Term
|
Definition
Exanatide (Byetta)
-Type 2 Only
-Increased Insulin Secretion when increased BGLs
-Improves 1st phase insulin response to meals
-Decreases Glucagon/Glucose production by liver
-Slows gastric emptying, decrease appetite |
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Term
Incretin Mimetic
Side effects |
|
Definition
-N/V
-Dyspepsia
-Note used with Gastroparesis + Kidney Disease
-Can slow med absorption
-Room temp okay |
|
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Term
| Which type of DM medication is okay during pregnancy? |
|
Definition
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Term
Victoza (Liraglutide)
Dose |
|
Definition
-DM type 2 (SQ)
-1.2-1.8mg QD
-Start 0.6mg QD x 1wk,
then 1.2mg QD
-Max 1.8mg/day |
|
|
Term
Victoza (Liraglutide)
Contraindications |
|
Definition
-DM type 1
-Medullary Thyroid Carcinoma Hx
-Multiple Endocrine Neoplasia Syndrome
-DKA
**CAUTION WITH:
-Gastroporesis
-Pancreatitis Hx |
|
|
Term
Victoza (Liraglutide)
Side effects |
|
Definition
H/A, N/D
(Nausea most common over time) |
|
|
Term
|
Definition
-Stimulates entry of Glucose + Amino Acids into cells
-Promotes storage of Glycogen and fat
-Enhances Protein Synthesis
-Inhibits fat breakdown
-Inhibits production of Glucose
-Inhibits Glucose formation from non-CHO sources
**Keep in Fridge.
-In use: Okay at room temp for 1 month |
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Term
|
Definition
-Turn knob to set dose
-Audible and Tactile click
-Pts make fewer dosing errors due to click |
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Term
|
Definition
-Reservoir for Rapid and Bolus insulin
-Commitment |
|
|
Term
|
Definition
-Capacities: 0.25-1cc (25-100 Units)
-Choose smallest syringe that will hold required dose |
|
|
Term
|
Definition
-Most closely mimics natural
(long acting + meal bolus) |
|
|
Term
|
Definition
-1st time Type 1:
0.5-1.0 Units/kg wt
-More with illness, puberty of metabolic instabilities
-Lower during Honeymoon phase
-Lower during physical acitvity |
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|
Term
Basal Insulin Rate Calculation Methods
(TDD= total daily dose) |
|
Definition
1. TDD - lower by 25-30% / 50%. Divide by 24 hours (unit/hr)
2. 0.5 x kg = TDD - 20-25% / 50%. Divide by 24 hours (unit/hr)
3. Good control Pts:
TTD Glargine / 24 hours |
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|
Term
|
Definition
-1 Unit rapid acting insulin is needed to cover CHO intake.
-Total # CHO / Insulin = ratio |
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|
Term
| Correction Bolus Calculation Method |
|
Definition
| -Determine the correction dose for high BGL levels to determine mg/dl that one unit of insulin will lower BGL value. |
|
|
Term
| Insulin Sensitivity Factor Method |
|
Definition
-Divide into 1500 when using regular insulin or 1700 when using Lispro/Aspart
Ex: 1700 / TDD = ISF |
|
|
Term
| Insulin Sensitivity Factor |
|
Definition
-(ISF) Calculate amount of Insulin needed to bring BGLs to target.
-Calculate correction/supplemental insulin when levels are too high/low before meals. |
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|
Term
| Bolus Insulin Calculation Methods |
|
Definition
1. 450 or 500 / TDD = grams of CHO affected by 1 Unit
ex: 500 / 50 u/d(TDD) = 1unit per 10 gm CHO.
2. 2.8 x lbs / TDD = ICR
3. Well controlled B/Bolus MDI can convert from previous ICR. |
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|
Term
|
Definition
|
|
Term
|
Definition
-Lowers glucose production in Liver
-Increases Insulin-stimulating transport in fat/muscle cells |
|
|
Term
|
Definition
-Bloating
-Metallic taste (take with food)
-Lactic acid
-Do not take with decreased renal or liver function.
