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88 Cards in this Set
- Front
- Back
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typical type 1: |
-sudden onset -thin phenotype -insulin dependent -DKA presentation -pancreatic antibodies -associates autoimmune disease |
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typical type 2: |
-insidious onset -family hx -obese phenotype -acanthosis nigricans -insulin resistance -may have DKA -rx with oral agents -c peptide present -negative GAD-65 antibodies |
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what is type 1.5 DM? |
-combo of both phenotypic and labratory characteristics of both type 1 and 2 |
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what is the presentation of DM 1.5? |
-DKA -acanthosis nigricans -obesity -positve GAD-65 antibodies |
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how do you treat DM 1.5? |
-insulin and or oral agents |
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fasting BG for DM on 2 separate occasions? |
126 or greater |
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random BG for DM? |
200 or greater |
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a HbA1C greater than or equal to 6.5 (gives a three month estimate) is a mean BG of? |
139.85 |
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the effects of insulin on the liver? |
lessen liver glucose output (inhibit glycogenolysis and glyconeogenesis) |
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insulin decreases gluconeogenic precursors, inhibiting ____ and _____. |
-lipolysis and proteolysis |
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2 chain peptide hormone with disulfide links derived from single protein, proinsulin. |
insulin |
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insulin + c peptide= |
proinsulin |
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primary effects of insulin on blood glucose? |
-decrease hepatic glucose production -increase peripheral glucose uptake |
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insulin as a drug is described bu duration. duration reflects _____ usually. |
absorption |
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what are the three main categories of insulin? |
-rapid acting -intermediate acting -long acting |
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____ insulin is required during fasting in order to cover blood sugar release by liver for energy. |
basal |
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____ insulin required to cover ingested carbs |
bolus |
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the goal of insulin therapy is to mimic the function of the pancreas with ___ and ____ insulin. |
basal and bolus |
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what are the basal insulins? |
-NPH (intermediate-BID) -Lantus (24 hourrs and peakless, QD) -levemir (12 hours, peakless, BID) |
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what are the bolus insulins? |
-regular insulin -analogues ~lispro (humalog) ~aspart (novalog) ~actrapid (apidra) |
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Lantus or levemir is an insulin analogue for ___ requirements. each dose lasts ____ hours and is given how often? |
-basal -24 hours -once/day |
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lantus provides ____ coverage and must not be mixed with other insulins. it is approved for over ___ years. |
-peakless -6 years |
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insulins were originally isolated from beef or pig pancreas but are now all ____ sequence, recombiant. |
human |
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the unique formula of human insulin _____ absorption of insulin from sq site. |
delays |
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truly short acting insulin analogues are? |
-lispro (humalog) -aspart (novalog) |
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truly long acting insulin analogues are? |
-glargine (lantus) -detemir (levemir) |
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normal sequence of pro at position 28 and lys at 29 of the b chain is reversed. |
lispro |
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lispro acts within ___ mins, peaks in ___ and disappears in __-__ hours. |
-15 mins -1 hour -2-4 hours |
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protamine formulation of lispro is an ____ insulin available in 25/75 or 50/50 mixture. |
intermediate |
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lispro in pregnancy has fewer ____ episodes. |
hypoglycemic |
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proline at B28 is changed to Asp and reduce self association of the molecule. |
aspart (novolog) |
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aspart is comparable to lispro but may have better...? |
post prandial BG control |
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aspart provides reasonable BG control when injected ___ mins after the start of meals. |
15 mins |
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abdominal injections of aspart has ____ duration of glucose lower effect than when given in the thigh. |
shorter |
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elongation of c terminal of B by 2 arg residues and substitution of A21 asp with gly |
lantus (glargine) |
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the shift in pH from 5.4-6.7 makes lantus less soluble at physiologic pH level which...? |
delays absorption and prolongs duration of action |
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lantus has a lower incidence of ____. |
polyglycemia |
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Regular insulin (novolin R, humulin R, Relyon R) Onset: Peak: Duration: T1/2 of SC absorp: T1/2 of IV clearance: |
