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

Gestational diabetes

Answer 3

• often occurs in 3rd trimester of pregnancy
• goes away when baby is delivered, but mother is at higher risk of developing DM type 2 later in life

Question 4

First line treatment of type 2 diabetes

Answer 4

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

Question 5

Insulin MOA

Answer 5

• 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 6

Rapid acting Insulin: lispro (Humalog) - Aspart (NovoLog) “Logs” - glulisine (Apidra)

Answer 6

• Bolus insulin (Prandial, mealtime)
• onset in 5 minutes - peaks in 1 hour - duration 4-5 hours
• take 5-15 minutes before a meal

Question 7

Short acting insulin: “regular” (Humulin R - Novilin R)

Answer 7

• Bolus insulin
• take about 30 to 45 minutes before eating
• peaks in 3 to 4 hours, duration 4 to 10 hours

Question 8

Intermediate acting insulin: NPH insulin - Humalin N/ Novalin N

Answer 8

• Basal insulin
• onset: 1/2 to 1 hour; 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 9

Long acting insulin: glargine (Lantus); detemir (Levemir); degludec (Tresiba)

Answer 9

• Basal insulin
• onset 2-4 hours; duration 24 hours with little or no peak

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 10

Insulin ADRs

Answer 10

• hypoglycemia
• weight gain

Question 11

Insulin patient education

Answer 11

• 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 12

Glucagon MOA

Answer 12

• 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 13

Glucagon ADRs

Answer 13

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

Question 14

Profile of antibiotic medications

Question 15

Diabetes Medication Algorithm

Question 16

Diabetes insulin algorithm