Term
What synthesizes insulin and where?
|
|
Definition
- Beta cells of pancreas
- Located in Islets of Langerhans
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Term
| 2 types of insulin action |
|
Definition
- Glucoregulatory
- Anti-lipolytic
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Term
2 stimuli of insulin secreations
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Definition
- Elevation in blood glucose levels
- Release of fatty acids, amino acids, or ketones
- Sympathetic stimulation
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Term
| Primary stimulus of insulin secretions |
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Definition
| Elevation of blood glucose levels |
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|
Term
|
Definition
- DM (Type 1 and 2)
- Hyperkalemia
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|
Term
| How does insulin help in hyperkalemia? |
|
Definition
Drives potassium back into cell, along with glucose
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|
Term
Immediate precursor to natural insulin
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Definition
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|
Term
| What is different about natural insulin and manufactured insulin? |
|
Definition
Natural insulin has C-peptide (connective peptide)
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Term
| Why does it matter that natural insulin has C-peptide? |
|
Definition
It means you can measure the amount of natural vs manufactured insulin in the blood
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Term
|
Definition
- Inheritance
- Auto-immunity
- Environmental Damage (illness, chemical, injury)
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|
Term
|
Definition
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|
Term
| What does insulin resistance mean? |
|
Definition
It is still produced, just does not get into the cell
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|
Term
Can we tell how resistant someone is?
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|
Definition
No, there is no good lab value that measures degree of resistance
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Term
| Which type of DM is preventable? |
|
Definition
|
|
Term
| What kind of DM is gestational? |
|
Definition
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|
Term
| The incr is prevalence of GDM seems to mimic the incr in what? |
|
Definition
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|
Term
Post-partum, of those with GDM, how many will have T2DM?
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Definition
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|
Term
| Within 5-10 years, how many of those with GDM will develop T2DM? |
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Definition
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
Glucagon vs Insulin
Similar or opposite action?
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Definition
|
|
Term
4 things promoted/reduced by glucagon
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|
Definition
- Promotes breakdown of glycogen
- Promotes glucose biosynthesis
- Promotes relaxation of GI smooth muscles
- Reduces glycogen synthesis
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Term
In NPO patients waiting for GI procedures, what drug might be used to prevent hypoglycemia?
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|
Definition
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|
Term
| Glucagon treats hyperglycemia secondary to what? |
|
Definition
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|
Term
When would glucagon not work for hyperglycemia?
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|
Definition
- Hyperglycemia secondary to starvation
- Glycogen is stored in the muscles and most anorexics don't have muscles, so they don't have glycogen
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Term
| How can glucagon be given and what is the preferred method? |
|
Definition
- IV (prefered)
- Oral (if awake and no chance of unconsciousness)
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|
Term
Is regular insulin clear or cloudy?
|
|
Definition
|
|
Term
| Regular insulin is the only insulin that can be administered _____ |
|
Definition
|
|
Term
Where should regular insulin be kept?
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|
Definition
Refrigeration is not necessary, but it must be kept out of the warmth and sunlight |
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|
Term
Why should regular insulin be kept out of the warmth and sunlight?
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|
Definition
| Denatures the insulin protein |
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|
Term
| When do you give humalog (Lispro) insulin? |
|
Definition
Within 5 minutes of eating
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|
|
Term
How is humalog (Lispro) made?
|
|
Definition
Through recombinant DNA technology, via E. coli
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|
|
Term
What is the difference between the chemistry of humalog (Lispro) and regular insulin?
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|
Definition
| Placement of 2 amino acids |
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|
Term
What do the 2 amino acids in humalog (Lispro) change?
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|
Definition
|
|
Term
| How does the chemistry of NPH differ from regular insulin? |
|
Definition
| It has a large protein, protamine, attached to regular insulin |
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|
Term
|
Definition
|
|
Term
| How often is NPH usually given? |
|
Definition
|
|
Term
| Is NPH used for quick results, when insulin is needed immediately? |
|
Definition
|
|
Term
| How is NPH usually given at breakfast? |
|
Definition
| With a short-acting insulin |
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|
Term
Which drug has a long duration, so that peak is around 3-4pm and a midafternoon snack is needed?
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|
Definition
|
|
Term
| Why is a midafternoon snack needed with NPH? |
|
Definition
|
|
Term
|
Definition
| Peaks and valleys are not good for fatty acid production and glucagon rescue efforts |
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|
Term
|
Definition
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|
Term
What do blood sugar levels look like with glargine (Lantus)?
|
|
Definition
|
|
Term
| What is minimized with glargine (Lantus)? |
|
Definition
Risks of hypo/hyperglycemia
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|
|
Term
| How is glargine (Lantus) given? |
|
Definition
|
|
Term
If mixing a cloudy and a clear insulin together, which is loaded into the syringe first and why?
