Oral Glycemics 2 Flashcards Preview

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Flashcards in Oral Glycemics 2 Deck (18)
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1
Q
Which two types of drugs is hypoglycemia most common in? What are some risk factors for hypoglycemia?
A
-sulfonylurea drugs and insulin
->60 years old, impaired renal function, poor nutrition, liver disease, increased physical activity
2
Q
List some of the symptoms of hypoglycemia.
A
-confusion, slurred speech, dizzy
-shaking
-sweating
-palpitations
-extreme hunger
headache
-vision changes
-unresponsiveness
-unconsciousness
-seizures
3
Q
What are the treatment options for hypoglycemia?
A
1) Glucose
2) Glucagon- prophylactic rx for those at high risk (type 1 and type 2 with previous severe low blood sugar)
4
Q
When is a glucagon emergency kit used? Whats given if a patient in the hospital has severe hypoglycemia?
A
-if unconscious or unable to swallow
-after administration turn on side and call 911
-Hospital: IV dextrose
5
Q
What are some possible causes of oral therapy inadequacy (failure to reach targeted treatment goals)?
A
-dietary noncompliance and physical activity
-stress
-insulin resistance
-simultaneous use of diabetogenic drugs
-progressive B-cell dysfxn
6
Q
What is Amylin? Name the Amylin analog that is used in insulin-requiring diabetics.
A
-peptide released with insulin from B cells that slows gastric emptying, suppresses postprandial glucagon secretion and reduces appetite
-Analog: Pramlintide (injection before meals)
7
Q
Which patients is insulin used in?
A
-Type 1 diabetics
- Type 2 when there is glucose toxicity, insufficient endogenous insulin or a contraindication to oral therapy
**DO NOT use Insulin as a threat, last resort or as a reflector of pt compliance failure**
8
Q
What are some of the reasons patients have for not wanting to use insulin?
A
-fear of injection
-permanence of having to take insulin
-failure in managing their diabetes
-inconvenience of monitoring
-fear the demands of insulin therapy
9
Q
What are some indications for using insulin in type 2 diabetics?
A
-significant hyperglycemia at presentation
-hyperglycemia at max doses of oral
-Decompensation (weight loss, injury, stress, MI)
-surgery
-pregnancy
-renal or hepatic disease
10
Q
What are the 3 rapid acting insulins?
A
-Lispro
-Aspart
-Glulisine
Onset: 5-30 min, Peak: 0.5-3 hrs, Duration: 3-5 hrs
11
Q
What is the short acting insulin?
A
regular insulin-only insulin that can be given IV
Onset: 30-60 min; Peak: 1-5 hrs; Duration: 6-8 hrs
12
Q
What are the 4 intermediate acting insulins?
A
NPH
NPL
NPA
Onset: 1-4 hrs, Peak: 4-10 hrs, Duration: 14-24 hrs
Detemir at lower doses Onset: 3-4hrs, Peak: 4-8hrs, Duration: 6-24hrs
13
Q
What are the 2 long acting insulins?
A
Detemir- at higher doses
Glargine-can't be mixed in syringe with any other type insulin (Onset: 2-3 hrs; Peak: none, Duration: 24-30 hrs)
**used for basal insulin**
14
Q
Name the 5 premixed insulins and what their components are.
A
Humulin/Novolin (70/30) -30% reg and 70% NPH
Novolog Mix (70/30)- 30% aspart and 70% aspart protamine
Humalog Mix 75/25- 25% lispro and 75% lispro protamine
Humulin 50/50- 50% reg and 50% NPH
Humalog Mix 50/50-50%lispro and 50% lispro protamine
15
Q
What are some advantages to using premixed insulin?
A
-convenient
-longer shelf life
-less dosing errors
-simpler
16
Q
What are some disadvantages to using premixed insulin?
A
-Loss of flexibility (matching to carb intake and activity)
-harder to tx short term high or low glucose levels
-hypoglycemia risk
**rarely used in Type 1**
17
Q
How is Insulin stored?
A
-refrigerated, never freeze, avoid direct sunlight
18
Q
List the common areas for insulin injection in order of increased absorption to decreased?
A
Abdomen>arm>buttocks>thigh
**must rotate sites to avoid lipohypertrophy or lipoatrophy**