Exam 6: DM Flashcards
Type 1 vs Type 2
Type 1 - beta cells of the pancreas (which produce insulin) are destroyed by antibodies
Type 2 - body cells become resistant to insulin and cannot bind and eventually impaired secretion as well from beta cell atrophy and death
Diagnostic tests and ranges
Hemoglobin A1C > 6.5% (aim for DM to be <7%)
Fasting plasma glucose >126 mg/dL (premeal aim for 80-130 and post meal <180)
Oral glucose tolerance test >200 mg/dL
order of mixing insulin
clear before cloudy
Somogye effect
“rebound hyperglycemia” from taking too much insulin before bed
recent contradicting evidence
wake up hyper bc hypo overnight -> tx w/ bedtime snack
Dawn phenomenon
happens naturally to everyone w/ diabetes because of natural diurnal hormone patterns
overall ADRs for insulin
Hypoglycemia
Lipodystrophy
Lispro
(Humalog)
Solution: clear
Admin: SQ
Concentration: U100
Onset: 10-30 min
Peak: 30m-2.5hrs
Duration: 3-6 hrs
*can mix w/NPH
Afrezza
Rapid acting (meal time insulin)
Admin: Inhaled
Concentration: 4, 8, 12 u cartridges
Onset: ?
Peak:
Duration:
Humulin R/Novolin R
Regular insulin (short duration: slower acting)
Solution: clear
Admin/Concentration: U100 = SQ, IM, IV; U500 = SQ, IM
Onset: 30-60 min
Peak: 1-5 hrs
Duration: 6-10 hrs
*can mix w/NPH
Humulin N/Novolin N
iNtermediate acting insulin (NPH)
Solution: cloudy
Admin: SQ - must roll before admin (do not shake)
Concentration: ?
Onset: 1-2 hrs
Peak: 6-14 hrs
Duration: 16-24 hrs
- only one approved to mix with rapid and short acting
Glargine/Detemir
(Lantus) (Levemir)
Long Duration Insulin
Solution: Clear
Admin: Qday SQ
Concentration: ?
Onset: 1-2 hrs
Peak: None
Duration: 24 hrs
Glargine/Degludec
(Toujeo)/(Tresiba)
Ultra-long Duration Insulin
Solution: Clear
Admin: Prefilled pens SQ Qday
Concentration: Toujeo - U300; Tresiba - U100, U200
Onset: 6 hrs
Peak: None
Duration: >24 hrs
T2DM tx
Step 1:
Lifestyle changes + Metformin
Step 2: A1C is >7.5
Continue lifestyle changes & Metformin
One additional drug
Step 3:
Progress to a 3-drug regimen
Step 4:
Include insulin in the regimen
Insulin storage
no direct sunlight
lasts longer if refridgerated
room temp = 1 month
fridge = 3 months
Insulin teaching points
roll, don’t shake NPH
don’t share pen device
controls ^BGL, doesn’t cure diabetes
glucose testing
s/s hypoglycemia
nutrition education
carry sugar and med ID
rotate sites and clean well
admin @ start of meal or right after (NOT before)
Metformin
(Biguanides) PO [1st line]
MOA: suppresses gluconeogenesis & increases insulin sensitivity (slightly reduces GI glucose absorption)
ADRs:
- lactic acidosis - hyperventilation/myalgia/malaise
- GI upset (eat w/food)
- decrease appetite (weight loss - benefit)
Contraindications: renal disease (CBC), contrast CT (48 hours)
only med given in pregnancy
Glipizide
(Sulfonylureas) Glyburide, Glimepiride
MOA: stimulates beta cells to release insulin (helps make more)
ADRs: hypoglycemia, weight gain, antabuse, teratogenic, Bblkers diminish effects
risk for hypoglycemia
Repaglinide
Meglitinides (Glinides)
(Prandin)
MOA: stimulates pancreatic release of insulin
*quick onset and short duration
ADR: hypoglycemia (eat w/in 30 min of taking meds)
Pioglitazone/Rosiglitazone
Thiazolidinediones (Glitazones)
MOA: decreased insulin resistance -> increase insulin sensitivity -> increased uptake into tissues and decreased release
ADRs: weight gain, **fluid retention -> exacerbate HF, bone fractures, hepatotoxicity
Acarbose
Alpha-glucosidase inhibitors
MOA: delay absorption of carbs -> blocks enzyme in small intestine that breaks down complex carbs
ADRs: GI (from carbs in colon not broken down), decrease absorption of iron (anemia)
Sitagliptin
DPP4 Inhibitors (Gliptins)
MOA: enhances action of incretin hormones (release insulin, inhibit glucagon, slow gastric empty, suppress appetite)
ADR: pancreatitis, hypersensitivity
-gliflozin
SGLT2 Inhibitors
MOA: block reabsorption of glucose -> increase urinary glucose to decrease serum glucose
Contra: renal disease
ADR: fungal infx, UTI, polyuria, hypotension
Exenatide
Incretin Mimetics (SQ) (T2DM only)
combo w/metformin or sulfonylurea
MOA: mimics incretin (release insulin, inhibit glucagon, slow gastric empty, suppress appetite) -> glucose control and weight loss
ADR: hypoglycemia w/sulfonylurea, GI, pancreatitis, slows gastric motility
Pramlintide
Amylin Mimetics (T1DM & T2DM)
MOA: supplements mealtime insulin -> delays gastric empyting and suppress glucagon release
ADRs: hypoglycemia (insulin may need to be reduced), GI
seperate sites from insulin, immediately before meals, wait an hour before any PO meds
