wk 6. Diabetes

Question 1

What fasting and casual plasma glucose levels suggest diabetes mellitus?

Answer 1

Fasting: > 126 mg/mL
Casual: > 200 mg/mL

Question 2

2. What are the preprandial and postprandial targets for patients with DM/ What is the target for A1c?

Answer 2

Preprandial: 70-130 mg/mL
Postprandial: < 180 mg/mL
A1c: < 7% (154 mg/dL)

Question 3

3. What is an electrolyte indication for insulin?

Answer 3

Hyperkalemia

Question 4

4. How are insulin durations changed?

Answer 4

Change amino acid sequence or add a protein.

Question 5

5. What are the mechanisms of action of insulin?

Answer 5

Transports glucose, amino acids, nucleotides, and potassium into cells. Promotes synthesis of glycogen, proteins, and triglycerides.

Question 6

6. What are two contraindications for insulin?

Answer 6

Hypoglycemia and hypokalemia.

Question 7

7. How long may opened insulin vials be stored at room temperature?

Answer 7

1 month.

Question 8

8. When drawing up a short-acting insulin and NPH insulin in the same syringe, which is drawn first? Which short-acting insulins may be mixed with NPH insulin?

Answer 8

Short-acting insulin.

Regular insulin and the insulin analogs – insulin lispro, insulin aspart, & insulin glulisine

Question 9

9. Are all clear insulins short-acting? Explain.

Answer 9

No. Insulin detemir (Levemir) and insulin glargine (Lantus) are intermediate- and long-acting insulins respectively and are clear.

Question 10

10. How can you minimize lipohypertrophy with insulin injections?

Answer 10

Use the same site only one time per month and keep the sites one inch apart.

Question 11

11. Which of the insulins may be given IV?

Answer 11

Insulin lispro (Humalog), insulin aspart (Novolog), insulin glulisine (Apidra), regular insulin (Humulin R or Novolin R).

Question 12

12. When should short, rapid-acting insulins be given?

Answer 12

5-15 minutes before meals

Question 13

13. When should regular insulin be given?

Answer 13

30 minutes before meals

Question 14

14. When is NPH insulin given when given mixed with regular insulin?

Answer 14

30 minutes before breakfast and dinner

Question 15

15. How often is insulin glargine (Lantus) given? When is the drug usually dosed?

Answer 15

Once per day. Same time each day.

Question 16

16. Why are beta-blockers not recommended to be given to patients with diabetes?

Answer 16

Beta-blockers mask the signs of hypoglycemia and also prevent glycogenolysis, which allows glycogen to breakdown into glucose (necessary to prevent hypoglycemia).

Question 17

17. What are the symptoms of hypoglycemia?

Answer 17

Tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue. Also convulsions, coma, death.

Question 18

18. What is the treatment for hypoglycemia in alert patients? What about those taking alpha-glycosidase inhibitors?

Answer 18

Glucose tablet, orange juice, sugar cubes, honey, corn syrup, nondiet soda. Must use glucose tablets if take alpha-glycosidase inhibitors that prevent the breakdown of sugars into monosaccharides.

Question 19

19. What drug is administered to unconscious patients with hypoglycemia? How does it work? What works faster?

Answer 19

Glucagon. Breaks down glycogen into glucose and accelerates hepatic gluconeogenesis. IV glucose.

Question 20

20. What are the mechanisms of action of metformin (Glucophage), a biguanide?

Answer 20

Sensitizes cells to insulin and decreases liver glucose production. Also slightly inhibits intestinal absorption of glucose.

Question 21

21. What procedure is used for patients who use metformin (Glucophage) who are undergoing tests with radiocontrast dye?

Answer 21

Stop drug 1-2 days before procedure, drink lots of fluids, restart drug if BUN, Cr have normalized 48 hours after the procedure.

Question 22

22. What are the mechanisms of action of second-generation sulfonylureas? What occurs over time?

Answer 22

Stimulates the release of insulin from pancreatic beta cells. Lose effectiveness over time.

Question 23

23. What allergic contraindication do sulfonylureas have?

Answer 23

Sulfa

Question 24

24. What is adverse effect occurs with sulfonylureas and alcohol?

Answer 24

Dilsulfiram-like reaction

Question 25

25. What is the difference in mechanisms of action between sulfonylureas and glinides?

Answer 25

Glinides must be given immediately before meals, because their action is much faster than sulfonylureas.

Question 26

26. What is the mechanism of action of thiazolidinediones?

Answer 26

Sensitizes cells to insulin and decreases liver glucose production.

Question 27

27. What is the black box warning for thiazolidinediones? Signs to look for?

Answer 27

Avoid with severe heart failure due to water retention. Shortness of breath with exertion, crackles, chest pain, restlessness, change in level of consciousness, increasing weight.

Question 28

28. What is the mechanism of action of alpha-glycosidase inhibitors?

Answer 28

Prevents breakdown of carbohydrates into monosaccharides.

Question 29

29. What adverse effect may occur with gliptins, incretin mimetics, and amylin mimetics?

Answer 29

Pancreatitis.

Question 30

30. What drug interactions may occur with gliptins, incretin mimetics, and amylin mimetics?

Answer 30

Hypoglycemia if taken with other antidiabetic drugs. Slows absorption of other drugs.