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Flashcards in Antidiabetics Deck (34)
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1

hallmark of untreated T1 DM is elevated levels of blood ___ and ___

patients have virtually no insulin secretion → must rely on _____ injected 

hallmark of untreated T1 DM is elevated levels of blood glucose and ketone bodies

patients have virtually no insulin secretion → must rely on exogenous insulin injected 

2

Type ___ DM is the most common form of the disease (over 90% of adults with DM have this type)

Type 2 DM is the most common form of the disease (over 90% of adults with DM have this type)

3

in T2 DM, insulin secretion is enough to restrain ____ 

there is hyperglycemia but no ____

in T2 DM, insulin secretion is enough to restrain ketogenesis 

there is hyperglycemia but no ketoacidosis

4

The secretion of insulin by B cells is stimulated by (3)

  • Glucose (most important stimulus)
  • Amino acids
  • Gastrointestinal hormones (Incretins)
    • released after food ingestion

5

describe the image below 

Incretin Effect - glucose given orally results in higher insulin levels than given IV because incretins released by gut enhance insulin secretion 

 

6

describe the mechanism of insulin secretion

Hyperglycemia results in high ATP levels → close ATP-dependent K+ channels → membrane depolarization and opening of voltage-gated calcium channels → Ca2+ influx causes pulsatile insulin exocytosis

7

describe the insulin receptor and where they are found 

consists of two covalently linked heterodimers, each containing an a subunit and a ß subunit

found in liver, muscle, adipose tissue

8

Insulin is inactivated by the enzyme ____, which is found mainly in the ___ (60%) and ___ (40%)

(ratio is reversed in insulin-treated diabetics receiving SC injections) 

The half-life of circulating insulin is ____ 

Insulin is inactivated by the enzyme insulinase, which is found mainly in the liver (60%) and kidney (40%).

(ratio is reversed in insulin-treated diabetics receiving SC injections)

half-life of circulating insulin is 3-5 min

9

describe the effects of insulin 

10

list the 3 injected, rapid-acting insulin analogs

Lispro 

Aspart

Glulisine

11

Rapid-acting insulins mimic the ___ release of insulin

they have greater control of postprandial plasma glucose (PPG) and associated with less risk of ____

Given with a longer acting insulin to assure proper glucose control

 

Rapid-acting insulins mimic the prandial release of insulin

they have greater control of postprandial plasma glucose (PPG) and associated with less risk of hypoglycemic episodes

Given with a longer acting insulin to assure proper glucose control

12

Rapid-acting insulins should be injected ____

Peak serum levels seen ____ after injection
(50-120 minutes for regular insulin)

DOA is about  ____

Rapid-acting insulins should be injected 15 min before a meal

Peak serum levels are seen ~ 1 hr after injection
(50-120 minutes for regular insulin)

DOA is about 3-4 hrs

13

Short-acting insulin: ____

Short-acting soluble human ____

Should be given ____ before a meal

Usually given SC (or IV in emergencies)

Short-acting insulin: Regular insulin

Short-acting soluble human crystalline zinc insulin 

Should be given 30 minutes before a meal.

Usually given SC (or IV in emergencies)

14

Intermediate-Acting Insulin: ____

crystalline zinc insulin combined with __

what kind of appearance does this have? 

Given __ only

Neutral protamine Hagedorn (NPH)
also called Isophane Insulin

crystalline zinc insulin combined with protamine

cloudy appearance  

Given SC only

15

NPH is used for ___ control

usually given with ___ for ___ time control 

NPH is used for basal control

usually given with rapid/short-acting insulin for meal time control 

16

list long-acting insulin

Glargine

Detemir

Degludec

17

Glargine modifications make it more ____ in acidic pH, but precipitates in ____ pH after SC injection

It cannot be mixed with ____

Glargine modifications make it more soluble in acidic pH, but precipitates in neutral pH after SC injection

It cannot be mixed with short acting insulin

 

18

Detemir modifications increase _____ in SC tissue and fatty acid chain binds reversibly to ____

Detemir modifications increase self-aggregation in SC tissue and fatty acid chain binds reversibly to albumin 

19

What is the benefit of Glargine and Detemir?

How do they differ in administration

they have a lower risk of hypoglycemia than NPH insulin

Glargine: 1x/day

Detemir: 2x/day

20

when Degludec is injected SC, it forms ____ and binds to circulating ____ which delays its absorption 

how does Degludec differ from Glargine/Detemir in absorption and administration? 

when Degludec is injected SC, it forms multihexamers and binds to circulating albumin which delays its absorption 

DOA > 42 hrsdoes not have to be administered at the same time each day (unlike Glargine and Detemir)

21

onset and duration of different Insulins

  • rapid: 1 hr peak
  • short: 3 hr peak
  • intermediate: 5 hr peak
  • long: 24 hr (no peak) 

22

Properties of Currently Available Preparations

23

rapid and long-acting insulin analogs improve ___ levels, and reduce ____ compared with regimens with regular insulin and NPH insulin

rapid and long-acting insulin analogs improve HbA1C levels, and reduce hypoglycemia compared with regimens with regular insulin and NPH insulin

24

The standard mode of insulin therapy is ___

When is it given IV? 

The standard mode of insulin therapy is SC injection

IV: ketoacidosis, perioperative period, during labor and delivery, intensive care situations

25

describe inhaled insulin

Peak level at 12-15 min and decline to baseline in 3 hrs

AE: cough, throat pain, hypoglycemia.

Pulmonary function should be monitored

Contraindicated: asthma, COPD, smokers

26

two methods used to achieve physiological pattern of insulin release

  1. Basal-Bolus Insulin Regimens
  2. Insulin Pump Therapy

27

Basal-Bolus Insulin Regimens

  • 1 shot/day of long-acting insulin for basal coverage (at bedtime or morning), and 
  • doses of rapid-acting analog for each meal
  • skip a meal? omit a premeal bolus
  • eat a larger meal than usual? increase the premeal bolus

28

an insulin ___ is the best way to mimic normal insulin secretion

consists of a battery-operated pump and a computer that programs the pump to deliver ____

an insulin pump is the best way to mimic normal insulin secretion

consists of a battery-operated pump and a computer that programs the pump to deliver predetermined amounts of insulin

29

what drugs are used in the insulin pump? 

rapid-acting: Glulisine, Lispro, or Aspart

30

___ is the most serious and common adverse reaction to insulin overdose

there is ___ risk with rapid-acting insulin analogs than with regular or NPH insulin

Hypoglycemia is the most serious and common adverse reaction to insulin overdose

there is less risk with rapid-acting insulin analogs than with regular or NPH insulin