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Flashcards in Oral Glycemics 2 Deck (18)
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1

Which two types of drugs is hypoglycemia most common in? What are some risk factors for hypoglycemia?

-sulfonylurea drugs and insulin
->60 years old, impaired renal function, poor nutrition, liver disease, increased physical activity

2

List some of the symptoms of hypoglycemia.

-confusion, slurred speech, dizzy
-shaking
-sweating
-palpitations
-extreme hunger
headache
-vision changes
-unresponsiveness
-unconsciousness
-seizures

3

What are the treatment options for hypoglycemia?

1) Glucose
2) Glucagon- prophylactic rx for those at high risk (type 1 and type 2 with previous severe low blood sugar)

4

When is a glucagon emergency kit used? Whats given if a patient in the hospital has severe hypoglycemia?

-if unconscious or unable to swallow
-after administration turn on side and call 911
-Hospital: IV dextrose

5

What are some possible causes of oral therapy inadequacy (failure to reach targeted treatment goals)?

-dietary noncompliance and physical activity
-stress
-insulin resistance
-simultaneous use of diabetogenic drugs
-progressive B-cell dysfxn

6

What is Amylin? Name the Amylin analog that is used in insulin-requiring diabetics.

-peptide released with insulin from B cells that slows gastric emptying, suppresses postprandial glucagon secretion and reduces appetite
-Analog: Pramlintide (injection before meals)

7

Which patients is insulin used in?

-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

What are some of the reasons patients have for not wanting to use insulin?

-fear of injection
-permanence of having to take insulin
-failure in managing their diabetes
-inconvenience of monitoring
-fear the demands of insulin therapy

9

What are some indications for using insulin in type 2 diabetics?

-significant hyperglycemia at presentation
-hyperglycemia at max doses of oral
-Decompensation (weight loss, injury, stress, MI)
-surgery
-pregnancy
-renal or hepatic disease

10

What are the 3 rapid acting insulins?

-Lispro
-Aspart
-Glulisine
Onset: 5-30 min, Peak: 0.5-3 hrs, Duration: 3-5 hrs

11

What is the short acting insulin?

regular insulin-only insulin that can be given IV
Onset: 30-60 min; Peak: 1-5 hrs; Duration: 6-8 hrs

12

What are the 4 intermediate acting insulins?

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

What are the 2 long acting insulins?

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

Name the 5 premixed insulins and what their components are.

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

What are some advantages to using premixed insulin?

-convenient
-longer shelf life
-less dosing errors
-simpler

16

What are some disadvantages to using premixed insulin?

-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

How is Insulin stored?

-refrigerated, never freeze, avoid direct sunlight

18

List the common areas for insulin injection in order of increased absorption to decreased?

Abdomen>arm>buttocks>thigh
**must rotate sites to avoid lipohypertrophy or lipoatrophy**