Injectable DM Meds

Question 1

Rapid Acting Insulin

Answer 1

Types: Aspart, Glulisinie, Lispro, Human (inhaler)

Onset 10-20min
Peak: 30-90 min, 12-15min for human
Duration: 3-5hrs

Administer immediately before meals

Rapidly corrects hyperglycemia
Minimizes PPBG

Question 2

Short-Acting Insulin

Answer 2

Types: Regular

Onset 30-60min
Peak: 2-4 hrs
Duration 5-8hrs

Admin 20-40 min prior to meals

Potential for late PP hypoglycemia
Caution with PP exerciise

Question 3

Intermediate-Acting Insulin

Answer 3

Types: NPH

Onset 1-3hrs
Peak 8hrs
Duration 12-16 hrs

EXTREMELY VARIABLE ABSORPTION**

BID Dose

Risk of hypoglycemia at peak

Question 4

Long-Acting Insulin

Answer 4

Types: Detemir, glargine

Onset 1 hr
flat peak
duration 20-26 hrs (dose dependent)

mimics basal insulin
predictable effects
less risk of nocturnal hypoglycemia

Question 5

Ultra-Long-Acting Insulin

Answer 5

Types: Glargine, degludec

Glargine
onset 6 hrs
no peak
duration 36hrs
1x/day dosing

Degludec
onset 90min
no peak
duration > 42 hrs
1x-BID dosing

Question 6

50% Lispro protamine/ 50% insulin lispro

Answer 6

onset 10-15min
Peak 1-2 hrs
Duration 10-16hrs

Question 7

75% Lispro protamine/ 25% insulin lispro

Answer 7

onset 10-15min
Peak 1-2 hrs
Duration 10-16hrs

Question 8

70% aspart protamine/ 30% insulin aspart

Answer 8

onset 5-15min
Peak 1-2 hrs
Duration 10-16hrs

Question 9

70% NPH/ 30% regular

Answer 9

onset 30-60min
Peak 2-10 hrs
Duration 10-16hrs

Question 10

Concentrated Insulin

Answer 10

Type: Regular

Onset 15min
Peak 4-8hrs (dose dependent)
duration 13-24 hrs

Indicated for pt requiring > 200 units/day
2-3x/day dosing 30 min prior to meal

Question 11

GLP-1 Agonist

Answer 11

Exenatide
Exenatide XR
Liraglutide
Dulaglutide
Lixisenatide
Semaglutide

Question 12

Amylin Analog

Answer 12

Pramlintide

Question 13

Exenatide

Answer 13

Short Acting
5mcg BID 1 hr prior to AM/PM meals

Titrate to 10mcg PRN

Not recommended if eGFR < 30

Question 14

Exenatide XR

Answer 14

Long Acting
2mg weekly any time of day with/without meals

Must admin right after dose is prepped

Not recommended if eGFR < 30

Question 15

Liraglutide

Answer 15

Long Acting
0.6mg QD 1 week –> 1.2 mg QD

Titrate to 1.8mg PRN

Use caution with renal dysfunction; no dose adjustment

restart at 0.6mg if missed > 3 doses

Question 16

Dulaglutide

Answer 16

Long Acting
0.75mg Qweekly

Titrate to 1.5mg PRN

Use caution with renal dysfunction; no dose adjustment

Missed dose can be admin within 72 hr of missed dose

Question 17

Lixisenatide

Answer 17

Short acting
10mcg QD x 14 days –> 20 mcg QD starting on day 15

eGFR<15 AVOID
eGFR 15-59 MONITOR

Missed dose admin 1 hr prior to next meal

Question 18

Semaglutide

Answer 18

Long Acting
0.25mg Qweekly

Titrate to 0.5mg weekly after 4 weeks

admin any time with/without meals

Increase to 1 mg after another 4 weeks PRN

no renal dose adjustment

If dose missed <5 days –> admin ASAP

If dose missed > 5 days –> skip missed dose and admin next on regular scheduled day

Question 19

Pramlintide

Answer 19

T1DM
Reduce mealtime insulin 50%
Start: 60mcg SQ prior to each meal
Increase to 120 mcg when no clinically significant nausea has occurred for at least 3 days

T2DM
Reduce mealtime insulin dose 50% Start: 15mcg prior to each meal
Increase in increments of 15 mcg up to 60 mcg if tolerated