Pharmacology & Exercise for Diabetes Flashcards
(40 cards)
insulin therapy in Type 1 diabetes - 2 options
basal-bolus injection therapy or continuous subcutaneous insulin infusion
basal-bolus injection therapy
this is considered intensive therapy - bc requires at least 3-5 injections and is the co=losest to our bodies physiological response
bolus insulin at meal times and basal injection once or twice daily
- covers insulin requires fro meal
continuous subcutaneous insulin infusion
insulin pump therapy via catheter into subcutaneous tissue
- covers insulin need throughout the day and into the night- this is also considered intensive therapy
what is conventional therapy?
more commonly used in elderly and less educated patients and it is limited to 2 injections a day
why is basal insulin important?
bc our normal physiological response is never at zero - insulin has a base level - need to maintain this in therapy
why is bolus insulin important?
to cover the glucose bumps after meals
human basal injection
requires one injection/day in the morning
- it reaches basal insulin levels higher than required and has a slow release which will peak around lunch time, then reaches normal physiological peaks later in the day
analogue basal insulin
this is better formulated than the human basal insulin bc it maintains basal levels closer to normal physiological levels and avoids a peak in the middle of the day
human bolus
3 injections per day
- inject right before meal, and peak will be slightly delayed
analogue bolus
3 injection per day
- better pairing with blood glucose compared to human bolus
conventional therapy
not recommended or preferred treatment
- premixed insulin ( mis of long and short actin insulin with different ratios)
human vs analogue premixed insulin
human will partially cover break, lunch and dinner
analogue will cover quite well breakfast and dinner but skip lunch almost entirely ( risks of hypo and hyper)
types of bolus insulin
rapid acting (Lispo/humalog) and short acting (regular/ humulin)
types of basal insulin
intermediate acting ( NPH?humulin) long acting (Glargine/Lantus)
premixed
30 % reg / 70% NPH
considerations for conventional insulin therapy
strict meal plan, consistent meals day to day, PA may lead to hypoglycemia
intensive therapy considerations
more flexible with mea timing - MUST learn carb counting - dose may be adjusted for exercise -alwasys preferred over conventional -
why is intensive therapy better?
DCCT study showed that intensive sharply declined A1C, whereas conventional remained high (8.5%)
also reduced the risk of non-fatal MI, stoke and health from CVD (60% decrease- this is HUGE)
Metformin (glucophage) mechanism
first line medication for diabetes
- has 2 actions:
1. in liver- decrease gluconeogeneis
2. increase insulin sensitivity
other benefits of metformin
known safety, no hypoglycaemia, weight management, few side effects
what are side effects
mostly just GI , B12 and folate must be monitored annually!
contraindications for metaformin
renal insufficiency, liver or heart failure
Alpha-glucosidase inhibitors mechanism
in the intestine to delay intestine glucose absorption (must be taken with meals)
insulin secretagogues
will stimulate the secretion of insulin - short acting 4-7 hours or long lasting - once daily
