Week 8: Insulin and Glucagon

Question 1

Type 1 diabetes

Answer 1

auto immune disease that causes destruction of B cells in the pancreas

Question 2

Type 2 diabetes

Answer 2

insulin resistance - decreased production of endogenous insulin

Question 3

First line treatment of type 2 diabetes

Answer 3

• Lifestyle modifications: diet and exercise
• exercise increases glucose need thereby increasing upregulation of insulin receptors on the cells which helps with insulin sensitivity

Question 4

Insulin MOA

Answer 4

• Tissues primarily affected by insulin: muscle, adopose, and liver
• stimulate glucose entry into cells
• increase storage of glucose as glycogen in muscle and liver cells
• inhibits glucose production in liver and muscle cells
• promotes protein synthesis by increasing amino acid transport into cells
• enhances fat storage and prevents mobilization of fat for energy

Question 5

Rapid acting Insulin:

aspart/lispro (Humalog “logs”)/glulisine (Apidra)

Answer 5

• Bolus insulin (Prandial, mealtime)
• onset in 5 minutes - peaks in 30 mins-90 mins - duration 4-5 hours
• take 5-15 minutes before a meal

-monitor postprandial glucose to see effectiveness of insulin

Question 6

Short acting/Regular insulin: (Humulin R - Novilin R)

Answer 6

• Bolus insulin
• take about 30 to 45 minutes before eating
• onset 30 mins-1hr
• peaks in 3 to 4 hours
• duration 7-8 hrs

Question 7

Intermediate acting/NPH insulin:

Humalin N/ Novalin N

Answer 7

• Basal insulin
• onset: 1 to 1.5hr
• peak 4 to 10 hours
• duration 12 to 24 hours
• looks cloudy - has to be mixed before injecting

- Take twice daily - do not have to take before eating - can be given before or after the meal - can be mixed with regular insulin

Question 8

Long acting/glargine:

(Lantus); detemir (Levemir); degludec (Tresiba)

Answer 8

• Basal insulin
• onset 2-4 hours
• NO PEAK
• duration 24 hours

Lantus - ideally taken in the PM unless dose of 100u or more daily (divide into 2 doses and take BID)

Levemir - usually taken BID

Tresiba - ultralong acting - works for 48 hours - taken daily at the same time of day; good for people with erratic work schedule

Question 9

Insulin ADRs

Answer 9

• hypoglycemia
• weight gain
• hypothyroid pts have delays insulin turnover so need LESS insulin & hyperthryoid pts need more

Question 10

Insulin patient education

Answer 10

• Lifestyle management - diet and exercise
• Education on how to administer insulin - types of insulin
• Injection site selection - rotate sites (prevent lipodystrophy)
• Glucose monitoring - when to monitor and recording readings
• What do to regarding blood sugars and insulin when pt is sick
• Goal: HgbA1C less than 7% (ADA guidelines less than 7%; AACE guidelines < 6.5%)
• Goal: FBS < 130

Question 11

Glucagon MOA

Answer 11

• accelerates liver gluconeogenosis, which increases the breakdown of glycogen to glucose and inhibits glycogen synthesis - leads to elevated blood glucose levels
• given for hypoglycemia

**important to keep on hand for someone taking insulin**

Question 12

Glucagon ADRs

Answer 12

• nausea
• increased BP
• hypersensitivity rx
• anaphyalxis and skin rase (rare)

Question 13

Profile of antibiotic medications

Question 14

Diabetes Medication Algorithm

Question 15

Diabetes insulin algorithm