DIABETES Flashcards
Meglitinides
Stimulates the release of insulin from pancreatic cells
- works fast
- side effects: hypoglycemia, weight gain, nausea, back pain
- ex. Repaglinide
Biguanides
Inhibits release of glucose from liver + improves sensitivity to insulin
- may promote weight loss
- may decrease LDL lvls
- well-tolerated, few side effects
- ex. Metformin
Thiazolidinediones
- improves sensitivity to insulin
- inhibits the release of glucose from the liver
- may slightly increase HDLs
- side effects: heart failure, stroke, heart attack, liver disease
- ex. Rosiglitazone
Alpha-glucosidase inhibitors
slows the breakdown of starches and sugars
- side effects: stomach pain, gas, diarrhea
Recommendations for starting insulin
start w/ basal insulin
- long acting insulin releases insulin slowly in the blood
- mimics the way our body produces insulin
If ineffective, use mixed insulin
- long acting (no peak) + short acting (rapid, peaks)
Rapid-acting insulin
- onset
- peak
- duration
onset - 15 mins
- injected 0-15 mins before meal
peak - 60-90 mins
duration - 3-5 hrs
Short-acting insulin
- onset
- peak
- duration
“regular insulin”
- onset - 40-60 mins
- peak: 2-5 hrs
- duration: 6-8 hrs (R humulin)
Intermediate-acting insulin
- NHP
- onset
- peak
- duration
taken 2x a day, often combined w/ short-acting or rapid-acting insulin
onset - 1-3 hrs
peak - 6-8 hrs
duration - 18-24 hrs
Long-acting insulin (basal)
- released slowly and steadily
- injected 1X/day @ bedtime
- onset - 1-2 hrs
- peak - N/A
- duration - 24 hrs
- DO NOT mix w/ other insulin
How to store insulin
- do not heat or freeze
- if opened, can be left @ rt for 4 weeks
- extra insulin should be refrigerated
- avoid exposure to direct sunlight
What are some problems w/ insulin therapy?
- hypoglycemia
- allergic rxn
- lipodystrophy
- Somogyi effect
- dawn phenomenon
What is the Somogyi effect
A rebound hyperglycemia
- when you take insulin before bed and wake up with high blood sugar levels
- when insulin lowers your blood sugar too much, it can trigger a release of hormones that send your blood sugar levels into a rebound high
- hypoglycemic at night
- hyperglycemic at dawn
What is the Dawn phenomenon
- body produces hormones that result in raised blood sugars in the morning
- ex. GH, cortisol
- normal at night
- hyperglycaemic at dawn
What is a glycemic index?
How much a food/drink raises blood glucose after it is consumed.
Foods with a high GI increase blood glucose higher and faster than foods with a low GI
3 categories:
- low GI (<55)
- medium (56-69)
- high GI (>70)
GOAL
- consume mostly low GI foods to decrease risk of type II DM + complications, decrease risk of heart disease and stoke, feel full longer, maintain or lose weight
What are the recommended blood glucose values for most people w/ diabetes?
AIC < 7%
FBG 2-7
2hrBPG 5-10
