Term
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Definition
| Ultra Short acting Insulin for BOLUS and less hypoglycemia between meals and less nocturnal hypoglycemia |
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Term
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Definition
Medium duration Insulin: BASAL for SPLIT MIXED
duration 15 hrs
Protamine = fish allergies! cloudy
mix immediately before use |
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Term
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Definition
Long acting Insulin basal
pH = 4 means precipitates @ injection site THEREFORE DONT MIX
Zn allergic reaction possible 1/day
1 inject/dat |
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Term
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Definition
long acting Insulin basal
2/day
DO NT MIX |
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Term
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Definition
| short acting insulin (bolus) |
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Term
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Definition
Sulfonylurea insulin secretagogue DM2:
blocks ATP dependent K + channels which depolarize cell and allows Ca2+ to enter thereby enabling insulin vesicle fusion
Reduces glucagon levels
Increased insulin binding to target T.
Absorbed GI (hyperglycemia can reduce)
given 30 mins prior to meal and binds plasma proteins
Metabolised by liver, excretedy by kidney
Thizide and Ca2+ reduce
salicates,gemofibrozil, allopurinol, chloramphen, MAO increase
HYPOGLYCEMIA AND WEIGHT GAIN contraindicated in renal/hepatic disease or gestational diabetes
A1c 1.5 - 2
better on SE than glyburide
poorer outcomes after mi |
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Term
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Definition
Sulfonylurea insulin secretagogue DM2: blocks ATP dependant K (depolarizes --> Ca influx --> vesicle fusion)
Absorbed GI (hyperglycemia can reduce) given thirty mins prior to meal met liver excrete kidney
More potent and side effects than glimeperide (hypoglycemia and weight gain)
Thizide and Ca2+ reduce
salicates,gemofibrozil, allopurinol, chloramphen, MAO increase |
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Term
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Definition
| sulfonylurea insulin secretagogue |
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Term
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Definition
biguanide DM2: Stimulated AMPK inhibits hepatic glucose production, increases B oxidation, increases Glut4. Also decreases glucagon.
(AMPK and Glucagon)
Absorbed SI, no plasma pro binding, excreted unchanged urine.
No weight gain, positive effect lipids, no hypoglycemia
Diarrhea/abdominal/nausea/anorexia/DECREASED b12/FOLATE
Contraindicated HEPATIC/RENAL DX
HISTORY LACTIC ACIDOSIS or Cardiac failure
avoid concurent ionated contrast
AVOID CIMETIDINE (increases 60%)
A1c 1/5-2 |
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Term
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Definition
alpha glucosidase inhibitor for DM1/2: reduces CHO absorb brush border
Abdominal discomfort contraindicated in irritable bowel (measure transaminase every 3 mo).
B12/folate anemia |
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Term
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Definition
glinide insulin secretagogue: blocks ATP dependant K+ channels
rapid onset and short duration
BETTER MODERATE ELEVATED THAN HIGH
dosed at meal times, for PPG
causes hypoglycemia and weight gain
A1C = 1.5-1, down PPG, CYP 3A4
better than nateglinide
AVOID GEMOFIBROZIL AND ANTIFUNGALS BECUASE OF METABOLISM DECREASE |
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Term
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Definition
glinide insulin secretagogue: blocks ATP dependant K+ channels
rapid onset and short duration, dosed mealtimes for PPG
CYP 2C9
Better moderately elevated glucose
causes hypoglycemia and weight gain
A1C = 1.5-1, down PPG
RENAL EXCRETION (caution kidney problem) |
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Term
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Definition
TDZ/Glitazone insulin sensitizer: reverses resistance through PPAR-y --> fascilliates FFA storage and decreases HGP
Increases HDL
CYP3A4 metabolism (avoid fungals!)
fluid retention/weight gain/headache/upper gi/ reduced bone mineral density
contraindicated liver disease
A1C~1
contraindicated stage III/IV heart failure, may cause bladder cancer
fasting more than post prandal |
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Term
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Definition
TDZ/Glitazone insulin sensitizer: reverses resistance through PPAR-y --> fascilliates FFA storage and decreases HGP
CYP3A4 metabolism (avoid fungals!)
INCREASES HDL
contraindicated stage III/IV CHF due to fluid retention
A1C~1
may cause bladder cancer, not recommended patients taking nitrates
fasting not post prandial glucose |
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Term
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Definition
GLP-1 agonist for DM2 (incretin)IV:
causes insulin secretion for phase 1
CAUSES WEIGHT LOSS and/or Hypoglycemia
may have GI upset/pancreatitis/thyroid issues
may develope anti-bodies, reduce renal function
contraindicated thyroid cancer, pancreatitis, impaired renal, gi disease
interacts antibiotics, warfarin (increase bleeding)
A1C ~1%, approved mono therapy |
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Term
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Definition
Dpp4 Inhibitor DM2: block incretin degradation to increase 1st phase insulin, blocks glucagon
less potent exenitide, may cause hypoglycemia
avoid 3A4 reactions
no effect on weight or appetite, less gi issues than exenitide
may have hypersensitivity and pancreatic metaplasia and increased risk infection
A1C ~ .5%, approved mono therapy |
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Term
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Definition
Amyline analogue sc inject: slows gastic emptying and decreases glucagon for DM1 and DM2 for POST PRANDLE USE
may cause severe hypoglycemia/gi upset
(black box warning)
metabolized by kidneys, 1/2 bound plasma proteins
A1c .3-.6% |
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Term
| Theraputic A1c levels diabetes |
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Definition
6.5-7.5 = monotherapy
7.5-9.0 = dual therapy
9.0 + = insulin + other
GOAL <7% |
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Term
| common hypoglycemic drugs |
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Definition
b-blocker
ethanol
salicates
pentamidine (b-cell destruction |
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Term
| common hyperglycemic drugs |
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Definition
| epi,glucocorticoids, oral contraceptives, ca blockeres, diuretics, pentamidine, atypical antipsycotics, protease inhibitors |
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Term
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Definition
.55 * kg or weight/4
1/2 goes to long term
1700/Tdd = drop insulin per unit |
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