DM treatment

Question 1

• Pancreas normally secretes? Basal and? Phase 1? Phase 2?
• Steps of insulin release? (5)
• Animal was created then? Then?
• Who needs insulin?
• Breakdown of insulin? Purpose of basal? (2)
• When is insulin used in T2DM? (2)
• Insulin started in T2DM with what? (2)

Answer 1

• 30 units/d; glucose mediated; initial release; sustained hyperglycemia
• Glut 2 –> High ATP –> Close K+ depol –> Open voltage Ca2+ –> Insulin vessicles release
• Recombinant –> Analogs
• 50-50%; supress hepatic glu; maintain fasting
• Contrainidacted to other drugs (CHF/Renal/Hepatic); weightloss and non-inuslin don’t work
  1. ) Fasting >250; Aic>10; 2.) Hyper or DKA event

Question 2

Rapid Acting Insulin:

• Given how?
• Modified what?
• Onset?
• Peak?
• Duration?
• Drug names? (3)

Answer 2

• SQ
• Human insulin
• 5-15 min
• 1 hr
• 3-5 hrs
• Humalog, novolog, glulisine

Question 3

Short Acting Insulin:

• Given how? (2)
• Onset?
• Peak?
• Duration?
• Drug names? (2)

Answer 3

• SQ or IV
• 30-60 min
• 2 hrs
• 6-8 hours
• Humalin/Novolin R!!

Question 4

Intermediate Acting Insulin:

• Given how?
• Appearance?
• Onset?
• Peak?
• Duration?
• Drug names? (2)
• 2x/d for what?

Answer 4

• SQ or IV
• Cloudy
• 2-4 hrs
• 6-7 hrs
• 10-20 hours
• Humalin/Novolin NRH!!

Question 5

Long Acting Insulin:

• Given how?
• Mixed?
• Onset?
• Peak?
• Duration?
• Drug names? (2)

Answer 5

• SQ
• Never!
• 1-3 hrs
• Never
• 17 (D) or 24 (G) hours
• Glargine, detemir

Question 6

Sulfonylureas:

• MOA?
• Name? (3)
• 2 SE’s?

Answer 6

• Close ATP sensitive K+ channels to increase insulin release
• Glyb,glip, glim ide
• Wt gain, hypo risk

Question 7

Metformin/Biguinide:

• MOA?
• Does not? (2)
• SE? (2)

Answer 7

• Potentiates suppressive effect of insulin on hepatic glucose production
• Stim insulin release or insulin levels
• Lactic acidosis with CHF, PI, liver insuff.; GI issues

Question 8

TZD’s:

• MOA?
• Also decrease?
• SE?

Answer 8

• Increase insulin sensitivity by stim adiponectin
• Decrease lipolysis
• Heart Dz

Question 9

• Target FBG? 2 hr? A1c?
• T2DM: Lower BG, Lower wt, No lows? (5 drugs?)
• T2DM: Lower BG, Incr. wt, Lows? (3 drugs?)
• Incretins: 2? GLP1 useful by self? From where? Stim when? Augments what? When? 3 effects?

Answer 9

• 70-130; s
• GLP-1, GIP; No, need DPP4 block; L cells in gut; Digestion; Insulin; BG is high; Stim insulin release, supresses glucagon, inhibits food intake

Question 10

GLP-1 Agonists:

• MOA?
• Weight?
• Taken how?

Answer 10

• Glucose dependent effects
• Weight loss
• SC injections

Question 11

DPP4 Inihibitors:

• Taken how?
• Weight?

Answer 11

• Oral

- Neutral

Question 12

Amylin:

• MOA? (3)
• Is also normally secreted by?
• Acts on?
• Weight?
• Taken how?

Answer 12

• Supress post prandial glucagon, slow gastric emptying, decrease food intake
• B cells
• a cells
• Weight loss
• 7x SC injections

Question 13

SGLT-2 Inhibitors:

• MOA?
• Weight?
• SE? (2)

Answer 13

• Increase kidney glucose excretion
• Weight loss
• UTI/ Low K+