Endocrine (Diabetes) Drugs

Question 1

Type 1 Diabetes

Answer 1

No production of insulin, abrupt symptoms, no family history, not resistant to insulin
Treatment: insulin

Question 2

Type 2 Diabetes

Answer 2

Insulin not effectively used, insulin resistance, obese, positive family history
Treatment: weight reduction, exercise, diet, insulin

Question 3

Normal Blood Glucose

Answer 3

70-100 mg/dL

Question 4

Lispro, Aspart, Glulisine

Answer 4

Rapid, clear

Onset:

Question 5

Regular, Humulin R, Novolin R

Answer 5

Short, clear
Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 5-8 hours

Question 6

NPH (Humulin N, Novolin N)

Answer 6

Intermediate, cloudy
Onset: 1-3 hours
Peak: 4-12 hours
Duration: 12-16 hours
Implication: 2x a day, rolled gently before admin., 70% NPH, 30% regular

Question 7

Glargine (Lantus), Detemir (Levemir)

Answer 7

Long acting, clear
Onset: 1-2 hours
Peak: No peak
Implication: 20-24 hours
Implication: small amount over time, once daily sc at bedtime, do not mi with other insulin/IV

Question 8

Afrezza

Answer 8

Rapid inhalation powder
- Give at meal time for Type I/II
Side effects: cough, throat irritation, hypoglycemia
Contraindicated: lower BG (beta blocking agents), increase BG (thiazide diuretics, sympathomimetics)
Implication: Monitor lipohypertrophy, 1. abdominal, 2. arm
ACUTE BRONCHOSPASM IN ASTHMA/COPD PT

Question 9

Pen Injector Instructions

Answer 9

1. Prep injection
2. Prime pen (if used 1st time, prime with 10 U, if repeated, prime with 2 U)
3. Drop of med on tip
4. Verify cartridge free of air
5. Pen with palm of one hand, SQ technique, press all the way, count to 10

Question 10

Hypogylcemia (BG

Answer 10

-low blood glucose, too much inulin given, excessive exercise, drinking excess alcohol
Symptoms: shakiness, headache, cold sweats, pale skin, difficulty concentrating, blurred vision, nausea, increased appetite
Treatment: 15:15 Rule (take 15 g of CHO, taken another 15 g in 15 mins if no improvement)

Question 11

Hyperglycemia

Answer 11

-high blood glucose, not enough insulin, too much CHO, little exercise, fever, stress
Symptoms: polyuria, polydipsia, polyuria, dry/red skin and mouth, rapid breathing, rapid weight loss

Question 12

Type II: Sulfonylureas (glyburide, glipizide, glimepiride)

Answer 12

Side effects: hypoglycemia, cardiac ischemia, weight gain

Implication: early in treatment, 20% don’t respond

Question 13

Type II: Meglitinides (repaglinide, nateglinide)

Answer 13

Side effects: hypoglycemia, weight gain

Implication: LFTs, must be taken before each meal, 3x a day

Question 14

Type II: Biguanides (metformin)

Answer 14

-Drug of choice of type 2 DM
Side effects: anorexia, weight loss, diarrhea, lower absorption B12 and folic acid
Implication: 2x a day with morning and evening meal
Contraindication: MI, acute CHF, alcohol, kidney
*ONLY APPROVED DRUG FOR KIDS 10

Question 15

Type II: Thiazolidinediones (pioglitazone)

Answer 15

Side effects: low triglycerides, hepatotoxicity, high risk of bone fractures
Implication: second or third agent with metformin, 6-14 weeks to achieve effects, cause edema, 1-2x daily with or without food

Question 16

Type II: Alpha-glucosidase inhibitors (acarbose, migitol)

Answer 16

Side effects: flatulence, cramp, borborygmus, diarrhea

Implication: treat low BG with glucose tablets or milk, take before each meal

Question 17

Type II: Incretin mimetics (exenatide, liraglutide, dulaglutatide)

Answer 17

• SC injection
• exenatide: SC BID
• liraglutide: SC daily
• dulaglutatide: SC once a week
• 60 minutes before morning and evening meal

Question 18

Type II: Amylin analog (pramlintide)

Answer 18

-SC injection, do not mix with insulin, convert mcg to units, make you feel full

Question 19

Glucagon

Answer 19

-For insulin OD with extreme hypoglycemia
Onset: 20 minutes
Risk for aspiration, turn patient on side