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|
Definition
- Clear first
- So that clear is not contaminated with cloudy (the bottle you draw the clear from)
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|
|
Term
Which insulin cannot be mixed in the same syringe with any other insulin?
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|
Definition
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|
Term
When taking glargine (Lantus), how does it work when eating?
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|
Definition
| Always in the background, but you get a natural bolus when eating |
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|
Term
| What insulin concentrations are available? |
|
Definition
|
|
Term
What is the most common insulin concentration? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| If you have to give U-500, what should you do? |
|
Definition
| Call the pharmacy for help, as the calculations are not simple like with U-100 |
|
|
Term
What sizes are insulin syringes? |
|
Definition
|
|
Term
| In combo insulin, which two are mixed? |
|
Definition
|
|
Term
| If the combo is 70/30 what does that mean? |
|
Definition
|
|
Term
What are the disadvantages to combo insulin? |
|
Definition
| Set percentages that can't be adjusted for alterations in carbs, meal times, recent blood sugars, etc. |
|
|
Term
|
Definition
- Conventional Therapy
- Intensive Therapy
|
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|
Term
For whom does conventional therapy work best? |
|
Definition
|
|
Term
What is dosing for conventional therapy? |
|
Definition
|
|
Term
| What is the disadvantage to conventional therapy? |
|
Definition
No flexibiiity with timing, meals, or composition of insulin species
|
|
|
Term
What is the dosing for intensive therapy? |
|
Definition
- B, L, D is regular or short-acting based on blood sugars
- Bedtime is basal insulin
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|
|
Term
What is a complication of SQ injections?
|
|
Definition
|
|
Term
How can you prevent lipodystrophy?
|
|
Definition
|
|
Term
| Insulin drug interactions |
|
Definition
- Drugs that promote hypoglycemia (sulfonylureas, ETOH, beta blockers)
- Drugs that act as hyperglycemic agents (thiazides, glucocorticoids, sympathomimetics)
|
|
|
Term
Why are insulin pens popular?
|
|
Definition
- Dial up a dose
- No measuring a draw into a syringe
|
|
|
Term
How do insulin pens work?
|
|
Definition
- Pen has a cartridge and needle
- Cartridge is replaced when empty
- Needle can be replaced when needed, to prevent dullness
|
|
|
Term
| 4 causes of hypoglycemia in diabetics |
|
Definition
- Imbalance between calories and insulin
- N/V
- Not matching insulin to exercise requirements
- Dieting (drop caloric intake, but don't adjust insulin dose)
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|
|
Term
| Should you take insulin if you skip a meal? |
|
Definition
|
|
Term
|
Definition
- HA
- Confusion
- Drowsiness
- Irritability
|
|
|
Term
| S/S of severe hypoglycemia |
|
Definition
- Tachycardia
- Palpitations
- Sweating
- Nervousness
|
|
|
Term
How to treat hypoglycemia
|
|
Definition
- If conscious with a gag reflex - skim milk, regualr coke, OJ, sugar cubes, honey, corn syrup, glucose gel
- If no gag reflex - glucagon injection or D50 IV
|
|
|
Term
|
Definition
- Sulfonylureas
- Biguanides (Metformin/Glucophage)
- Thiazolidinediones (The Glitazones)
|
|
|
Term
| Do sulfonylureas have antibiotic properties? |
|
Definition
|
|
Term
| Are sulfonylureas stand-alone or combo drugs? |
|
Definition
|
|
Term
| What can be combined with sulfonylureas? |
|
Definition
|
|
Term
| How do sulfonylureas work? |
|
Definition
Stimulate the pancreatic beta cells to produce more insulin
|
|
|
Term
| Sulfonylurea drug interactions |
|
Definition
- ETOH + Drug = Disulfram Reaction (N/V)
- ETOH + Drug = Hypoglycemia
- Cimetidine + Drug = Hypoglycemia from potentiating of sulfonylurea
- Beta Blocker + Drug = Supression of insulin release, making the sympathetic reaction to hypoglycemia less obvious
|
|
|
Term
|
Definition
| Biguanides (metformin/Glucophage) |
|
|
Term
| How do biguanides (metformin/Glucophage) work? |
|
Definition
| Decr hepatic production of sugar and enhance peripheral utilization of glucose by skeletal muscles |
|
|
Term
How do biguanides (metformin/Glucophage) affect insulin?
