Antidiabetic drugs

Question 1

what is diabetes mellitus, what are the results of it?

Answer 1

chronic disease of deficient glucose metabolism
- results in hyperglycemia

Question 1

what are the major symptoms of diabetes mellitus?

Answer 1

polyuria, polydipsia, polyphagia

Question 2

what are the types of diabetes?

Answer 2

• type 1: insulin dependent
• type 2: non insulin dependent
• secondary (due to meds)
• gestational (hormone changes)

Question 3

where is insulin released from? what is the function?

Answer 3

• released from beta cells of islets of langerhans in pancreas
  functions:
• promotes uptake of glucose, amino acids and fatty acids
• converts glucose to glycogen

Question 4

what is the normal fasting blood glucose range

Answer 4

70-99

Question 5

what are the diagnostic HgA1C values?

Answer 5

• non diabetic: 5% or less
• pre-diabetic: 5.7-6.4%
• diabetic: 6.5% or more
  **optimal for diabetics is 7% or less

Question 6

how to store insulin?

Answer 6

• refrigerated if opened
• room temp for 1 month
• avoid sunlight and high temps

Question 7

what are the rapid acting insulins?

Answer 7

• insulin lispro (humalog)
• insulin aspart (novalog)
• insulin glulisine
• oral inhalation insulin

Question 8

what is the onset, peak and duration of rapid acting insulin?

Answer 8

onset: 15-30 min
peak: 30-90 min
duration: 3-5hr

Question 9

what are the short acting insulins?

Answer 9

• regular: humulin R, Novolin R, regular insulin

Question 10

what are the onset, peak and duration of short acting

Answer 10

onset: 30 min SQ, 15 min IV
peak: 2.5-5 hrs SQ, 15-30 min IV
duration: 4-12hrs SQ, 30-60 min IV

Question 11

what are the intermediate acting insulins? what are the onset, duration and peak of them?

Answer 11

• insulin isophane NPH (humulin N, Novolin N)
• onset: 1-2 hrs
• peak: 4-12 hrs
• duration: 14-24hrs

Question 12

what are the long acting insulins? what are the onset, peak and duration?

Answer 12

• insulin glargine (lantus, tovjeo)
• onset: 1 hr
• peak: none
• duration: 24 hrs
  **administered at bedtime

Question 13

what are the combos of insulins?

Answer 13

• composed of short and intermediated acting OR rapid and intermediate acting
• NPH 70/regular 30
• NPH 50/ regular 50

Question 14

what are insulin interaction?

Answer 14

• decreased hypoglycemic effect with thiazides, glucocorticoids and estrogen and oral contraceptives, thyroid drugs, furosemide and green tea and smoking
• increased hyperglycemic effect with TCAs and MOIs, tetracyclines, aspirin, oral anticoagulants, alcohol, beta blockers, ace inhibitors and ARBs(?)

Question 15

what are the general side effects of insulin

Answer 15

• hypoglycemia: tachy, slurred speech, lack of coordination, confusion, trembling, cold/clammy skin
• somogyi effect: response to excess insulin, occurs in pre-dawn hours, rapid decrease in BS during night
• lipodystrophy: when you continuously use same site for insulin
• dawn phenomenon: hyperglycemia when waking up
• diabetic ketoacidosis: hyperglycemic reaction leads to fat catabolism
  - extreme thirst, polyuria, fruity breath
• kussmaul respirations: deep, rapid, distressed breathing

Question 16

what is insulin resistance ?

Answer 16

• body tissues do not respond to action of insulin (insulin receptors or either unresponsive, or deficit in numbers)
• antibodies cause insulin resistance and allergy

Question 17

what are the methods of the insulin administration

Answer 17

• injection: SQ or IV (short acting)
• insulin pen injectors
• insulin jet injectors
• insulin pumps

Question 18

what does sliding scale insulin involve?

Answer 18

short or rapid acting