Rapid Insulin

Question 1

Rapid acting insulins include:

Answer 1

Aspart, lispro, glulisine

Question 2

The onset, peak and duration of action for rapid acting insulin

Answer 2

Onset: 5-15 min.
Peak: 45-75 min.
Duration: 2-4 hours

Question 3

Regular is considered

Answer 3

Short acting insulin and it has an onset of 30 minutes, a peak of 2-4 hours, and a duration of 6-8 hours

Question 4

Intermediate acting insulin includes

Answer 4

NPH

Question 5

The onset, peak, and duration of intermediate acting insulin is

Answer 5

Onset: 2 hours
Peak: 4-12 hours
Duration: 18-28 hours

Question 6

Long acting insulin includes

Answer 6

Detemir

Glargine

Question 7

Onset, peak and duration for long acting insulin is

Answer 7

Onset: 2 hours
Peak: 3-9
Duration up to 24

Question 8

The most commonly used commercial preparation is

Answer 8

Insulin U-100

Question 9

Type 1 DM patients

Answer 9

Require at least two daily SQ injections of intermediate or long acting insulin and rapid acting insulin following meals

Question 10

The benefit of lispro is

Answer 10

Decrease in postprandial hyperglycemia and less risk of hypoglycemia

Question 11

Lispro has a lysine switch that prevents

Answer 11

Hexamer formation and the monomer is rapidly absorbed

Question 12

Regular insulin is the only

Answer 12

Preparation that can be given IV and subcutaneous

Question 13

What are the five main side effects of insulin?

Answer 13

Hypoglycemia (most serious side effect) and the first symptoms are compensatory effects of increased epinephrine secretion (diaphoresis, tachycardia, HTN) 
Allergic reactions
Lipodystrophy
Insulin resistance
Drug interactions

Question 14

The four classes of oral anti diabetics include:

Answer 14

Secretagogues, biguanides, thiazolidinediones, and alpha glucosidase inhibitors

Question 15

Contraindications for metformin include

Answer 15

Lactic acidosis, AKI, GI intolerance, and acute hepatic disease

Question 16

Metformin does not

Answer 16

Undergo metabolism!

Question 17

The mechanism of action of metformin is

Answer 17

It activates adenosine monophosphate activated protein kinases

Question 18

Metformin should be

Answer 18

Discontinued 48 hours prior to surgery and should not be administered in patients with hepatic dysfunction, renal insufficiency, IV contrast dye, acute MI, CHF arterial hypoxemia and sepsis

Question 19

Sulfonylureas should not

Answer 19

Be administered to patients with sulfa allergy

Question 20

Secretagogues

Answer 20

Include sulfonylureas and meglitinides increase insulin availability

Question 21

Biguanides

Answer 21

Include metformin and it suppresses excessive hepatic glucose release

Question 22

Thiazolidinediones or glitazones

Answer 22

Include rosiglitazone and pioglitazone and they improve insulin sensitivity

Question 23

Alpha glucosidase inhibitors include

Answer 23

Acarbose and Miglio ok and they delay GI glucose absorption (used to maintain glucose control)

Question 24

With sulfonylurea oral hypoglycemics

Answer 24

Hypoglycemia while infrequent is more often prolonged and more dangerous than hypoglycemia from insulin

Question 25

Sulfonylureas close

Answer 25

K-ATPase channels and inhibit ischemic preconditioning (CV mortality has been associated with sulfonylureas)

Question 26

Accumulation of active metabolites

Answer 26

May cause hypoglycemia with nateglinide

Question 27

Acarbose and Miglitol work by

Answer 27

Decreasing carbohydrate digestion and absorption of dissachardies by interfering with intestinal glucosidase activity

Question 28

Thiazolidinediones work by

Answer 28

Decreasing insulin resistance and hepatic glucose production and increase use of glucose by the liver

Question 29

Glucagon like peptide 1 receptor agonists

Answer 29

Increase insulin secretion from beta cells (glucose dependent)

Question 30

Amylon agonists

Answer 30

Do not alter insulin levels and instead readied HBA1 C

Question 31

The goal of combination therapy is:

Answer 31

Decrease hba1c, decrease in daily insulin dose

Question 32

Diabetic autonomic neuropathy is

Answer 32

Decreased ability to compensate/risk of CV stability/ sudden cardiac death

Question 33

Diabetic patients should be

Answer 33

Assessed for temporomandibular joint and cervical spine mobility to assess difficult intubation

Question 34

Glucose levels should be kept less than

Answer 34

180 mg/dL Intraop

Question 35

AM dose of regular insulin

Answer 35

Should be held on the day of the surgery

Question 36

Plasma glucose should be monitored

Answer 36

Q30 minutes or hourly

Question 37

What drugs should be discontinued 24-48 hours before surgery?

Answer 37

Sulfonylureas and metformin due to long half lives