Meds

Question 0

Insulins (cont)

Answer 0

Human-derived. Using recombinant DNA

Goal:tight glucose control and reduce incidence of long-term complications

Question 1

Insulins

Answer 1

Function as a substitute for the endogenous hormone. Effects are the same. Restores the diabetics pts ability to metabolize CHO’s, fats, and proteins. Store glucose in the liver. Convert glycogen to fat stores.

Question 2

Rapid-Acting

Answer 2

Most rapid onset of action (5-15 mins)
Shorter duration
Pt must eat a meal after inj.

Question 3

Rapid acting insulins

Answer 3

Lispro (humalog)-similar to endogenous insulin
Insulin aspart (novolog) 
Insulin glulisine (apidra)-newest
May be given subQ or via continuous subQ infusion pump (but not IV)

Question 4

Short acting

Answer 4

Regular
Humulin R
Onset 30-60 mins
Only insulin that can be given IV bolus, IV infusion, or even IM

Question 5

Intermediate acting

Answer 5

Isophane insulin suspension (NPH)
Cloudy appearance
Slower in onset and more prolonged in duration than endogenous insulin

Question 6

Long-acting

Answer 6

Lantus and levemir
Clear, colorless solution
Referred to as basal insulin

Question 7

Combo insulin products

Answer 7

NPH 70% and regular insulin 30% (humulin 70/30, novolin, 70/30, novolog 70/30)

NPH 50% and reg insulin 50% (humulin 50/50)

Question 8

Sliding scale or reg insulin doses adj. according to blood glucose test results.

Answer 8

Typically used in hospitalized diabetic pt or those on tpn or enteral tube feelings
Sc insulin is ordered in an amt that increases as the blood glucose goes up
Disadvantage- delays insulin admin. Until hyperglycemia occurs-results in lrg swings in glucose control

Question 9

Oral

Answer 9

Only for type 2
Treatment also includes lifestyle mods
Oral meds will not be effective without lifestyle changes

Question 10

Biguanides

Answer 10

Metformin-glucophage
tells liver to stop making glucose
lactic acidosis
don’t use 48 hrs prior or after contrast agent

Question 11

Sulfonylureas

Answer 11

Main side effect is hypoglycemia
First gen-chloropropamide (diabinese) and tolazamide (tolinase)
Second gen-glimepride (amaryl) glipizide (glucotrol) glyburide (diabeta, micronase)

Question 12

Glinides

Answer 12

Main side effect-hypoglycemia 
Repaglinide (prandin) nateglinide (starlix)
stim. pancreas to release insulin
weight gain
liver and renal impairment

Question 13

Thiazolidinediones

Answer 13

Pioglitazone (actos) aka glitazones
sensitize tissues to insulin

increase weight
hypoglycemia
anemia
edema

Question 14

Alpha-glucosidase inhibitors

Answer 14

Slows movement of food through GI tract
GI effects occur-flatus, indigestion, diarrhea, pain, cramping
Acarbose (precose) miglitol (glyset)

Question 15

Amylin mimetics

Answer 15

Slows postprandial glucose levels n/v-blocks enzyme and slows food down through intestine gives u the sense that you’re full
Pramlintide (Symlin)

Question 16

Incretin mimetics

Answer 16

Mimics incretin
Makes u feel full
Exenatide (byetta)
Sitagliptin (januvia)