module 16 DM overview

Question 1

insulin

Answer 1

glucose uptake into cells

produced in the B-cells of the pancreas

Question 2

glucagon

Answer 2

hormone produced in a cells of pancreas, promotes breakdown of glycogen to glucose in liver.

Question 3

inulin

Answer 3

regulates appetite, gastric emptying

Question 4

Type 1

Answer 4

autoimmune destruction of B cells of the pancreas

- absolute insulin deficiency

Question 5

Type 2

Answer 5

progressive loss of B cell insulin secretion

- variable degrees of insulin resistance, impaired insulin secretion, and inc. hepatic glucose production

Question 6

drugs for DM: insulins

Answer 6

Rapid, short acting
- lispro, regular 
Intermediate-acting
- NPH, lente
Slow, long-acting
- glargine

Question 7

drugs for DM: non-insulin

Answer 7

insulin secretagogues
- glipizide
biguanides
- metformin
alpha-glucosidase inhibitors
- acarbose
thiazolidinediones
- pioglitazone
amylin analogs
- pramlintide
incretin modulators
- GLP1 analong: exenatide
- DPP4 inhibitor: sitagliptin
SGLT2 inhibitors
- canagliflozin

Question 8

insulin release stimuli

Answer 8

glucose
other sugars
hormones: GLP-1, glucagon
SNS: activation of B2 Rc

Question 9

effects of insulin/MOA

Answer 9

stimulates entry of glucose into cells
inhibits gluconeogenesis
inc. fat storage and prevents fat use for energy
stimulates amino acid uptake and protein synthesis

Question 10

Insulin use

Answer 10

T1DM

T2DM

Question 11

formulations of insulin

Answer 11

natural: regular

insulin analogues: modified

Question 12

rapid acting insulin meds

Answer 12

lispro
aspart
glulisine
humalog
novolog
apidra

Question 13

rapid acting insulin onset-duration

Answer 13

onset: 15-30 min
peak: 0.5-2.5hr
duration: 3-5hr

Question 14

rapid action insulin admin time

Answer 14

15 min. before meals

Question 15

short acting meds

Answer 15

regular
humulin R
novolin R

Question 16

short acting insulin onset-duration

Answer 16

onset: 30-60 min
peak: 2-3 hr
duration: 5-8 hr

Question 17

short acting insulin admin times

Answer 17

30 min before meals

Question 18

intermediate acting meds

Answer 18

isophane (NPH)
regular U500
Humulin N
novolin N
humulin R: U500

Question 19

NPH formulary

Answer 19

conjugated regular insulin with protamine

Question 20

intermediate acting onset-duration

Answer 20

onset: 2-4 hr
peak: 4-10hr
duration: 10-16hr

Question 21

intermediate acting admin time

Answer 21

30-60 min before meals

or bedtime

Question 22

long acting insulin meds

Answer 22

glargine
lantus
detemir
levemire

Question 23

glargine and lantus peak-duration

Answer 23

onset: 2-4 hr
peak: none
duration: 20-24hr

Question 24

detmir and levemire onset-duration

Answer 24

onset: 3-4hr
peak: 6-8hr
duration: 6-23hr

Question 25

glargine and lantus time admin

Answer 25

every 24 hr

Question 26

detemir and levemire admin times

Answer 26

every 12-14 hrs

Question 27

glargine formulary

Answer 27

dec. solubility at physiologic pH

- > release small amounts over time

Question 28

detemir MOA

Answer 28

binds to albumin

Question 29

ultra-long acting insulin med

Answer 29

degludec

Question 30

degludec onset-duration

Answer 30

duration: at least 42 hours

Question 31

degludec formulary

Answer 31

active at physiologic pH

-> depot form: slow, continuous absorption

Question 32

insulin dosing

Answer 32

T1DM: 0.5 unit/kg/day
T2DM: 0.2-0.6 unit/kg/day

Question 33

insulin AE

Answer 33

hypoglycemia
wt. gain
dec. K
lipodystrophy