Diabetes

Question 1

Biguanides

Answer 1

Glucophage (metformin)

MA: decreases hepatic glycogenolysis and gluconeogenesis, increases insulin sensitivity and cellular glucose uptake and utilization

comes in 500mg, and 850mg tablets

Initial dose: 250-500mg OD

Usual dose range: 500-1mg BID

onset of days to max at 2 weeks

This is a first line agent for diabetes, and particularly for diabetes with obesity

DOES NOT CAUSE HYPOGLYCEMIA

CI: decreased renal function, acute decompensated HF, liver dz

AE: dyspepsia, N/D, TID dosing can be used to decrease GI upset, lactic acidosis, can cause decreased B12 absorption and subsequent anemia

Question 2

sulphonylureas

Answer 2

Diamicron (Glicazide)

• available in 30, 60mg tabs
• initial dose 40mg
• usual dose 80mg
• max dose 160mg BID

Diabeta (glyburide)

• available in 2.5, 5mg tabs
• initial dose1.25-2.5mg daily
• usualy dose 5-7.5 mg BID

AE: wt gain, headache, dizziness, sulpha skin rxn ( rash/ photosensitivity), GI disturbances

Question 3

Rapid acting insulins

Answer 3

Humalog (Lispro)
NovoRapid (Aspart)

Onset 10-15minutes
Peak 60-90 minutes
Duration 1.5-6H

Question 4

Short acting/ regular inulin

Answer 4

Humulin R
Novolin ge (toronto)

Onset 30 minutes-1H
Peak 2-3H
Duration ~6.5H (5-10 H)

Question 5

Intermediate acting insulin

Answer 5

Humulin N
Novolin ge (NPH)

Onset 2-4H
Peak 4-10H
Duration 12-18H

Question 6

Long Acting insulin

Answer 6

Detemir (Levemir)

Onset 1H
Peak 6-8H
Duration 16-24H

Glargine (Lantus)

Onset 2-4H
Peak- NO PEAK
Duration- 20-24H