-Caution if >80 yo |
|
|
Term
| DPP 4 Inhibitor Compounds |
|
Definition
Januvia, SitaGLIPTIN
Onglyza, Saxaglipitin |
|
|
Term
|
Definition
-Works on both the Pancreas and Liver
-Stimulates Increased insulin production (Pancreas) when high BGLs
-Lowers Glucose production when high BGL (Liver) |
|
|
Term
| DPP 4 Inhibitor Side effects |
|
Definition
-Stuffy Nose/Sore throat, URI/UTI
-Caution with low renal function
-Does NOT cause weight loss or gain.
-NO Hypoglycemia when used alone |
|
|
Term
|
Definition
| -For type 2, in conjunction with diet and exercise (Not type 1) |
|
|
Term
|
Definition
| 2.5-5.0 mg QD regardless of meals |
|
|
Term
| DPP-4 Inhibitor Contraindications |
|
Definition
-When used with other DM meds, can cause drop in BGLs
-When used with TZDs, can cause peripheral edema to be worse |
|
|
Term
|
Definition
(NIDE)
Repaglinide/Prandin
Nateglinide/Starlix |
|
|
Term
|
Definition
-Increases Insulin secretion in approx 4 hours, in response to raised BGLs post meal.
-Good for post-prandial BGLs |
|
|
Term
| Meglitinides Side effects |
|
Definition
-Mild HYPOglycemia
-slight weight gain
-Take WITH meal, do NOT take if meal skipped
-Caution with elderly or liver disease |
|
|
Term
|
Definition
(MIDE)
1st gen: acetohexamide, chlorpropamide, tolazamide, tolbutamide.
(RIDE/ZIDE)
2nd gen: Glimepiride/Amaryl, Glipizide/Glucotrol, Glyburide/Diabeta |
|
|
Term
|
Definition
-Increases Insulin release from Pancreas
-Can increase insulin secretion without increased glucose. |
|
|
Term
| Sulfonylureas Side Effects |
|
Definition
-HYPOglycemia
-Weight gain
-Fluid retention
-photo-sensitivity |
|
|
Term
| Thiazolidinediones Compounds |
|
Definition
(ZONE)
Pioglitazone/Actos, Rosaglitazone/Avandia |
|
|
Term
| Thiazolidinediones Action |
|
Definition
| -Lowers Insulin resistance in peripheral tissues and Liver |
|
|
Term
| Thiazolidinediones Side effects |
|
Definition
-Fluid retention, wt gain, Edema
-Increased LDL with Rosaglitazone/Avandia
-Not with heart failure or Liver Dx |
|
|
Term
| Thiazolidinediones Benefits |
|
Definition
-Increase in HDL w/ Rosaglitazone/Avandia
-Decrease Triglyceride and Increase in HDL w/ Pioglitazone/Actos |
|
|
Term
| Alpha-Glucosidase Inhibitors Compounds |
|
Definition
| Acarbose/Precose, Miglitol/Glyset |
|
|
Term
| Alpha-Glucosidase Inhibitors Action |
|
Definition
-Taken with first bite.
-Inhibits digestion of starches and sugars in small intestine
-Thus, Slowing/reducing glucose absorption
-Good with post-prandial BGLs |
|
|
Term
| Alpha-Glucosidase Inhibitors Side Effects |
|
Definition
-Abd pain, Farts, Diarrhea
-DONT use with colonic ulcers, Obstructive Bowel Disorders or Digestions Disorders |
|
|
Term
| Six Different Classes of Oral Medications |
|
Definition
1. Alpha-Glucosidase Inhibitors
2. Biguanides
3. DPP 4 Inhibitors
4. Miglitinides
5. Sulfonylureas
6. Thiazolidinediones |
|
|
Term
Dose Adjustment for Normal Eating
(DAFNE) |
|
Definition
| DAFNE = CHO Intake to Insulin Doses |
|
|
Term
| Stacking Correction Doses |
|
Definition
-Short-acting insulin can cause drops in BGLs 2/2 too many correction doses administered too closely together
(Insulin over-lapping) |
|
|
Term
| Clinical indications for Insulin Pump Therapy |
|
Definition
- Unpredictable drop in BGLs
- Marked Dawn phenomenon
- Failure to get good BGL control within 3-4 months.
