Exam 1 DM

Question 1

A1c goal for DM

Answer 1

Less than 6.5-7%

Question 2

Fasting glucose goal for DM

Answer 2

80-130 mg/dL

Question 3

Rapid acting insulin

Answer 3

Lispro (humalog), aspart (novolog), glulisine (Aventis)

Question 4

Rapid acting insulin onset

Answer 4

15-30 min

Question 5

Rapid acting insulin peak

Answer 5

1-2 h

Question 6

Rapid acting insulin duration

Answer 6

3-4h

Question 7

When is rapid acting insulin administered?

Answer 7

Immediately before a meal

Question 8

Short acting insulin

Answer 8

Regular Humilin R

Question 9

Short acting insulin onset

Answer 9

30 minutes

Question 10

Short acting insulin is administered when?

Answer 10

30-45 minutes before meals

Question 11

Intermediate acting insulin

Answer 11

NPH humulin N and novolin N

Question 12

Intermediate acting insulin onset

Answer 12

2-4h

Question 13

Intermediate acting insulin duration

Answer 13

8-12h

Question 14

Intermediate acting insulin is not used for…

Answer 14

Emergency IV use

Question 15

Appearance of intermediate acting insulin?

Answer 15

Cloudy

Question 16

Long acting insulin

Answer 16

Glargine: lantus, basaglar, toujeo
Detemir: Levemir
Degludec: Tresiba

Question 17

Can long acting insulin be mixed with other types of insulin?

Answer 17

No

Question 18

Insulin glargine characteristics

Answer 18

Onset: 4-5, no peak, clear, duration: 24h

Question 19

Insulin detemir characteristics

Answer 19

Onset: 2h, peak 3-9h, duration 14-24h, clear

Question 20

Insulin - careful in which patients?

Answer 20

Hepatic and Renal failure - duration of action is prolonged

Question 21

Combination insulin products - novolin 70/30

Answer 21

70% NPH, 30% regular insulin

Question 22

Novolog 70/30 means?

Answer 22

70% aspart protamine suspension and 30% aspart

Question 23

Humalog 50/50 and 75/25

Answer 23

50 or 75% protamine lispro and 50 or 25% lispro

Question 24

Insulin dose based on?

Answer 24

Total body weight - DMII is 0.2 units/kg/day

Question 25

1 unit of insulin will lower blood glucose by how much?

Answer 25

50 mg/dL

Question 26

How often do you adjust an insulin dose?

Answer 26

Wait at least 24 hours

Question 27

Who should insulin be held in and not held in?

Answer 27

Type 1 DM - never stop insulin

Question 28

Which types of insulin can be given IV?

Answer 28

Rapid or short acting

Question 29

Which locations are ideal for SubQ insulin?

Answer 29

Abdomen > buttocks > arm/leg

Question 30

What accelerates absorption of insulin?

Answer 30

Exercise, rubbing, heat

Question 31

How long can insulin be kept at room temperature?

Answer 31

28 days - otherwise keep in the refrigerator

Question 32

Lipohypertrophy

Answer 32

Lump under skin caused by accumulation of fat as a result of frequent injections in same site

Question 33

Signs of hypoglycemia

Answer 33

Autonomic hyperactivity - sympathetic: tachycardic, palpitations, sweating, tremulousness. Parasympathetic: nausea and hunger

Question 34

Tx of hypoglycemia - mild

Answer 34

Able to swallow: simple sugar, juice, hard candy, sugar packets

Question 35

Tx of hypoglycemia - severe

Answer 35

Unconsciousness/stupor: 20-50mL of 50% dextrose by IV; or 1mg glucagon (SubQ or IM)

Question 36

Why do patients prefer un-refrigerated insulin?

Answer 36

Less painful

Question 37

Sulfonylureas are used in which patients?

Answer 37

Type II only

Question 38

Second generation sulfonylureas

Answer 38

Glyburide, glipizide, glimepiride

Question 39

Which sulfonylurea which you choose for a patient with renal failure?

Answer 39

NOT glyburide, either glipizide or glimepiride

Question 40

How often are sulfonylureas dosed?

Answer 40

1-2x per day

Question 41

Patient prone to hypoglycemia - would you prescribe a sulfonylurea?

Answer 41

NO - biggest adverse effect

Question 42

Would you prescribe a 300 lb Type II DM a sulfonylurea?

Answer 42

NO - weight gain is an adverse effect

Question 43

Biguanide - which medication?

Answer 43

Metformin (glucophage)

Question 44

First line agent for Type II DM

Answer 44

Metformin

Question 45

Contraindications for biguanides?

Answer 45

Renal impairment eGFR < 30 or 30-60 + contrast - hold for 48h, hepatic impairment

Question 46

Advantages of biguanides

Answer 46

Weight loss, no hypoglycemia

Question 47

Thiazolidinediones therapeutic use?

Answer 47

Type II DM - rosiglitazone and pioglitazone | “Glitazone”

Question 48

Thiazolidinediones contraindications

Answer 48

Heart failure - may cause CHF, mentor for s/s of heart failure

Question 49

GLP-1 agonists

Answer 49

Exenatide, liraglutide, albiglutide, dulaglutide

Question 50

GLP-1 Agonists downfall

Answer 50

Injection only

Question 51

DPP-4 inhibitors

Answer 51

Sitagliptin, saxagliptin, alogliptin, lingagliptin

Question 52

DPP-4 inhibitors - positive aspects

Answer 52

PO, no adverse effects, no weight gain

Question 53

SGLT 2 inhibitors

Answer 53

Canaglifozin, dapaglifozin, empaglifozin

Question 54

SGLT 2 inhibitors

Answer 54

Work in kidney to increase excretion of glucose in urine

Question 55

SGLT 2 inhibitors advantages

Answer 55

Renal protection, lower BP, weight loss

Question 56

SGLT 2 inhibitors adverse effects

Answer 56

Limp amputation, electrolyte disturbances, bacterial UTI

Question 57

SGLT 2 inhibitors - why these are chosen

Answer 57

Reduces risk of heart failure and cardiovascular disease/events

Question 58

Thioureas used for?

Answer 58

Propylthiouracil, methimazole - hyperthyroidism

Question 59

Thioureas MOA

Answer 59

Does not effect the release of preformed T4 and T3

Question 60

A1c reduction with insulin

Answer 60

2.5%

Question 61

Thioureas takes how long to start working?

Answer 61

1-2 months

Question 62

Thioureas adverse effects

Answer 62

Rash, fluid retention, decreased WBC

Question 63

Synthetic thyroid hormones

Answer 63

Levothyroxine, liothyronine, liotrix

Question 64

Levothyroxine

Answer 64

Prodrug, takes weeks to work, adverse effects - heart failure