Diabetes

Question 1

Mixed insulin drug names

Answer 1

Novolog 70/30 (70% Intermediate; 30% Rapid);

Novolin 70/30 (70% Intermediate; 30% Short);

Humulin 70/30 (70% Intermediate; 30% Short);

Humalog Mix 75/25 (75% Intermediate; 25% rapid);

Humulin 50/50 (50% Intermediate; 50% Short)

Question 2

Long-acting insulin drug names

Answer 2

Glargine (Lantus); Detemir (Levemir)

Question 3

Intermediate-acting insulin drug names

Answer 3

NPH (Humulin N; Novolin N)

Question 4

Short acting insulin drug names

Answer 4

Regular Insulin (Humulin R; Novolin R)

Question 5

Ultra-short acting insulin drug names

Answer 5

Lispro (Humalog); Aspart (Novolog); Glulisine (Apidra)

Question 6

Role of pancreas in diabetes

Answer 6

Endocrine function - secretion of insulin (beta cells); glucagon (alpha cells); Somatostatin (delta cells)

Question 7

Role of liver in diabetes

Answer 7

Conversion of excess glucose into glycogen for storage; (This glycogen can later be converted back to glucose for energy.)

Question 8

Type 1 Diabetes

Answer 8

Onset usually in childhood or puberty; Frequently undernourished at time of onset; 5-10% of DM diagnoses; moderate genetic predisposition; Defect - beta cells are destroyed, eliminating the production of insulin. INSULIN-DEPENDENT!

Question 9

Drug classes involved treatment of Type 1 Diabetes

Answer 9

Basal Insulins = Intermediate-acting (NPH); Long-acting

Bolus Insulins = Ultra-short acting; Short-acting (Regular Insulin)

Question 10

Ultra-short acting insulin use

Answer 10

Bolus; More rapid onset & shorter duration than regular insulin; Should be given within 15 minutes before a meal or within 20 minutes after starting a meal

Question 11

Ultra-short acting insulin onset, peak, and duration

Answer 11

Onset ~ 0.25 hr; Peak ~ 1-2 hr; Duration ~3-4 hr

Question 12

Short-Acting Insulin Use

Answer 12

Bolus insulin regulation; Regular insulin

Question 13

Short-Acting Insulin onset, peak, and duration

Answer 13

Onset ~ 0.5-1.0 hr; Peak ~2-3 hr; Duration ~3-6 hr

Question 14

Intermediate-acting insulin (NPH) use

Answer 14

Basal insulin regulation

Question 15

Intermediate-acting insulin onset, peak, and duration

Answer 15

Onset ~2-4 hr; Peak ~6-10 hr; Duration ~10-16 hr

Question 16

Long-Acting insulin use

Answer 16

Basal

Question 17

Long-acting insulin onset, peak, and duration

Answer 17

Onset ~4 hr; Peak = NONE; Duration up to 24 hr

Question 18

Mixing Insulins

Answer 18

Never mix any insulin in the same syringe with long-acting insulin (insulin glargine or insulin detemir)

Question 19

General adverse effects related to insulin

Answer 19

Most common side effect of insulin therapy is hypoglycemia; others include Weight gain, Lipodystrophy (degeneration of adipose tissue), Allergic reactions, Local injection site reactions

Question 20

Guidelines for Injecting Insulin

Answer 20

Areas of “loose skin”: abdomen, thighs, upper arms, upper buttocks; Rotation of injection sites to help prevent fibrosis or lipohypertrophy; Use the same region & rotate injection sites to have less variability in insulin absorption, but also minimize lipodystrophy

Question 21

Type 2 Diabetes

Answer 21

Onset frequently over 35 (although becoming more prevalent in kids due to childhood obesity); usually obese at onset; 90-95% of DM diagnoses; VERY STRONG genetic predisposition; Defect - inability of beta cells to produce appropriate quantities of insulin, insulin resistance, and/or other defects

Question 22

Drug classes involved treatment of Type 2 Diabetes

Answer 22

Oral

Non-Insulin Injectables

Basal Insulin

Bolus Insulin

Question 23

Oral Agent Pharmacologic Mechanisms

Answer 23

1. Increase production of insulin
2. Decrease glucose output
3. Increase sensitivity to insulin
4. Delay digestion of carbohydrates
5. Inhibition of enzymes

