Exam 6: DM

Question 1

Type 1 vs Type 2

Answer 1

Type 1 - beta cells of the pancreas (which produce insulin) are destroyed by antibodies

Type 2 - body cells become resistant to insulin and cannot bind and eventually impaired secretion as well from beta cell atrophy and death

Question 2

Diagnostic tests and ranges

Answer 2

Hemoglobin A1C > 6.5% (aim for DM to be <7%)
Fasting plasma glucose >126 mg/dL (premeal aim for 80-130 and post meal <180)
Oral glucose tolerance test >200 mg/dL

Question 3

order of mixing insulin

Answer 3

clear before cloudy

Question 4

Somogye effect

Answer 4

“rebound hyperglycemia” from taking too much insulin before bed

recent contradicting evidence

wake up hyper bc hypo overnight -> tx w/ bedtime snack

Question 5

Dawn phenomenon

Answer 5

happens naturally to everyone w/ diabetes because of natural diurnal hormone patterns

Question 6

overall ADRs for insulin

Answer 6

Hypoglycemia
Lipodystrophy

Question 7

Lispro

Answer 7

(Humalog)

Solution: clear
Admin: SQ
Concentration: U100

Onset: 10-30 min
Peak: 30m-2.5hrs
Duration: 3-6 hrs

*can mix w/NPH

Question 8

Afrezza

Answer 8

Rapid acting (meal time insulin)

Admin: Inhaled
Concentration: 4, 8, 12 u cartridges

Onset: ?
Peak:
Duration:

Question 9

Humulin R/Novolin R

Answer 9

Regular insulin (short duration: slower acting)

Solution: clear
Admin/Concentration: U100 = SQ, IM, IV; U500 = SQ, IM

Onset: 30-60 min
Peak: 1-5 hrs
Duration: 6-10 hrs

*can mix w/NPH

Question 10

Humulin N/Novolin N

Answer 10

iNtermediate acting insulin (NPH)

Solution: cloudy
Admin: SQ - must roll before admin (do not shake)
Concentration: ?

Onset: 1-2 hrs
Peak: 6-14 hrs
Duration: 16-24 hrs

• only one approved to mix with rapid and short acting

Question 11

Glargine/Detemir

Answer 11

(Lantus) (Levemir)
Long Duration Insulin

Solution: Clear
Admin: Qday SQ
Concentration: ?

Onset: 1-2 hrs
Peak: None
Duration: 24 hrs

Question 12

Glargine/Degludec

Answer 12

(Toujeo)/(Tresiba)
Ultra-long Duration Insulin

Solution: Clear
Admin: Prefilled pens SQ Qday
Concentration: Toujeo - U300; Tresiba - U100, U200

Onset: 6 hrs
Peak: None
Duration: >24 hrs

Question 13

T2DM tx

Answer 13

Step 1:
Lifestyle changes + Metformin

Step 2: A1C is >7.5
Continue lifestyle changes & Metformin
One additional drug

Step 3:
Progress to a 3-drug regimen

Step 4:
Include insulin in the regimen

Question 14

Insulin storage

Answer 14

no direct sunlight
lasts longer if refridgerated
room temp = 1 month
fridge = 3 months

Question 15

Insulin teaching points

Answer 15

roll, don’t shake NPH
don’t share pen device
controls ^BGL, doesn’t cure diabetes
glucose testing
s/s hypoglycemia
nutrition education
carry sugar and med ID
rotate sites and clean well
admin @ start of meal or right after (NOT before)

Question 16

Metformin

Answer 16

(Biguanides) PO [1st line]

MOA: suppresses gluconeogenesis & increases insulin sensitivity (slightly reduces GI glucose absorption)

ADRs:
- lactic acidosis - hyperventilation/myalgia/malaise
- GI upset (eat w/food)
- decrease appetite (weight loss - benefit)

Contraindications: renal disease (CBC), contrast CT (48 hours)

only med given in pregnancy

Question 17

Glipizide

Answer 17

(Sulfonylureas) Glyburide, Glimepiride

MOA: stimulates beta cells to release insulin (helps make more)

ADRs: hypoglycemia, weight gain, antabuse, teratogenic, Bblkers diminish effects

risk for hypoglycemia

Question 18

Repaglinide

Answer 18

Meglitinides (Glinides)
(Prandin)

MOA: stimulates pancreatic release of insulin
*quick onset and short duration

ADR: hypoglycemia (eat w/in 30 min of taking meds)

Question 19

Pioglitazone/Rosiglitazone

Answer 19

Thiazolidinediones (Glitazones)

MOA: decreased insulin resistance -> increase insulin sensitivity -> increased uptake into tissues and decreased release

ADRs: weight gain, **fluid retention -> exacerbate HF, bone fractures, hepatotoxicity

Question 20

Acarbose

Answer 20

Alpha-glucosidase inhibitors

MOA: delay absorption of carbs -> blocks enzyme in small intestine that breaks down complex carbs

ADRs: GI (from carbs in colon not broken down), decrease absorption of iron (anemia)

Question 21

Sitagliptin

Answer 21

DPP4 Inhibitors (Gliptins)

MOA: enhances action of incretin hormones (release insulin, inhibit glucagon, slow gastric empty, suppress appetite)

ADR: pancreatitis, hypersensitivity

Question 22

-gliflozin

Answer 22

SGLT2 Inhibitors

MOA: block reabsorption of glucose -> increase urinary glucose to decrease serum glucose
Contra: renal disease

ADR: fungal infx, UTI, polyuria, hypotension

Question 23

Exenatide

Answer 23

Incretin Mimetics (SQ) (T2DM only)
combo w/metformin or sulfonylurea

MOA: mimics incretin (release insulin, inhibit glucagon, slow gastric empty, suppress appetite) -> glucose control and weight loss

ADR: hypoglycemia w/sulfonylurea, GI, pancreatitis, slows gastric motility

Question 24

Pramlintide

Answer 24

Amylin Mimetics (T1DM & T2DM)

MOA: supplements mealtime insulin -> delays gastric empyting and suppress glucagon release

ADRs: hypoglycemia (insulin may need to be reduced), GI

seperate sites from insulin, immediately before meals, wait an hour before any PO meds

Question 25

Other meds for DM

Answer 25

ACEi/ARB - reduce risk of nephropathy, help w/albuminuria,
Statins - help w/cholesterol, reduce CV events

Question 26

Hypoglycemia treatment

Answer 26

mild - fruit juice, candy, sugar gel

moderate/severe - IV D5 (parental glucagon also given, but longer onset)

Question 27

glycogen

Answer 27

storage carbohydrate (stored glucose)

Question 28

glycogenesis

Answer 28

the conversion of glucose into glycogen

Question 29

glycogenolysis

Answer 29

the breakdown of glycogen into glucose

Question 30

gluconeogenesis

Answer 30

the manufacture of glucose from non carbohydrate sources, mostly protein

hepatic glucose production