakness
trembling
irritabilty
tachycardia
pallor

Question 38

what are neuroglycopenic s/s of hypoglycemia

Answer 38

heache
mental dullness
irrational behavior
slurred pseech
loss of consciousness
seizure
coma
death

Question 39

what are interventions when conscious with hypoglycemia

Answer 39

blood glucose
15 g of carbohydrate
wait 15 min to recheck BS
repeat carb if low
include protein if meal is not soon

Question 40

what are interventions when unconscious with hypoglycemia

Answer 40

check blood sugar
SC or IM glucagon (1 mg)
IV glucose (25-50 ml of 50%)
recheck BS in 15 min
treat as conscious