Diabetes Drugs

Question 1

Name of Insulin rapid-acting drug?

Answer 1

-log

Eg: Humalog, Novolog

Question 2

Name of insulin short-acting drug?

Answer 2

-lin R

Eg: Humulin-R, Novolin-R

Question 3

Name of insulin intermediate-acting drug

Answer 3

-lin N

Eg: Humulin N, Novlolin N

Question 4

Insulin Rapid-acting

Answer 4

1. Inject right before
   * Onset 5-15 min
   * Peak 1-1.5 hr
   * Lasts 3-5 hrs
2. Subcutaneous injection or insulin pump
3. Can mix with Intermediate-acting drug

Question 5

Insulin Short-acting

Answer 5

1. Inject 30-min before eating
   * 30-60 min
   * Peak 2 hrs
   * Last 6-8 hrs
2. Subcut injection / IV
3. Used in hospital setting for DKA

Question 6

Insulin Intermediate-acting

Answer 6

1. Cloudy => mix before administration
   * Onset 2-4 hrs
   * Peak 6-7 hrs
   * Last 10-20 hrs
2. Subcut injection 2x/day

Question 7

Insulin Long-acting

Answer 7

1. Cannot be mixed in same syringe with other insulins!!!
   * Onset 1-3 hr
   * No pronounced peak
   * Last 17hrs (detemir) or 24 hrs (glargine)
2. Subcut injection ONLY

Question 8

Biphasic/Mixed

Answer 8

1. Rapid onset => right before meal

Question 9

Biphasic/Mixed types

Answer 9

1. NPH/Regular = 70/30 mixes injected before breakfast & dinner
2. Intermediate/rapid-acting = before eating

Question 10

Advantages of Biphasic/Mixed

Answer 10

1. Reduce number of injections

2. Get basal and pradinal insulin at the same time

Question 11

Normal insulin

Answer 11

1. Pancreas secretes 30 units insulin per day

2. Prandial insulin => concentrated peak at 30-45 min after ingestion

Question 12

Normal Insulin - Prandial phases

Answer 12

Prandial (post-eating) insulin two phases:

1. 1st phase = immediate
2. 2nd phase = 8-10 min after ingestion

Question 13

T1DM regime: Basal Bolus Therapy

Answer 13

Long-acting (once/day) + Rapid-acting before meal

Question 14

T1DM regimen: Continuous subcutaneous insulin infusion

Answer 14

Insulin pump = rapid-acting 
Advantages:
* eliminates multiple injection
* set different basal rates, partial units, give different bolus types
Disadvantages:
* cost
* training => ability to trouble shoot
* motivation
* interruption / "bad site" = DKA within hrs

Question 15

When to use insulin in T2DM?

Answer 15

Signs of severe insulin deficiency:

• fasting glucose > 250 mg/dL
• random glucose > 300 mg/dL
• HbA1c > 10%
• Hospital admission (DKA …)

Question 16

Insulin therapy targets

Answer 16

1. Fasting glucose: 70-130 mg/dL

2. 2hr prandial

Question 17

Hyperglycemia in-patient setting

Answer 17

Stop ALL oral agents and Administer Insulin
Target:
* random glucose

Question 18

Weight loss/weight neutral drugs

Answer 18

1. Metformin
2. GLP-1 Agonist
3. DPP-IV
4. SGLT-2

Question 19

Weight gain drugs

Answer 19

1. Sulfonylureas
2. TZDs
3. Insulin

Question 20

Top 3 potent drugs (biggest reduction in HbA1c)

Answer 20

Insulin > metformin > sulfonylureas