- Lifestyle flexibility
- Patient Motivated
- Pregnancy |
|
|
Term
| Increased Fasting BGL treatments |
|
Definition
1.Observing changes from bedtime to Dawn
2.Change Bolus doses ratio for supper or snacks
3.Basal changes can be increased if BGLs slowly rise overnight
4.If BGL drops to 70 by 3am, reducing Basal Rate would be appropriate |
|
|
Term
MDI Adjustments relating to exercise:
Light Activities |
|
Definition
| Decrease 10-20% 1 hour before and 1 hour after |
|
|
Term
MDI Adjustments relating to exercise:
Moderate but of short duration
(1-2 hours: tennis, biking, walking) |
|
Definition
| Reduce 30-50% 1 hour before and 1 hour after |
|
|
Term
MDI Adjustments relating to exercise:
Isometric |
|
Definition
|
|
Term
MDI Adjustments relating to exercise:
Prolonged |
|
Definition
| Sustained reduction for duration and possibly extended |
|
|
Term
| Long Acting Insulin Compounds |
|
Definition
Glargine (Lantus)
Detemir (Levemir) |
|
|
Term
| Long Acting Insulin Onset |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Long Acting Insulin Duration |
|
Definition
|
|
Term
| Long Acting Insulin Action |
|
Definition
| Suppress the Glucose production b/t meals and overnight/fasting BGLs |
|
|
Term
Non-Insulin Injection
Amylin Analog Coumpound |
|
Definition
|
|
Term
Non-Insulin Injection
Amylin Analog Action |
|
Definition
-Slows Gastric Emptying
-Lowers Glucagon secretion
-Lowers appetite this lowering PO intake |
|
|
Term
Non-Insulin Injection
Amylin Analog Side effects |
|
Definition
N/V, Anorexia
Fatigue
H/A
-Can NOT be mixed with Insulins
-do NOT use with gastroparesis |
|
|
Term
Non-Insulin Injection
Amylin Analog Timing |
|
Definition
-Given right before meals
-Unopened vials must be refrigerated
-In-Use vials may be stored at room temp for 28 days |
|
|
Term
| Intermediate Acting Insulin Compounds |
|
Definition
|
|
Term
| Intermediate Acting Insulin Onset |
|
Definition
|
|
Term
| Intermediate Acting Insulin Peak |
|
Definition
|
|
Term
| Intermediate Acting Insulin Duration |
|
Definition
|
|
Term
| Intermediate Acting Insulin Common Use |
|
Definition
-Basal Insulin with peak coverage midday meal
-Rapid/Regular covering meals
-Occ bedtime to correct AM high BGLs (dawn effect)
-With Oral meds |
|
|
Term
|
Definition
70/30: NPH/Regular
70/30: NPH/Rapid
50/50: NPH/Regular
75/25: NPH/Rapid |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Rapid Insulin Common Uses |
|
Definition
-Mealtime (right before or after meal)
-To correct high BGLs
-Insulin Pumps |
|
|
Term
| Short acting Insulin Compounds |
|
Definition
|
|
Term
| Short acting Insulin Onset |
|
Definition
|
|
Term
| Short acting Insulin Peak |
|
Definition
|
|
Term
| Short acting Insulin Duration |
|
Definition
|
|
Term
| Short acting Insulin Common Uses |
|
Definition
-Mealtime, 30 minutes prior
-Correction for high BGLs
-Occasional insulin, pump insulin |
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