Type 2 Diabetes treatment steps - Correct Ans-Step 1: lifestyle changes + metformin
Step 2: continue step 1 and add 2nd drug
Step 3 : step up to 3 drug combination (including metformin)
Step4: more complex insulin regimen
Target values for blood glucose - Correct Ans-70-130 mg/dL before meals; 100-140
mg/dL at bedtime
Insulin Lispro (Humalog) - Correct Ans-Short-duration (3-5 hours), rapid acting (10-20
minutes); analog of human insulin. Administered immediately before or after eating
Insulin Aspart (Novolog) - Correct Ans-Short-duration (3-6 hours), rapid acting (15-30
minutes after subQ injection). Rapid-acting analog of regular insulin. Acts faster than
regular insulin but has a shorter duration of action. Should be injected 5-10 minutes
before meals.
Insulin Glulisine (Apidra) - Correct Ans-Short-duration (3-5 hours), rapid acting (10-15
minutes). Synthetic analog of natural human insulin. Should be administered close to
the time of eating
Regular insulin (Humulin R, Novolin R) - Correct Ans-Short-duration, slower-acting
insulin. Unmodified human insulin. Routes: subQ, subQ infusion, IM, and oral. Effects
begin in 30-60 minutes; peaks in 1-5 hours; duration up to 10 hours. CLEAR solution.
NPH Insulin (Humulin N, Novolin N) - Correct Ans-Intermediate-duration insulin. Injected
2-3 times daily to provide glycemic control between meals and during the night. Only
one suitable for mixing with short-acting. CLOUDY suspensions. Administered subQ.
, Insulin Glargine (Lantus) - Correct Ans-Long-duration insulin. Modified human insulin.
Prolonged duration of action (up to 24 hours). Once-daily subQ. CLEAR solution - do
not mix with other insulins.
Insulin detemir (Levemir) - Correct Ans-Long-duration insulin. Human insulin analog.
Slow onset and dose-dependent duration of action. Used to provide basal glycemic
control (NOT given before meals to control post-prandial hyperglycemia). CLEAR,
colorless solution. Dosing: 1-2 times daily by subQ. Do not mix with other insulins.
Afrezza - Correct Ans-Inhalation insulin. Used for mealtime insulin. Provides good
glycemic control with relatively low incidents of hypoglycemia. Little to no effect on the
pulmonary function, but can cause bronchospasm, so us with caution in patients with
chronic lung disease.
Metformin - Correct Ans-Drug of choice for initial therapy in most patients with T2DM.
Most common side effects: GI disturbances; lactic acidosis (be cautious in patients with
CKD). Inhibits glucose production in the liver; reduces glucose absorption in the gut;
sensitizes insulin receptors in target tissues scubas fat and skeletal muscle and
increases the glucose uptake and response to whatever insulin is available. Drug
interactions: alcohol, cimetidine, iodinated radio contrast (d/c drug 2-3 days before dye)
Sulfonylureas - Correct Ans-First generation: Chlorpropamide, Tolbutamide
Second: Glimepiride, Glipizide, Glyburide.
Promote insulin release; only to be used for T2DM. Major side effects: hypoglycemia,
weight gain. Drug interactions: alcohol, NSAIDs, cimetidine, beta blockers
Meglitindies - Correct Ans-Repaglinide and Nateglinide. Same MOA as Sulfonylureas;
stimulate the pancreatic insulin release. Adverse effect: hypoglycemia. Drug
interactions: gemfibrozil
Thiazolidinediones (Glitazones) - Correct Ans-Reduce glucose levels primarily by
decreasing insulin resistance; only indicated for T2DM (add-on to metformin).
Rosiglitazone; pioglitazone. Do not give to patients with HF.
Pioglitazone - Correct Ans-Reduces insulin resistance and may also decrease glucose
production. Adverse effects: URI, headache, sinusitis, and myalgia. Drug interactions:
insulin; drugs that induce or inhibit the CYP2C8 system
Alpha-glucosidase inhibitors - Correct Ans-Act in the intestine to delay the absorption of
carbohydrates. T2DM. Acarbose ADE: frequently causes flatulence, cramps, abdominal
distention, borborygmus, diarrhea, and liver dysfunction. Miglitol: especially effective in
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