|
|
Definition
| No insulin release from pancreas |
|
|
Term
| Which oral DM drug does not cause hypoglycemia? |
|
Definition
Biguanides (metformin/Glucophage)
|
|
|
Term
What test is important with biguanides (metformin/Glucophage)?
|
|
Definition
|
|
Term
With what can biguanides (metformin/Glucophage) be used?
|
|
Definition
|
|
Term
| What is the major problem with biguanides (metformin/Glucophage) and why? |
|
Definition
- Lactic acidosis
- Inhibits metabolism of lactic acid, inducing metabilic acidosis
- 50% mortality rate, occurs almost exclusively in renal insufficiancy
|
|
|
Term
| What drug was taken off the mass market in 2011 because it causes CHF and HTN? |
|
Definition
Thiazolidinediones (The Glitazones)
|
|
|
Term
| How do the glitazones work? |
|
Definition
| Decr insulin resistance or alternatively resensitizes peripheral cells (skeletal muscles and liver) to insulin so they can take up more glucose |
|
|
Term
With what can the glitazones be combined? |
|
Definition
- Insulin
- Sulfonylureas
- Metformin/Glucophage
|
|
|
Term
|
Definition
- Fluid retention
- Edema
- Weight gain
- CHF
- HTN
- CHF caused by massive Na and fluid retention
|
|
|
Term
Injectable non-insulin drug
|
|
Definition
| Incretin Mimetics (Exenitide/Byetta) |
|
|
Term
| What is the prototype for incretin mimetics? |
|
Definition
|
|
Term
With what can incretin mimetics (exenitide/Byetta) be used?
|
|
Definition
- Sulfonylureas
- Metformin
- Insulin (as of 2011)
|
|
|
Term
What are incretin mimetics (exinitide/Byetta)? |
|
Definition
Synthetic GLP-1 (human incretin) |
|
|
Term
|
Definition
| Augments insulin secretion as long as glucose is present |
|
|
Term
The "incretin effect" is responsible for _____ of total insulin released following a meal
|
|
Definition
|
|
Term
| How and when are incretin mimetics (exenitide/Byetta) taken |
|
Definition
SQ before B, D
(two main meals - if not a breakfast eater than with lunch) |
|
|
Term
| Advantage of incretin mimetics (exenitide/Byetta) |
|
Definition
|
|
Term
Primary SE of incretic mimetics (exenitide/Byetta) |
|
Definition
|
|
Term
Drug interactions with incretin mimetics (exenitide/Byetta)
|
|
Definition
If taken with sulfonylureas, hypoglycemia is possible
|
|
|
Term
What new dose of incretin mimetics (exentitide/Byetta) is available?
|
|
Definition
|
|
Term
| How is the weekly dose of incretin mimetic (exenitide/Byetta) prepared and what are the advantages? |
|
Definition
- Must be reconstituted immediately before use
- Perhaps better HgA1C reduction than daily injections
- More weight loss
|
|
|
Term
|
Definition
- Incr satiety
- Reduced appetite
- Eat less
- Lose weight
|
|
|
Term
| GLP-1 effects on pancreatic alpha cells |
|
Definition
| Decr post-prandial glucagon secretion |
|
|
Term
|
Definition
Decr hepatic production of sugar
|
|
|
Term
GLP-1 effects on pancreatic beta cells
|
|
Definition
| Enhanced glucose-dependent insulin secretion |
|
|
Term
|
Definition
- Decr gastic emptying
- Eating less food
- Weight loss
|
|
|
Term
| How do incretin mimetics (exenitide/Byetta) effect insulin production? |
|
Definition
Signals the pancreas to make the right amount of insulin and to then stop after blood sugar levels get closer to normal
|
|
|
Term
How do incretin mimetics (exenitide/Byetta) effect sugar production? |
|
Definition
| Helps stop the liver from producing too much sugar when you don't need it (avoiding hyperglycemia) |
|
|
Term
| How do incretin mimetics (exenitide/Byetta) effect sugar digestion? |
|
Definition
| Helps slow down the rate at which sugar enters the bloodstream, which helps avoid blood sugar spikes |
|
|
Term
| Incretin enhancers prototype |
|
Definition
|
|
Term
| What do incretin enhancers (sitagliptin/Januvia) inhibit? |
|
Definition
|
|
Term
| How do incretin enhancers (sitagliptin/Januvia) work? |
|
Definition
| Inhibit incretic breakdown by DPP-4 to enhance the activity of endogenous incretins |
|
|
Term
How do incretin enhancers (sitagliptin/Januvia) work?
