Oral Glycemics 2

Question 1

Which two types of drugs is hypoglycemia most common in? What are some risk factors for hypoglycemia?

Answer 1

• sulfonylurea drugs and insulin

- >60 years old, impaired renal function, poor nutrition, liver disease, increased physical activity

Question 2

List some of the symptoms of hypoglycemia.

Answer 2

-confusion, slurred speech, dizzy
-shaking
-sweating
-palpitations
-extreme hunger
headache
-vision changes
-unresponsiveness
-unconsciousness
-seizures

Question 3

What are the treatment options for hypoglycemia?

Answer 3

1) Glucose

2) Glucagon- prophylactic rx for those at high risk (type 1 and type 2 with previous severe low blood sugar)

Question 4

When is a glucagon emergency kit used? Whats given if a patient in the hospital has severe hypoglycemia?

Answer 4

• if unconscious or unable to swallow
• after administration turn on side and call 911
• Hospital: IV dextrose

Question 5

What are some possible causes of oral therapy inadequacy (failure to reach targeted treatment goals)?

Answer 5

• dietary noncompliance and physical activity
• stress
• insulin resistance
• simultaneous use of diabetogenic drugs
• progressive B-cell dysfxn

Question 6

What is Amylin? Name the Amylin analog that is used in insulin-requiring diabetics.

Answer 6

• peptide released with insulin from B cells that slows gastric emptying, suppresses postprandial glucagon secretion and reduces appetite
• Analog: Pramlintide (injection before meals)

Question 7

Which patients is insulin used in?

Answer 7

• Type 1 diabetics
• Type 2 when there is glucose toxicity, insufficient endogenous insulin or a contraindication to oral therapy
• *DO NOT use Insulin as a threat, last resort or as a reflector of pt compliance failure**

Question 8

What are some of the reasons patients have for not wanting to use insulin?

Answer 8

• fear of injection
• permanence of having to take insulin
• failure in managing their diabetes
• inconvenience of monitoring
• fear the demands of insulin therapy

Question 9

What are some indications for using insulin in type 2 diabetics?

Answer 9

• significant hyperglycemia at presentation
• hyperglycemia at max doses of oral
• Decompensation (weight loss, injury, stress, MI)
• surgery
• pregnancy
• renal or hepatic disease

Question 10

What are the 3 rapid acting insulins?

Answer 10

-Lispro
-Aspart
-Glulisine
Onset: 5-30 min, Peak: 0.5-3 hrs, Duration: 3-5 hrs

Question 11

What is the short acting insulin?

Answer 11

regular insulin-only insulin that can be given IV

Onset: 30-60 min; Peak: 1-5 hrs; Duration: 6-8 hrs

Question 12

What are the 4 intermediate acting insulins?

Answer 12

NPH
NPL
NPA
Onset: 1-4 hrs, Peak: 4-10 hrs, Duration: 14-24 hrs
Detemir at lower doses Onset: 3-4hrs, Peak: 4-8hrs, Duration: 6-24hrs

Question 13

What are the 2 long acting insulins?

Answer 13

Detemir- at higher doses
Glargine-can’t be mixed in syringe with any other type insulin (Onset: 2-3 hrs; Peak: none, Duration: 24-30 hrs)
used for basal insulin

Question 14

Name the 5 premixed insulins and what their components are.

Answer 14

Humulin/Novolin (70/30) -30% reg and 70% NPH
Novolog Mix (70/30)- 30% aspart and 70% aspart protamine
Humalog Mix 75/25- 25% lispro and 75% lispro protamine
Humulin 50/50- 50% reg and 50% NPH
Humalog Mix 50/50-50%lispro and 50% lispro protamine

Question 15

What are some advantages to using premixed insulin?

Answer 15

• convenient
• longer shelf life
• less dosing errors
• simpler

Question 16

What are some disadvantages to using premixed insulin?

Answer 16

• Loss of flexibility (matching to carb intake and activity)
• harder to tx short term high or low glucose levels
• hypoglycemia risk
• *rarely used in Type 1**

Question 17

How is Insulin stored?

Answer 17

-refrigerated, never freeze, avoid direct sunlight

Question 18

List the common areas for insulin injection in order of increased absorption to decreased?

Answer 18

Abdomen>arm>buttocks>thigh

must rotate sites to avoid lipohypertrophy or lipoatrophy