Question 24

Oral Agents

Answer 24

1. Sulfonylureas
2. Meglitinides
3. Biguanides
4. Glitazones
5. Alpha-glucosidase inhibitors
6. DPP4 Inhibitors

Question 25

Sulfonylureas Action

Answer 25

Binds to sulfonylurea receptors on B-cells & stimulates pancreatic secretion of insulin

Question 26

Sulfonylureas Side Effects

Answer 26

Hypoglycemia, weight gain, hemolytic anemia, GI upset

Question 27

Sulfonylureas Dosing

Answer 27

Twice daily dosing before meals; Start at lower doses in elderly and compromised renal or hepatic function

Question 28

Advantages of 2nd Gen Sulfonylureas

Answer 28

more potent, fewer adverse effects & drug interactions

Question 29

Action of Meglitinides

Answer 29

Bind to receptors on βcells & lowers glucose by stimulating pancreatic isulin secretion; Produces more physiologic insulin release after a meal & better postprandial BG lowering

Question 30

Side Effects of Meglitinides

Answer 30

hypoglycemia, weight gain

Question 31

Cautions of Meglitinides

Answer 31

Hepatic Impairment

Question 32

Biguanides Actions

Answer 32

Decrease hepatic glucose production; Increase peripheral glucose utilization

Question 33

Biguanides Side Effects

Answer 33

N/V/D, & metallic taste are the most common SE Lactic acidosis: minimize use in renal insufficiency, CHF Avoid if SCr \> 1.5 in males & 1.4 in females Does NOT induce hypoglycemia when used as monotherapy GI SE can be minimized by taking with food & titrate

Question 34

Biguanides Medications

Answer 34

METFORMIN (Glucophage)

Question 35

Glitazone Actions

Answer 35

Sensitize muscle & fat to effects of insuline (thru activation of PPAR gamma receptor) Insulin must be present for medication to work! May take 3 months for full effect

Question 36

Glitazone Side Effects

Answer 36

Edema and weight gain (caution in CHF and edema) Monitor LFTs closely due to potential Liver dysfunction (trioglitazone) Mixed effects on lipids (DecreaseTG, IncreaseHDL, but negative effect on LDL)

Question 37

Glitazone Medications

Answer 37

Pioglitazone (Actos); Rosiglitazone (Avandia)

Question 38

Alpha-glucosidase inhibitor Actions

Answer 38

**Prolongs the absorption of carbohydrates** (by preventing breakdown of sucrose & complex carbohydrates in the small intestine) Net effect: Decrease postprandial glucose; fasting BG is relatively unchanged

Question 39

Alpha-glucosidase inhibitor Side Effects

Answer 39

GI Side effects: diarrhea, abdominal cramps

Question 40

DPP4 Inhibitor

Answer 40

Dipeptidyl Peptidase 4-Inhibitors

Question 41

DPP4 Inhibitor Action

Answer 41

1. Increases insulin release 2. decreases glucagon levels in the circulation

Question 42

DPP4 Inhibitor Use

Answer 42

Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Question 43

DPP4 Inhibitor Side Effects

Answer 43

URI, nasopharyngitis and headache, hypoglycemia

Question 44

Incretins

Answer 44

Group of GI hormones that: 1. increase postprandial insulin secretion 2. slow the rate of absorption of nutrients from GI tract 3. inhibit glucagon release

Question 45

Amylins

Answer 45

Group of GI Hormones that: Slows the absorption of nutrients (slows gastric emptying time

Question 46

Incretin Mimetic Actions

Answer 46

1. Glucose-dependent stimulation of insulin release 2. suppression of glucagon 3. slows gastric emptying 4. May preserve B-cell function (useful in early disease)

Question 47

Incretin Mimetic Side Effects

Answer 47

Nausea, vomiting, weight loss, injection site irritation

Question 48

Amylin Analog Drug

Answer 48

Pramlintide (Symlin)

Question 49

Amylin Analog Action

Answer 49

Suppresses glucagon secretion; Delays gastric emptying; Decreases postprandial hyperglycemia; Promotes satiety;

Question 50

Amylin Analog Uses

Answer 50

type 1 and type 2 diabetes (on insulin)

Question 51

Amylin Analog Side Effects

Answer 51

nausea& vomiting, weight loss

Question 52

Non-insulin Injectables

Answer 52

Incretin Mimetics; Amylin Analogs