|
|
Definition
| Inhibit incretic breakdown by DPP-4 to enhance the activity of endogenous incretins |
|
|
Term
| Are incretin enhancers (sitagliptin/Januvia) used along or with other meds? If so, which ones? |
|
Definition
- Can be used alone or with:
- Metformin/Glucophage
- Glitazones
|
|
|
Term
By how much do incretin enhancers (sitagliptin/Januvia) lower the HgA1C?
|
|
Definition
|
|
Term
| What SE are not caused by incretin enhancers (sitagliptin/Januvia)? |
|
Definition
- Hypoglycemia
- Nausea
- Weight gain
|
|
|
Term
Which drug has no significant drug reactions?
|
|
Definition
Incretin enhancers (sitagliptin/Januvia)
|
|
|
Term
| Can incretin enhancers (sitagliptin/Januvia) be used with the renally impaired? |
|
Definition
| Yes, the drug can be renally dosed |
|
|
Term
| It is the _____ not the pancreas that causes most problems for diabetics |
|
Definition
|
|
Term
Common symptoms of diabetics that meds/diet try to prevent
|
|
Definition
- Dialysis
- Foot/toe amputation
- Bad eyes
- Peripheral neuropathy
|
|
|
Term
| Which drugs are renally protective in diabetics? |
|
Definition
|
|
Term
When do you stop the use of ACEs/ARBs and why?
|
|
Definition
- Stage 3/4 because they begin to make renal function worse
- They are stopped shortly before dialysis is necessary
|
|
|
Term
What is the #1 killer of diabetics |
|
Definition
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
Lispro (Humalog |
|
Definition
- Short Duration
- Rapid Acting
|
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
Aspart (NovoLog)
|
|
Definition
Short Duration
Rapid Acting |
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
Glulisine (Apidra)
|
|
Definition
- Short Duration
- Rapid Acting
|
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
Regular Insuline (Humulin R, Novolin R)
|
|
Definition
- Short Duration
- Slower Acting
|
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
NPH (Humulin N, Novolin N) |
|
Definition
Short/Intermediate/Long Duration Rapid/Slow Acting
NPH (Humulin N, Novolin N) |
|
|
Term
Short/Intermediate/Long Duration Rapid/Slow Acting
Detemir (Levemir) |
|
Definition
- Intermediate Duration
- Slow Acting
|
|
|
Term
Short/Intermediate/Long Duration
Glargine (Lantus) |
|
Definition
|
|
Term
Type 1 or Type 2
Juvenile Onset
|
|
Definition
|
|
Term
Type 1 or Type 2
Age of Onset Over 40 |
|
Definition
|
|
Term
Type 1 or Type 2
Unknown defect, but strong familial association |
|
Definition
|
|
Term
Type 1 or Type 2
Age of Onset Childhood
|
|
Definition
|
|
Term
Type 1 or Type 2
Abrupt Onset |
|
Definition
|
|
Term
Type 1 or Type 2
Usually lacking ketosis |
|
Definition
|
|
Term
Type 1 or Type 2
5-10% of Diabetics |
|
Definition
|
|
Term
Type 1 or Type 2
Due to autoimmune response
|
|
Definition
|
|
Term
Type 1 or Type 2
Adult Onset |
|
Definition
|
|
Term
Type 1 or Type 2
Possible to control through diet and exercise |
|
Definition
|
|
Term
Type 1 or Type 2
Loss of pancreatic beta cells
|
|
Definition
|
|
Term
Type 1 or Type 2
Insulin levels reduced early in the disease and completely absent later |
|
Definition
|
|
Term
Type 1 or Type 2
Insulin replacement is mandatory
|
|
Definition
|
|
Term
Type 1 or Type 2
May be asymptomatic |
|
Definition
|
|
Term
Type 1 or Type 2
Blood glucose levels fluctuate widely
|
|
Definition
|
|
Term
|
Definition
|
|
Term
Type 1 or Type 2
Gradual Onset
|
|
Definition
|
|
Term
Type 1 or Type 2
Frequently positive family history |
|
Definition
|
|
Term
Type 1 or Type 2
Insulin resistance and inappropriate insulin secretion
Type 2 |
|
Definition
|
|
Term
Type 1 or Type 2
Negative Family History |
|
Definition
|
|
Term
Type 1 or Type 2
Insulin levels may be low, normal, or high |
|
Definition
|
|
Term
Type 1 or Type 2
Blood glucose levels more stable |
|
Definition
|
|
Term
Type 1 or Type 2
Usually thin and undernourished looking
|
|
Definition
|
|
Term
Type 1 or Type 2
Frequently Obese |
|
Definition
|
|
