DM1 - Intro and Types of Insulin

Question 1

Which type of diabetes is caused by Beta cell destruction in the pancreas?

Answer 1

Type 1 Diabetes Mellitus (T1DM)

Question 2

Which type of diabetes results from progressive insulin secretory defect and systemic insulin resistance?

Answer 2

Type 2 Diabetes Mellitus (T2DM)

Question 3

What are the three P’s T2DM?

Answer 3

Polyuria
Polydipsia
Polyphagia

Question 4

What is HbA1c? What is it useful for evaluating?

Answer 4

A form of hemoglobin that has glucose attached to it

Useful evaluating long-term glucose control

Snapshot of the last few months

Question 5

Fasting plasma glucose above ______ mg/dL suggests diabetes

Answer 5

126mg/dL

Question 6

Oral glucose tolerance test above ______ mg/dL suggests diabetes:

Answer 6

200mg/dL

Question 7

Hemoglobin A1c above ______% suggests diabetes

Answer 7

6.5 %

Question 8

How often should a T1DM patient monitor their SBG levels

Answer 8

At least TID

Question 9

How often should A1C be evaluated for patients meeting their goals?

Answer 9

Twice a year

Question 10

How often should A1C be evaluated in patients not meeting their goals?

Answer 10

4 times a year

Question 11

What test to order when glucose is consistently high?

Answer 11

Urine ketones

Question 12

Examples of macrovascular complications from diabetes:

Answer 12

1. MI
2. CVA
3. PAD

Question 13

Examples of microvascular complications from diabetes:

Answer 13

1. Retinopathy
2. Neuropathy
3. Nephropathy

Question 14

Examples of acute complications from diabetes:

Answer 14

1. Hypoglycemia
2. DKA
3. HHS

Question 15

What is the preferred medication for gestational diabetes mellitus?

Answer 15

Insulin

Question 16

Name two medication for GDM as an alternatives to insulin:

Answer 16

1. Glyburide

2. Metformin

Question 17

How does alcohol ingestion affect blood sugar?

Answer 17

Reduction in endogenous glucose production

Question 18

Mild hypoglycemia - range and tx?

Answer 18

60 to 70 mg/dL on fingerstick

15g oral glucose

Question 19

Moderate hypoglycemia - range and tx?

Answer 19

41 to 59 mg/dL

30g oral glucose

Question 20

Severe hypoglycemia - range and tx?

Answer 20

< 40 mg/dL

Glucagon 1mg SubQ/IM

OR

1 amp D50 (25g dextrose)

Question 21

How many grams of sugar are in 1 tbsp (granulated sugar) (appx)?

Answer 21

12.5 grams

Question 22

Primary cause of DKA?

Answer 22

Body’s inability to produce insulin

Question 23

DKA most commonly seen in T1DM or T2DM?

Answer 23

T1DM

Question 24

Cause of hyperosmolar hyperglycemic state? (HHS)

Answer 24

Increased glucose in urine impairs concentrating ability of kidney

More water loss than sodium, leading to hyperosmotic state

Question 25

Hallmark characteristics of DKA?

Answer 25

Acidosis Ketonuria Rapid onset

Question 26

Hallmark characteristics of HHS?

Answer 26

Significant hyperglycemia (in excess of 600mg/dL) Typically normal acid-levels Insidious onset

Question 27

Emergent hyperglycemic management - four major interventions:

Answer 27

1. IV fluids 2. IV bicarb (DKA) 3. IV insulin 4. IV K+

Question 28

Why do we need to monitor / sometimes push K+ in treating hyperglycemia?

Answer 28

Insulin can drop K+ levels, precipitating tachyarryhthmias

Question 29

Two mechanisms by which visceral adipose tissue (VAT) contributes to decreased insulin sensitivity?

Answer 29

1. Increased lipolysis, increased free FA’s, increased VLDL, which decreased insulin sensitivity 2. VAT’s produce cytokines, which contribute to insulin resistance

Question 30

Metabolic syndrome, which increases risk for developing T2DM - five criteria? (Need 3/5)

Answer 30

1. Obesity 2. Low HDL 3. High TG’s 4. HTN 5. High fasting glucose

Question 31

Standard target A1C goal for adult with diabetes?

Answer 31

Below 7.0%

Question 32

What is insulin’s job?

Answer 32

Facilitate glucose entry into cells

Question 33

How is insulin cleared?

Answer 33

1. Renal (60%) | 2. Hepatic (40%)

Question 34

Two big categories for insulin?

Answer 34

Bolus | Basal

Question 35

Main purpose of bolus insulin?

Answer 35

Provide a boost in insulin for meals (controls post-prandial hyperglycemia)

Question 36

Main purpose of basal insulin?

Answer 36

Control fasting hyperglycemia

Question 37

Name three rapid-acting insulins:

Answer 37

1. Glulisine 2. Aspart 3. Lispro

Question 38

Which type of insulins are “-log” medicines?

Answer 38

Either rapid acting or mixtures

Question 39

Which type of insulins are “-lin” medicines?

Answer 39

Short-acting or intermediate acting

Question 40

What does “clear before cloudy” refer to?

Answer 40

When mixing rapid acting and intermediate acting insulins, you must first draw up the clear medicine (rapid acting), THEN draw up the intermediate acting medicine (the NPH)

Question 41

What is Afrezza?

Answer 41

Inhaled insulin - taken at beginning of meal - for T1DM must be used with a long-acting insulin as well

Question 42

Regular insulin (short acting insulin) - names?

Answer 42

Humilin R and Novolin R

Question 43

Humilin R and Novolin R - given when?

Answer 43

30 minutes before meals

Question 44

What is the drug of choice for IV-infusion insulin?

Answer 44

Humilin R or Novolin R (short-acting, regular insulin)

Question 45

U-500 insulin - concentration?

Answer 45

500 units per mL

Question 46

Who gets prescribed U-500?

Answer 46

Patients with severe insulin resistance (requiring more than 200 units per day)

Question 47

Humilin N and Novolin N - what type of insulin?

Answer 47

Intermediate-acting (NPH)

Question 48

Glargine and Detemir - what kind of insulin?

Answer 48

Long-acting

Question 49

Which long-acting insulin is bound to albumin?

Answer 49

Detemir (Levemir)

Question 50

Which type of insulin can you NORT mix with other insulins or dilute?

Answer 50

Long-acting insulins (Glargine and Detemir)

Question 51

What do all the insulin combinations have in common?

Answer 51

They all contain protamine

Question 52

What does Novolog Mix 70/30 contain?

Answer 52

70% aspart protamine | 30% aspart

Question 53

What does Humalog Mix 75/25 contain?

Answer 53

75% lispro protamine | 25% lispro

Question 54

What does Humalog Mix 50/50 contain?

Answer 54

50% lispro protamine | 50% lispro

Question 55

What does Humulin 70/30 contain?

Answer 55

70% NPH | 30% Regular

Question 56

What does Novolin 70/30 contain?

Answer 56

70% NPH | 30% regular

Question 57

Advantage of rapid-acting insulin over regular insulin?

Answer 57

Rapid-acting has less risk of post-prandial hypoglycemia bc it has a sharper peak and shorter duration of action

Question 58

What would happen if you took your rapid-acting insulin at the start of the meal? What would happen if you took regular insulin at the start of a meal?

Answer 58

Nothing - it’s meant to be taken right before or at the start of a meal You would run the risk of hypoglycemia

Question 59

What is an advantageous feature of insulin analogues when compared to NPH’s?

Answer 59

Less risk of nocturnal hypoglycemia