Insulin and Oral Hypoglycemics

Question 1

Where is insulin made?

In what form is it made and what are the steps to become insulin?

Answer 1

made in the beta cells of Islets of Langerhans

Preproinsulin->proinsulin->insulin+C-peptide

Question 2

Insulin leads to increased synthesis of _________, _________., and ___________

Answer 2

glycogen, protein and fatty acid

Question 3

Insulin decreases glucose phosphorylation in cells. t/f

Answer 3

F, it enhances phosphorylation

Question 4

Name 5 metabolic processes insulin decreases

Answer 4

Glycogenolysis
gluconeogenesis
ketogenesis
lipolysis
protein catabolism

Question 5

what is the main function of insulin?

Answer 5

carry glucose across cell membrane?

Question 6

Aside from monitoring glucose during an insulin infusion, what other lab is important to consider?

Answer 6

potassium

insulin drive K intracellular

Question 7

Insulin is made of 2_________, joined by 3 ___________.

Answer 7

amino acid chains

disulfide bonds

Question 8

Endogenous insulin is metabolized by kidney and liver, and ____% first pass

Answer 8

50

Question 9

What is the duration of action of endogenous insulin

Answer 9

30-60 minutes

Question 10

What is the basal rate of insulin production

Answer 10

1 u/hour

up to 40 u/day

Question 11

What is onset, peak, and duration of Fast acting insulin?

What’s an example?

Answer 11

Lispro
Onset 5-15 min
peak 1 hour
Duration: 4-5 hours

Question 12

What is onset, peak, and duration of regular insulin?

Answer 12

Onset: 30 min
Peak 2-3 hours
Duration 6-10 hours

Question 13

What is onset and duration of NPHt’s an example?

Answer 13

Isophane
Onset 2-5 hours
Duration 10-20 hours
Variable peak

Question 14

What is onset and duration of Long acting insulin?

What’s an example?

Answer 14

Ultralente
Onset: slow
duration prolonged: 16-20 hours

Question 15

What are guidelines for insulin preoperatively?

Answer 15

cut A.M. insulin in half or cut all of it
DM pts should be first case of the day
or start an IV and check glucose as soon as they come in

Question 16

What is the real long acting insulin that doesn’t have much of a peak

Answer 16

glargine/lantus

Question 17

give 3 examples of bolus insulins and 4 basal insulins

Answer 17

Bolus: regular, humalog/lispro, Novolog/aspart (Apidra/glulisine)
Basal; NPH, Lente, Ultralenta, lantus/glargin (Levemir/detemir)

Question 18

________ (Bolus/Basal) insulin more accurately reflects endogenous insulin

Answer 18

Bolus

Question 19

What are uses of regular insulin?

Answer 19

Abrupt onset of hyperglycemia
Ketoacidosis
Hyperkalemia

Question 20

What does NPH stand for?

Answer 20

Neutral protamine hagedorn

Hagedorn was a danish guy who created NPH insulin

Question 21

How does protamine affect subQ insulin?

Answer 21

slows subQ absorption

Question 22

How much protamine in is nph insulin?

Answer 22

0.005 mg/u

Question 23

What is the calculation for basal dose or infusion of insulin?

Answer 23

(glucose-100)/40

Question 24

What is the calculation for a bolus dose of insulin?

Answer 24

glucose/150

Question 25

1 U of insulin lows blood glucose ___________mg/dL

Answer 25

25-30

Question 26

What are the side effects of insulin?

Answer 26

``` Hypoglycemia!!!!! Allergic rxn Lipodystrophy resistance drug interactions ```

Question 27

What are initial symptoms of hypoglycemia?

Answer 27

Diaphoresis tachycardia hypertension

Question 28

What is the allergic reaction to insulin etiology?

Answer 28

Immune reactions are rare, it is usually a local allergy | protamine

Question 29

What is lipodystrophy?

Answer 29

Loss of fat from one area Lump or small dent in the skin that forms when a person performs injections repeatedly in the same spot. Can cause rejection or slowed absorption of injected medication Rotate injection sites

Question 30

What drugs do insulin interact with?

Answer 30

``` Epinephrine-inhibits insulin release MAO Inhibitors-inhibits pancreatic islets Antibiotics -tetracycline-inhibits insulin release Salicylates-increase insulin release ```

Question 31

HOw do sulfonylureas work?

Answer 31

Stimulate insulin secretion | hypoglycemia is a risk

Question 32

How do meglitinides work?

Answer 32

stimulate insulin secretion | hypoglycemia is a risk

Question 33

How do biguanides work?

Answer 33

Inhibit glucose production by liver | metformin

Question 34

What are the alph-glucosidase inhibitors?

Answer 34

Slows digestion and absorption of carbohydrates | acarbose

Question 35

Which group of pts would you want you want to avoid sulfonylurea?

Answer 35

sulfa allergy | They will be ineffective in type 1 dm

Question 36

Waht is mechanism and site of action of sulfonylurea?

Answer 36

Binds to ATP dependent channel on b cells in islets of longerhans causes an increase in intracellular Ca which results in increased fusion of insulin granulae with the cell membrane

Question 37

What is primary and secondary failure of sulfonylurea?

Answer 37

primary-pt never achieve satisfactory response | secondary- pts become resistant

Question 38

______% of sulfonylurea are protein bound

Answer 38

90-95% bound to albumen

Question 39

where is sulfonylurea metabolized?

Answer 39

liver metabolism | renal excretion

Question 40

Tolbutamide (orinase), Acetohexamide and chlorpropamide are examples of?

Answer 40

first gen sulfonylureas

Question 41

Glyburide and glipizide are examples of ?

Answer 41

second gen sulfonylureas

Question 42

What drug class does metformin belong to? HOw does it work?

Answer 42

biguanide | inhibits gluconeogenesis

Question 43

What is the side effect of metformin?

Answer 43

Lactic acidosis

Question 44

Metformin should be held at least _____ hours before surgery

Answer 44

12

Question 45

Too much acarbose can induce hypoglycemia. T/F

Answer 45

F

Question 46

IN a pt with type II diabetes, what is a strong independent predictor of cardiomyopathy?

Answer 46

Hgb A1C levels

Question 47

What is prediabetes range of A1C?

Answer 47

5.7-6.4%, whcih corresponds to fasting plasma glucose test 100-125

Question 48

The goal for A1C is less than _____% which is estimated average glucose of ____

Answer 48

7% | 154

Question 49

A1C measures glucose over the last ____ months

Answer 49

3