Exam 6: DM Flashcards
Type 1 vs Type 2
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
Diagnostic tests and ranges
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
order of mixing insulin
clear before cloudy
Somogye effect
“rebound hyperglycemia” from taking too much insulin before bed
recent contradicting evidence
wake up hyper bc hypo overnight -> tx w/ bedtime snack
Dawn phenomenon
happens naturally to everyone w/ diabetes because of natural diurnal hormone patterns
overall ADRs for insulin
Hypoglycemia
Lipodystrophy
Lispro
(Humalog)
Solution: clear
Admin: SQ
Concentration: U100
Onset: 10-30 min
Peak: 30m-2.5hrs
Duration: 3-6 hrs
*can mix w/NPH
Afrezza
Rapid acting (meal time insulin)
Admin: Inhaled
Concentration: 4, 8, 12 u cartridges
Onset: ?
Peak:
Duration:
Humulin R/Novolin R
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
Humulin N/Novolin N
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
Glargine/Detemir
(Lantus) (Levemir)
Long Duration Insulin
Solution: Clear
Admin: Qday SQ
Concentration: ?
Onset: 1-2 hrs
Peak: None
Duration: 24 hrs
Glargine/Degludec
(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
T2DM tx
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
Insulin storage
no direct sunlight
lasts longer if refridgerated
room temp = 1 month
fridge = 3 months
Insulin teaching points
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)
Metformin
(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
Glipizide
(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
Repaglinide
Meglitinides (Glinides)
(Prandin)
MOA: stimulates pancreatic release of insulin
*quick onset and short duration
ADR: hypoglycemia (eat w/in 30 min of taking meds)
Pioglitazone/Rosiglitazone
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
Acarbose
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)
Sitagliptin
DPP4 Inhibitors (Gliptins)
MOA: enhances action of incretin hormones (release insulin, inhibit glucagon, slow gastric empty, suppress appetite)
ADR: pancreatitis, hypersensitivity
-gliflozin
SGLT2 Inhibitors
MOA: block reabsorption of glucose -> increase urinary glucose to decrease serum glucose
Contra: renal disease
ADR: fungal infx, UTI, polyuria, hypotension
Exenatide
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
Pramlintide
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
Other meds for DM
ACEi/ARB - reduce risk of nephropathy, help w/albuminuria,
Statins - help w/cholesterol, reduce CV events
Hypoglycemia treatment
mild - fruit juice, candy, sugar gel
moderate/severe - IV D5 (parental glucagon also given, but longer onset)
glycogen
storage carbohydrate (stored glucose)
glycogenesis
the conversion of glucose into glycogen
glycogenolysis
the breakdown of glycogen into glucose
gluconeogenesis
the manufacture of glucose from non carbohydrate sources, mostly protein
hepatic glucose production
