Insulin

Question 1

Insulin

Answer 1

IND: DMT1/2 and gestational
MOA: Mimics endogenous insulin
BOX: N/A
CON: Active hypoglycemia
ADR: Hypoglycemia, Injection site burning
Kinetics: onset and duration of action vary between agents.
Some have peak effect and treat prandial sugars.
Some lack a pronounced peak and treat basal sugars

Question 2

Insulin Glargine

Answer 2

Long-acting
ADRs: HTN, peripheral edema
Onset 3-6hrs
Duration >24hrs
NO peak

Question 3

Insulin Detemir

Answer 3

Long-acting
ADR: Ab pain, HA
Onset: 3-4hrs
Duration is dose dependent. Low: 5-12. Moderate: 20. High: 23
Mild peak effect, kind of at 3-9 hours
Dose 1-2/day depending on dose

Question 4

Insulin Degludec

Answer 4

Long-acting
ADR: Antibody development
Onset 1 hr.
Duration: 42hrs
Mild peak effect at 9 hours kind of

Question 5

Insulin NPH

Answer 5

Intermediate-acting
ADR: Peripheral edema. Inj site rxns
Onset 1-2 hours
Duration: 14-24 hours
Peak 4-12
Dose 2x/day. Pretty cheap

Question 6

Insulin Regular

Answer 6

Fast acting
ADR: peripheral edema, inj site rxns
Onset: IV 10-20 mins. Subq: 30 min. U-500 15 mins
Duration: IV endogenous levels return to normal 1.5 hrs after stopping infusion. Subq: 8 hours. U-500: 4-8 hours.
Peak: IV 5 hours. Subq: 1.5-3.5hrs. U500: 4-8 hours

Question 7

Insulin Lispro

Answer 7

Rapid acting
ADR: peripheral edema. Antibody development. inj site pain
Onset: 30min
Duration: 6 hrs
Peak: 2.5 hours

20-30 min before a meal

Question 8

Insulin Aspart

Answer 8

Rapid acting
ADR: antibody development
Onset: Fiasp ("much quicker" "thank you waiter" safe during meal even): 10-15 min. Novolog: 15-25min, harder to gauge at restaurants
Duration: 3-7 hours
peak: 1-3 hours

Question 9

Insulin Glulisine

Answer 9

Rapid acting
Onset: 12-30 min
Duration: 3-4 hours
Peak: 1.5-2.5 hours

Question 10

Insulin (Afrezza)

Answer 10

IND: DMT1/2. RAPID acting
MOA: Mimics endogenous insulin
BOX: Acute bronchospasm in pts with restrictive airway dz, including asthma, COPD. Perform a detailed MHx, physical, and spirometry to ID lung dz.
CON: Chronic lung dz such as COPD and asthma
ADR: Acute bronchospasm and cough
Onset: 12 min. Duration: 1.5-4.5hrs. Peak: 30-60 min

Question 11

HTN Management

Answer 11

Target of 130/80 if safely attainable in ASCVD or 10 yearr ASCVD risk of >15%
Lower risk CVD can have a target of 140/90
Usually use an ACE for renal protection -ils
ARBS also good -sartan

Question 12

Lipid Management of DM

Answer 12

20-39y/o with ASCVD risk: Start Statin
40-79 w/o ASCVD risk: Use moderate intensity Statin
40-75 with high risk or current ASCVD: Use High intensity statins. Latorvastatin and______

Question 13

Anti-PLT

Answer 13

Aspirin 81mg qd to prevent CVA/CVD especially in pts with ASCVD
Aspirin allergy: Clopidogrel

Question 14

Immunizations

Answer 14

Annual influenza
Pneumococcal
Hep B
COVID?