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Flashcards in Diabetes Deck (57):
1

What method is used to give insulin and where is insulin derived from?

Given parenterally (not absorbed PO)
Derived from human insulin–more rapidly absorbed and less immunogenic than animal sources

2

What is the standard preparation of insulin

100 units per milliliter

3

List examples of immediate, short, intermediate, and long insulin drugs

Immediate –lispro, aspart, glulisine
Short – regular insulin
Intermediate – NPH
Long – Detemir, Glargine

4

Which type of insulin lasts for 12 hours but peaks at four hours?

Intermediate (NPH)

5

Which type of insulin most closely mimics human insulin?

Immediate (lispro)

6

Which type of insulin requires the most frequent administrations?

Immediate (lispro)

7

What is a conventional insulin prescription?

Two biphasic (70/30) injections daily with short acting agents PRN

8

List six drugs that cause hyperglycemia

Glucagon, steroids, epinephrine, thyroid hormones, oral contraceptives, diuretics

9

Describe how an all day insulin dose works

Long acting insulin agent (Glargine or detemir) covered by lispro

10

What is added to insulin to make it long-acting?

Zinc and protamine

11

What type of insulin is in an insulin pump?

Lispro (immediate)

12

Who is more likely to be insulin dependent, patient under 30 with diabetes or a patient over 30 with diabetes?

Under 30 with diabetes always require insulin
(Over 30 with diabetes can manage with diet, insulin, and PO agents)

13

Which types of insulin maybe mixed?

Shorter acting agents maybe mixed in one syringe and immediately used
long-acting insulin should never be mixed

14

What happens to long acting insulin agents administered by IV?

They separate and precipitate (as all suspensions do) when administered IV
Only non-suspension insolent products should be administered via IV drip

15

Why should insulin never be shaken?

Shaking denatures the protein (indicated by foam)
Instead, roll between hands to warm

16

When should insulin be refrigerated?

If prepared more than 30 days in advance

17

What size syringe should be used for insulin administration?

1 mL (or smaller, never larger)

18

What are the four signs of hypoglycemia?

Tremor, headache, malaise, tachycardia

19

How are pregnant patients with DM usually treated?

Switch to insulin – does not cross placenta

20

Why should patients on beta blockers be careful when taking insulin?

Beta blockers can mask signs of hypoglycemia (decrease headache, treat tremor, prevent tachycardia)

21

Describe a proper insulin injection

Subcutaneously in hip/flank at 45° angle

22

Summarize the mechanism of sulfonylureas in treatment of DM

Increase insulin release and sensitivity

23

Which type of oral diabetic agents require a 30% pancreatic function?

Sulfonylureas

24

Which kind of sulfonylurea should be avoided in the elderly?

Long acting agents (chlorpropamide, tolbutamide)-can bottom out their blood sugar

25

How are sulfonylureas excreted?

Renally, highly plasma protein bound

26

What is the most common adverse effect of sulfonylureas?

Rash

27

Which type of sulfonylurea may be coadministered with insulin?

Second or third generation (glimepiride, glyburide)

28

Describe how biguanides work

They reduce hepatic glucose production (ineffective in absence of insulin)

29

Why was phenformin removed from the market in 1970s?

It caused fatal lactic acidosis

30

What is the only kind of biguanide agent still used?

Metformin (Glucophage)

31

What is one added bonus of Exenatide (Byetta)?

Weight-loss

32

Which patients should be extra cautious of taking biguanides (Metformin)?

Those with renal dysfunction – metformin can cause lactic acidosis, increased serum creatinine
Also, patients with hepatic dysfunction, cardiogenic shock, and pregnancy

33

How is metformin dosing altered with the use of contrast dye?

Hold for 24 to 48 hours before use of dye

34

What is another name for thiazolidinediones?

Glitazones

35

How do Glitazones work?

They reduce peripheral insulin resistance (stimulate PPAR gamma resulting in adipose tissue differentiation)

36

Which of these three tend to be least effective in diabetes treatment – sulfonylureas, biguanide's, Glitazones ?

Glitazones are less effective

37

List two common side effects of Glitazones

Weight gain and peripheral edema

38

Which patients should avoid taking Glitazones?

Those with heart or hepatic failure

39

How do Meglitinides work to treat diabetes?

Short acting secretagogues that release stored insulin (similar to sulfonylureas)

40

List examples of two Meglitinides and when you should take them

Repaglinide (take QID 30 minutes before meal) and Nateglinide (TID)

41

How does Exenatide work?

Functional analog of GLP-1 that enhances insulin secretion and delays gastric emptying, used as adjunct therapy with insulin or other oral

42

What is an added bonus side effect of using Exenatide?

Weight loss

43

List three major side effects of Exenatide

Nausea, vomiting, pancreatitis

44

Why do long acting GLP-1 agonists come with a black box warning?

They can cause thyroid C cell tumors

45

Explain the dosing of Exenatide

Take 5 to 10 µg b.i.d. one hour before morning and evening meals

46

Explain how dipeptidylpeptidase-4 (DDP-4) inhibitors improve glucose control

They prevent metabolism of GLP-1 thereby enhancing insulin secretion and delaying gastric emptying

47

List an example of a DPP-4 inhibitor

Januvia

48

Explain how Acarbose and Miglitol work to control diabetes

Alpha–glucosidase inhibitor that reduces digestion of complex carbohydrates in the gut causing increased sugar excretion in stool (used as adjuncts with other diabetes meds)

49

What are potential side effects of Acarbose and Miglitol?

Diarrhea, flatulence – bacteria in gut feed on undigested sugar

50

Which 3 diabetes medications are given subcutaneously?

Insulin, Byetta, Symlin

51

Describe how Pramlinitide (Symlin) works to control diabetes

Amylin analogue with longer half-life that reduces postprandial glucagon secretion, slows gastric emptying, reduces caloric intake and enhances effects of insulin

52

What are 2 side effects of pramlintide (Symlin)?

Weight loss, nausea

53

How is Symlin dosed?

15 µg subcutaneously just prior to large meals, titrate to 120 µg as tolerated

54

How does Canaglifozin (Invokana) work to control diabetes?

Inhibits sodium–glucose cotransporter 2 (SGPT-2) in kidney to waste urinary glucose

55

What are common side effects of Invokana?

Yeast infections, UTI, balanitis due to increased sugar in urine
Also osteoporosis and osteopenia due to potential calcium excretion (?)

56

How is Invokana usually dosed?

100 mg QD before first daily meal for type two diabetes only

57

What two tests must be monitored for patients on Invokana?

CrCl and serum K levels