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Sophomore - Pharm test 3 > DM1 - Intro and Types of Insulin > Flashcards

DM1 - Intro and Types of Insulin Flashcards

1
Q

Which type of diabetes is caused by Beta cell destruction in the pancreas?

A

Type 1 Diabetes Mellitus (T1DM)

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2
Q

Which type of diabetes results from progressive insulin secretory defect and systemic insulin resistance?

A

Type 2 Diabetes Mellitus (T2DM)

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3
Q

What are the three P’s T2DM?

A

Polyuria
Polydipsia
Polyphagia

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4
Q

What is HbA1c? What is it useful for evaluating?

A

A form of hemoglobin that has glucose attached to it

Useful evaluating long-term glucose control

Snapshot of the last few months

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5
Q

Fasting plasma glucose above ______ mg/dL suggests diabetes

A

126mg/dL

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6
Q

Oral glucose tolerance test above ______ mg/dL suggests diabetes:

A

200mg/dL

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7
Q

Hemoglobin A1c above ______% suggests diabetes

A

6.5 %

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8
Q

How often should a T1DM patient monitor their SBG levels

A

At least TID

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9
Q

How often should A1C be evaluated for patients meeting their goals?

A

Twice a year

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10
Q

How often should A1C be evaluated in patients not meeting their goals?

A

4 times a year

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11
Q

What test to order when glucose is consistently high?

A

Urine ketones

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12
Q

Examples of macrovascular complications from diabetes:

A
  1. MI
  2. CVA
  3. PAD
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13
Q

Examples of microvascular complications from diabetes:

A
  1. Retinopathy
  2. Neuropathy
  3. Nephropathy
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14
Q

Examples of acute complications from diabetes:

A
  1. Hypoglycemia
  2. DKA
  3. HHS
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15
Q

What is the preferred medication for gestational diabetes mellitus?

A

Insulin

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16
Q

Name two medication for GDM as an alternatives to insulin:

A
  1. Glyburide

2. Metformin

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17
Q

How does alcohol ingestion affect blood sugar?

A

Reduction in endogenous glucose production

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18
Q

Mild hypoglycemia - range and tx?

A

60 to 70 mg/dL on fingerstick

15g oral glucose

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19
Q

Moderate hypoglycemia - range and tx?

A

41 to 59 mg/dL

30g oral glucose

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20
Q

Severe hypoglycemia - range and tx?

A

< 40 mg/dL

Glucagon 1mg SubQ/IM

OR

1 amp D50 (25g dextrose)

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21
Q

How many grams of sugar are in 1 tbsp (granulated sugar) (appx)?

A

12.5 grams

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22
Q

Primary cause of DKA?

A

Body’s inability to produce insulin

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23
Q

DKA most commonly seen in T1DM or T2DM?

A

T1DM

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24
Q

Cause of hyperosmolar hyperglycemic state? (HHS)

A

Increased glucose in urine impairs concentrating ability of kidney

More water loss than sodium, leading to hyperosmotic state

25
Q

Hallmark characteristics of DKA?

A

Acidosis
Ketonuria
Rapid onset

26
Q

Hallmark characteristics of HHS?

A

Significant hyperglycemia (in excess of 600mg/dL)

Typically normal acid-levels

Insidious onset

27
Q

Emergent hyperglycemic management - four major interventions:

A
  1. IV fluids
  2. IV bicarb (DKA)
  3. IV insulin
  4. IV K+
28
Q

Why do we need to monitor / sometimes push K+ in treating hyperglycemia?

A

Insulin can drop K+ levels, precipitating tachyarryhthmias

29
Q

Two mechanisms by which visceral adipose tissue (VAT) contributes to decreased insulin sensitivity?

A
  1. Increased lipolysis, increased free FA’s, increased VLDL, which decreased insulin sensitivity
  2. VAT’s produce cytokines, which contribute to insulin resistance
30
Q

Metabolic syndrome, which increases risk for developing T2DM - five criteria? (Need 3/5)

A
  1. Obesity
  2. Low HDL
  3. High TG’s
  4. HTN
  5. High fasting glucose
31
Q

Standard target A1C goal for adult with diabetes?

A

Below 7.0%

32
Q

What is insulin’s job?

A

Facilitate glucose entry into cells

33
Q

How is insulin cleared?

A
  1. Renal (60%)

2. Hepatic (40%)

34
Q

Two big categories for insulin?

A

Bolus

Basal

35
Q

Main purpose of bolus insulin?

A

Provide a boost in insulin for meals (controls post-prandial hyperglycemia)

36
Q

Main purpose of basal insulin?

A

Control fasting hyperglycemia

37
Q

Name three rapid-acting insulins:

A
  1. Glulisine
  2. Aspart
  3. Lispro
38
Q

Which type of insulins are “-log” medicines?

A

Either rapid acting or mixtures

39
Q

Which type of insulins are “-lin” medicines?

A

Short-acting or intermediate acting

40
Q

What does “clear before cloudy” refer to?

A

When mixing rapid acting and intermediate acting insulins, you must first draw up the clear medicine (rapid acting), THEN draw up the intermediate acting medicine (the NPH)

41
Q

What is Afrezza?

A

Inhaled insulin - taken at beginning of meal - for T1DM must be used with a long-acting insulin as well

42
Q

Regular insulin (short acting insulin) - names?

A

Humilin R and Novolin R

43
Q

Humilin R and Novolin R - given when?

A

30 minutes before meals

44
Q

What is the drug of choice for IV-infusion insulin?

A

Humilin R or Novolin R (short-acting, regular insulin)

45
Q

U-500 insulin - concentration?

A

500 units per mL

46
Q

Who gets prescribed U-500?

A

Patients with severe insulin resistance (requiring more than 200 units per day)

47
Q

Humilin N and Novolin N - what type of insulin?

A

Intermediate-acting (NPH)

48
Q

Glargine and Detemir - what kind of insulin?

A

Long-acting

49
Q

Which long-acting insulin is bound to albumin?

A

Detemir (Levemir)

50
Q

Which type of insulin can you NORT mix with other insulins or dilute?

A

Long-acting insulins (Glargine and Detemir)

51
Q

What do all the insulin combinations have in common?

A

They all contain protamine

52
Q

What does Novolog Mix 70/30 contain?

A

70% aspart protamine

30% aspart

53
Q

What does Humalog Mix 75/25 contain?

A

75% lispro protamine

25% lispro

54
Q

What does Humalog Mix 50/50 contain?

A

50% lispro protamine

50% lispro

55
Q

What does Humulin 70/30 contain?

A

70% NPH

30% Regular

56
Q

What does Novolin 70/30 contain?

A

70% NPH

30% regular

57
Q

Advantage of rapid-acting insulin over regular insulin?

A

Rapid-acting has less risk of post-prandial hypoglycemia bc it has a sharper peak and shorter duration of action

58
Q

What would happen if you took your rapid-acting insulin at the start of the meal? What would happen if you took regular insulin at the start of a meal?

A

Nothing - it’s meant to be taken right before or at the start of a meal

You would run the risk of hypoglycemia

59
Q

What is an advantageous feature of insulin analogues when compared to NPH’s?

A

Less risk of nocturnal hypoglycemia

Sophomore - Pharm test 3 (7 decks)

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