Lecture: Diabetes

Question 1

Insulin is available in ___ units.

Answer 1

U-100,

Regular insulin is also available U-500.

Question 2

Rapid acting insulin

Answer 2

Insulin lispro, aspart, glulisine

Onset: 10-15 min
Peak: 1-3 hours
Duration: 3-5 hours

Route: SQ, pump

Question 3

Short acting insulin

Answer 3

Regular insulin

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

Route: SQ, pump, IM, oral inhalation, IV
regular insulin is the only insulin that can be given IV

Question 4

Intermediate acting insulins

Answer 4

NPH, detemir

Onset: 1-2 hours
Peak: 6-14 hours (12-24 detemir)
Duration: 16-24 hours

Route SQ
NPH is the only cloudy insulin
NPH is the only insulin that can be mixed with shorter acting insulins -> mix Newly registered registered nurse

Question 5

Long acting insulin

Answer 5

Insulin glargine

Onset: 1 hour
Peak: none
Duration: 18-24 hours

Question 6

Unopened insulin should be stored in the ___

Answer 6

refrigerator (DO NOT FREEZE!)

once opened it can be kept until expiration date, or for 1 month at room temperature

Question 7

Insulin mixtures can be kept ___

Answer 7

1 month at room temperature,
3 months in refrigerator

1-2 weeks in refrigerator if in prefilled syringe.
Store these vertically with needle up.

Question 8

Complications of insulin treatment are:

Answer 8

#1 - hypoglycemia,
lipohypertrophy (SQ fat deposits),
and hypokalemia (insulin promotes K+ uptake into cells).

For hypoglycemia, treat with a fast-acting oral sugar (glucose tabs, OJ), IV glucose, or parental glucagon. (Table sugar is TOO SLOW)

Question 9

glucose target levels

Answer 9

HbA1c <7%
Premeal 80-130
Postmeal <180

Question 10

oral hypoglycemics include:

Answer 10

1. Biguanides (metformin)
2. Sulfonylureas (gli-, gly-)
3. meglinitiedes (-glinides)
4. thiazolidinediones (-glitizones)
5. alpha-glucosidase inhibitors (acarbose, miglitol)
6. incretin enhancers/DPP-4 (-liptin, -gliptin)
7. SGLT-2 inhibitors (-flozins)

Question 11

metformin (a biguanide) works by:

Answer 11

(1) Decreases glucose production in liver
(2) Decreases (a little) glucose absorption in gut
(3) Increases tissue response to insulin
(4) DOES NOT stimulate insulin release - So no worries of hypoglycemia

Stop metformin 24 hours before a procedure

Question 12

Sulfonylureas (glipizide, glyburide, glimepiride) work by:

Answer 12

(1) Promote insulin secretion by the pancreas
(2) May increase tissue response to insulin

AEs:
HYPOGLYCEMIA, weight gain, and interaction with alcohol

If taking too high a dose, or not eating enough then patient will have hypoglycemia…
So TAKE WITH A MEAL
Always have a snack on hand

Question 13

Meglitinides (-glinides) work by:

Answer 13

they promote insulin secretion by the pancreas.
So take with a meal (0-30 min before)

repaglinide, nateglinide

Question 14

alpha-glucosidae inhibitors (acarbose and miglitol) work by:

Answer 14

decreasing carb digestion and absorption

So take with first bite of meal, and understand that the side effects have to do with this block of absorption: flatulence, cramps, abd distention, borborygmus, diarrhea, etc

Question 15

DPP-4 inhibitors 9 (-gliptins) are used as:

Answer 15

add-ons to metformin

sitagliptin, saxagliptin, lingaliptin, alogliptin

Question 16

SGLT-2 inhibitors (-flozins) work by:

Answer 16

increase glucose excretion (block reabsorption) in urine → decreasing glucose levels & inducing wt loss via urine calorie loss
Thus these patients are more susceptible to UTIs

flozins -> “flows in urine”