What drugs are used to treat gestational diabetes? - correct answer Metformin abd Insulin
What A1C value indicates diabetes mellitus? Pre-DM? - correct answer 6.5% or greater is
considered diabetes o 5.7-6.4%pre-diabetes
What fasting and random values indicate DM? - correct answer Fasting plasma glucose—126
or greater is diabetes. Random (casual) plasma glucose—anything greater than 200 is diabetes
What are complications of insulin therapy? - correct answer Hypoglycemia
Can develop lipohypertrophy. Accumulation of subcutaneous fat that occurs when it is injected
too frequently at the same site. Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes difficult
If severe allergy develops:
Desensitization procedure (small doses to larger doses). Hypokalemia
Promotes the uptake of potassium cells and insulin activates a membrane-bound enzyme with
sodium potassium and ATPase that pumps potassium into the cells and sodium out
insulin drug interactions - correct answer o Hypoglycemicagents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides, alcohol o Usewithcautionwithhyperglycemicagents
Examples: thiazide and glucocorticoids and sympathomimetics
What effect do beta blockers have on insulin? - correct answer delay awareness of and
response to hypoglycemia by masking the signs that are associated with stimulation of
sympathetic nervous system
o Impairglycogenolysis
o Prevent the bodies counter-regulatory response
What are other therapeutic uses besides DM? - correct answer Hyperkalemia o Aids in
diagnosis of GH deficiency o Diabeticketoacidosis
Insulin dosage must be coordinated with what? - correct answer Carbohydrate intake
What is B/P goal in diabetic? - correct answer o To be controlled, within normal 120/80
What medication can be given to decrease risk of diabetic nephropathy? - correct answer ACE
inhibitor or ARB
What role does exercise play in treatment of both type 1 and type 2 DM? - correct answer
Exercise increases cellular responsiveness to insulin and increases glucose tolerance o 150
minute per week of moderate intensity exercise is recommended
What are the 4 steps in the 4-step approach? - correct answer Step1—diagnosis
Lifestyle changes plus metformin o Step2
Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a DPP4 inhibitor, a
sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like peptide 1, or a GLP-1
receptor agonist or basal insulin
Second drug choice made considering efficacy, the hypoglycemia risk of the patient, the
patient tolerability, and weight-related considerations (some help weight loss, some cause
weight gain), cost
o Step3
Three drug combination
Metformin
Plus 2 other drugs from step 2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
If 3 drug combination that includes basal insulin fails after 3-6 months, more
complex insulin regimen
Usually in combination with one or more non-insulin medications
When a patient is on insulin therapy what are the blood glucose goals before meals? At
bedtime? - correct answer Beforemeals—70-130
o Bedtime—100-140
What is the A1C goal? When is goal below 7 not appropriate? - correct answer 7%or below o
Those with severe hypoglycemia risk, limited life expectancy ,advanced microvascular or
macrovascular complications—not below 7
What are the short acting insulins? Intermediate? Long acting? - correct answer
Shortduration:Rapidacting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine [Apidra] o Shortduration:Sloweracting
Regular insulin [Humulin R, Novolin R] o Intermediateduration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir [Levemir] o Longduration
Insulin glargine
When are short duration insulins used? - correct answer Administered in association with
meals to control the post-prandial rise in blood glucose between meals and at night
When are intermediate insulins needed? - correct answer Administer 2-3 times daily to provide
glycemic control between meals and during the
night
How long is duration of glargine? Levemir? Degludec? - correct answer Glargine—up to 24
hours o Levemir
Low dose (0.2 units/kg)—12 hours
High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
What are routes of administration? Which can be inhaled? - correct answer SQ injection IV
infusion. Inhalation—Afrezza, meal time insulin
Typical insulin dosing for type 1? Type 2? - correct answer Total doses may range from 0.1
unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
What are the 3 dosing schedules? - correct answer o Twice daily dosing o Intensive basal/bolus
strategy o Continued subcutaneous insulin
How does metformin work? - correct answer o Inhibits glucose production in the livero
Reduces glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat and
skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
Metformin What are side effects? BB warning? - correct answer o GI effects—diarrhea
o Lactic acidosis
How does alcohol effect? - correct answer Inhibits the breakdown of lactic acid
What are the therapeutic uses other than DM? - correct answer o Gestational diabetes
o PCOS
Sulfonylureas - correct answer o First generation
Chlorpropamide [Diabinese]
Tolazamide [Tolinase]
Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
MOA?
~~~~~~~~~~~~
Main side effect? - correct answer Promote insulin release
~~~~~~~~
Hypoglycemia
Weight gain
How does cimetidine effect? Beta blocker? - correct answer Cimetidine—intensifies the
response
Beta blockers—diminish the benefits by suppressing the insulin release
Meglitinides (Repaglinide and Nateglinide) - correct answer o MOA—stimulate pancreatic
insulin release
o Drug/Drug interaction—gemfibrozil
Thiazolidinediones (glitazones) - correct answer Reduce glucose levels primarily by decreasing
insulin resistance
o Only indication is type 2 diabetes, mainly as an add-on to metformin
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