Term
| What are the rapid acting insulin preparations, and what is their onset time? |
|
Definition
Lispro, aspart, glulisine, crystalline zinc (30 min)
onset time: ~15 minutes |
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Term
| What is the duration of the different insulin preparations? |
|
Definition
rapid acting: 3-6 hours (regular insulin is 6-8 hrs)
intermediate acting: 12-16 hours
long acting: 24-36 hours (detemir is 12-24) |
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Term
| What are the intermediate & long acting insulin preparations, and what is their onset time? |
|
Definition
1-2 hours
lente insulin(zinc) (12-16)
NPH insulin (protamine) (12-16)
insulin glargine (24+)
insulin detemir (12-24) |
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Term
| What are the adverse effects from overdose of insulin preparation? |
|
Definition
| hypoglycemia: fatigue, rapid HR, confusion, coma, localized & systemic allergic rxns |
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Term
| What factors increase the dose requirement for insulin? |
|
Definition
hyperthryoidism
stress (surgery, injury, mental)
cessation of physical exercise
increased food intake
drugs (estrogens, thiazide diuretics) |
|
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Term
| How do you treat emergency ketoacidosis? |
|
Definition
|
|
Term
| What are the pre-mixtures? |
|
Definition
70% NPH & 30% Aspart
50% NPH & 50% Lispro |
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Term
| How do sulfonylureas work? |
|
Definition
They increase insulin by:
bind to receptors near K+ channels & close them preventing K+ efflux, depolarize the cell, Ca channels open/Ca flows in, insulin is secreted |
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Term
| What is the result of chronic administration of sulfonylureas? |
|
Definition
| decreased glucagon & potentiated effects of insulin |
|
|
Term
| What are the adverse effects of sulfonylureas? |
|
Definition
| hypoglycemia, GI Sxs, muscle weakness, mental confusion |
|
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Term
| What are the 1st generation sulfonylureas and what is their duration of action? |
|
Definition
tolbutamide (6-12)
tolazamide (10-14)
chlorpropamide (up to 60hrs) |
|
|
Term
| What are the 2nd generation sulfonlyureas, and what is their duration of action? |
|
Definition
10-24hrs
glyburide
glipizide
glimepiride |
|
|
Term
|
Definition
oral hypoglycemic agent that stimulates insulin secretion (closes K+ channels)
lasts 1-3 hours
taken only w/meals |
|
|
Term
|
Definition
does NOT cause hypoglycemia
decreases gluc production and increases gluc uptake in the liver
requires insulin to be effective |
|
|
Term
| What are the adverse effects of metformin? |
|
Definition
lactic acidosis in renal patients
metallic taste, GI upset, anorexia |
|
|
Term
|
Definition
| inhibits alpha-glucosidase so carbs are not hydrolyzed; delays absorption of glucose (taken at beginning of meal) |
|
|
Term
| What are the adverse effects of acarbose? |
|
Definition
flatulence, cramps, diarrhea
may reduce iron absorption |
|
|
Term
| rosiglitazone/pioglitazone |
|
Definition
decrease insulin resistance by increasing transcription of insulin-responsive genes
decreases gluconeogensis and ^ gluc uptake
Rosiglitazone in combo w/metformin |
|
|
Term
| What are the adverse effects of rosiglitazone/pioglitazone? |
|
Definition
| weight gain, edema, ^ risk of heart failure |
|
|
Term
|
Definition
potentiate insulin synthesis/release, decrease glucagon production
inhibits DPP4 (prevents metab of incretin hormones)
AE: mild GI upset, hypoglycemia |
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|
Term
| What is the only oral hypoglycemic agent that does not cause hypoglycemia? |
|
Definition
|
|
Term
|
Definition
injectable:2x/day--added on to other meds (metformin or sulfonylurea)
GLP1 receptor agonist
stimulates insulin when glucose is high
delays gastric emptying
blocks glucagon release
AE: nausea |
|
|
Term
|
Definition
injectable analog of amylin
decreases glucagon secretion
modulates post-prandial glucose
to tx type I: combine w/insulin
to tx type II: combined w/insulin, metformin, or sulfonylureas |
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