Diabetes

Question 1

How often should a patient with Type 1 diabetes check their blood glucose level

Answer 1

6 - 10 times daily (Preprandial, 2 hr postprandial, pre-bedtime, pre-exercise, before critical tasks such as driving, when suspecting and after treating hypoglycemia, middle of night {once a month})

Question 2

Where are the injection sites for insulin?

Answer 2

● Injection sites → Upper lateral arms, abdomen, buttocks, upper lateral thighs

Question 3

What activities should be avoided after insulin injection?

Answer 3

Avoid exercising muscles or massage in the area of the injection (Guest slides)

Question 4

What increases absorption of insulin?

Answer 4

Increase absorption → heat (ambient or local), abdomen > leg and arm, exercise in general and/or exercising muscles near injection site (Gladson slides)

Question 5

when should ultra short acting insulin be taken

Answer 5

Ultra short acting: take 5 min before meal, duration 3-5 hours, peaks at one hour (Lispro, Aspart)

Question 6

when should regular insulin be taken

Answer 6

take 30 min before meal, duration 6-8 hours. Often used with intermediate. Peaks in 2 hours

Question 7

when should intermediate insulin be taken

Answer 7

NPH (neutral protamine hagedo insulin); Onset is 1-4 hours, peaks in 6-12 hours, duration 14-24 hours.

Question 8

when should peakless long acting insulin be taken

Answer 8

mean onset of action is within 1 hour with a duration of close to 24 hr; has no peak and instead mimics continuous infusion of rapid-acting regular insulin from a pump (Glargine)

Question 9

Split and mixed insulin regimen

Answer 9

Split and Mixed: regular or short-acting insulin mixed with intermediate, given before breakfast and dinner (2 injections)

Question 10

split and mixed with intermediate at bedtime

Answer 10

Split and mixed with bedtime intermediate: For purposes of improving morning fasting reading control the second intermediate-acting insulin can be held until bedtime (9:00PM) (3 injections-1 at breakfast, 1 at dinner, 1 intermediate at bedtime)

Question 11

normal glucose level

Answer 11

80-120

Question 12

if morning blood glucose is low

Answer 12

decrease insulin at bedtime

Question 13

if morning blood glucose is high

Answer 13

need to increase insulin

Question 14

Multiple pre-meal injections and Bedtime Long Acting regimen

Answer 14

good for maintaining blood glucose level (best is continuous insulin pump) (The more injections the person takes, the more controlled blood glucose should be)

Question 15

What are the adverse effects of insulin?

Answer 15

● Hypoglycemia-if amt of insulin is too high, missed meal, strenuous exercise.
● Lipohypertrophy or lipoatrophy at injection site
● Rebound hyperglycemia
● Weight gain

Question 16

interaction between insulin and exercise and what type of exercise would have the least effect on glucose level? What recommendations do you have for the newly diagnosed Type 1 patient who exercises every day

Answer 16

● Exercise acts as insulin so take lower pre-exercise insulin dose and have a carb snack (40g) prior to exercise
● Aim for 150min aerobic exercise per week (non-consecutive days)
● Blood sugar does NOT drop as much during sprint (less effect on glucose level) compared to aerobic
● Hydrate during exercise
● Check blood glucose levels before exercise and after
● Might want to include 10s sprint at end of exercise to reduce post-exercise hypoglycemia
● Exercise program must be individualized for particular pt
● Pt must live a life of monotony (eat same food at same time of day, perform same exercises at the same time of day (helps pt predict/prepare for glycemic changes)
● Always have simple sugar/glucose gel

Question 17

Metformin MOA and ADRs

Answer 17

MOA: inhibits gene expression for gluconeogenesis (Improves glucose utilization in skeletal muscle)
○ Side Effects: Modest weight loss, nausea, diarrhea; Does NOT cause hypoglycemia

Question 18

Incretin Mimetics MOA and ADRs

Answer 18

glucagon-like peptide (GLP-1) analog, Protective effects on beta cells
○ Side Effects: nausea, vomiting, diarrhea, risk of mild to moderate hypoglycemia

Question 19

Glitazones MOA and ADRs

Answer 19

Insulin sensitizers, Improves insulin resistance, Improves lipid and cholesterol levels (May also delay progression of disease)
○ Side Effects: Fluid retention, weight gain, inc risk of fxs

Question 20

Pipeptidyl MOA and ADRs

Answer 20

Pipeptidyl: competitively inhibit DPP-4 enzyme, slows incretin degradation-potentiating glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP)
○ Side Effects: nasopharynigitis, nausea

Question 21

Sulfonylureas MOA and ADRs

Answer 21

Insulin secreatogues- blocks ATP sensitive K+ channels, facilitates insulin release, suppresses Glucagon, Stimulates appetite and causes weight gain
○ Side Effects: HYPOGLYCEMIA, mild weight gain

Question 22

What is the treatment for hypoglycemia?

Answer 22

1. Eat 15 grams of carbohydrate
2. Recheck glucose level in 15 min
3. If reading is not above 70, eat another 15 g Test again in 15 min,
4. if not above 70 consume another 15 g of CHO and call MD
5. 15 grams = 4oz. Of juice or soda (not diet), 1Tbl of table sugar, honey, orange juice—any simple sugar (non a complex CHO)

Question 23

What confirms the diagnosis of diabetes?

Answer 23

● Prediabetes: FBG 100-126, A1c 5.7-6.4%

● Diabetes: FBG >126, A1C >6.5%

Question 24

What is diabetic ketoacidosis?

Answer 24

Without insulin to shuttle sugar into cells for usage, the body breaks down fat as fuel, resulting in a buildup of acid in the bloodstream called ketone, eventually leading to ketoacidosis; can be due to exercise because exercise decreases insulin release