Onset: 15-40 mins Peak: 90-240 mins Duration: 4-5 hours T1/2 of SC absorp: 100 min T1/2 of IV clearance: 3-5 min |
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Insulin Lispro (humalog) Onset: Peak: Duration: T1/2 of IV clearance: |
Onset: 5 mins Peak: 60 mins Duration: 4 hrs T1/2 of IV clearance: 3-5 mins |
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Insulin Aspart (Novalog) Onset: Peak: Duration:
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Onset: 5 mins Peak: 60 mins Duration: 4-6 hours
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Insulin Glulisine (apidra) Onset: Peak: Duration:
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Onset: 2-5 mins Peak: 60 mins Duration: 3-4 hours
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Aspart: Onset, peak, duration |
5-10 mins, 1-3 hours, 3-4 hours |
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Lispro: Onset, peak duration |
5-15 mins, 0.5-1.5 hours, 2-4 hours |
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regular: onset, peak, duration |
0.5-1 hour, 2-3 hours, 3-6 hours |
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Intermediate Insulin Isophane (NPH) Humalin N Onset: Peak: Duration: T1/2 of SC absorp:
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Onset: 1-2.5 hours Peak: 4-12 hours Duration: 18-25 hours T1/2 of SC absorp: 4-9 hours
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Intermediate Insulin Detemir (Levemir) Onset: Peak: Duration: T1/2 of SC absorp: T1/2 of IV clearance: |
Onset: 1-2 hours Peak: 6-8 hours Duration: 6-24 hours low dose: 5-7 hours, high dose: 24 hours |
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detemir is ____ potent than NPH |
less |
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Intermediate ____+____ = INS premix |
NPH + Rapid insulin |
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what are some premixes? |
Novolin: 70/30 (NPH, Reg) Humulin: 70/30, 50/50 Humalog mix: 75/25 (NPL, lispro) Novolog mix: 70, 30 (NPA, Aspart) |
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Intermediate Premix Onset: Peak: Duration:
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Onset: 0.5- 2.5 hours Peak: 4-8 hours Duration: 17-25 hrs
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what are controlling factors of insulin absorption? |
-insulin aggregation -input site (skin, muscle, lung) -edema -regional muscle activity -SQ bloof flow -volume and concentration |
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what makes insulin less effective? |
-obesity, inactivity -infection, inflammation -T2DM -TPN, lipids -Congenital -hyperthyroid -ketoacidosis -catecholamines -acromegaly -glucocorticoid -end pregnancy -cocaine |
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what are oral DM medications? |
-insulin sensitizers -DPP4 inhibitors -Oral hypoglycemics |
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what is an insulin sensitizer and what is it used primarily in? |
-metformin or pioglitazone -type 2 (unless type 1 has resistance) |
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how does a DPP4 work and what is it used for? |
-inhibits DPP4, slowing incretin metabolism, increasing insulin synthesis and release, decreasing glucagon -type 2 DM |
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what is an oral hypoglycemic? |
sulfonylureas (glyburide, glipizide, glucotrol) -for type 2 |
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Metformin MOA |
1. intestine: glucose absorption 2. muscle and adipose tissue: glucose uptake metformin glucose utilization 3. Pancreas: insulin secretion 4. liver: hepatic glucose output metformin HGO |
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what is the normal dosage of metformin? |
2000mg/day divided into two doses |
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what are the side effects of metformin? |
-GI disturbances (dyspepsia, diarrhea) |
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when is metformin contraindicated? |
-renal disease -CHF -excessive alcohol -liver disease |
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Metformin is derived from ____. |
guanidine |
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the mechanism for metformin is? |
-MAJOR: suppress hepatic glucose production - increase insulin action at fat and muscle -NO effect on insulin secretion |
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_____ with metformin is rare (~5%) |
hypoglycemia |
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Psychological resistance to insulin (pt) |
-denial, wishful thinking, avoidance, procrast -difficulty with confrontation, disagreements - fear of losing or alienating Dr - fear of professionals anger - insulin usage is time consuming -fear of hypoglycemic events |
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a teen with type 2 DM taking metformin has symptoms with severe muscle weakness, fatigue, difficulty breathing, abd pain, dizziness and slow heart beat may be experiencing which adverse reaction? |
D. Lactic acidosis |
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child with type 1 DM being treated for asthma exacerbation with albuterol nebs. anticipatory guidance for parent include? |
B. BG monitoring should occur more often |
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which of the following should be monitored preriodically for child with schizophrenia on respiradol, has BMI > 95% and family hx of T2DM. |
C. Fasting BG |
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a 16 year old with diabetes being treated for UTI and receiving phenazopyridine for urinary discomfort. teaching should include. |
B. testing for urine ketones may be inaccurate |
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a child with type 1 DM and asthma is being treated with prednisolone for asthma exacerbation. anticipatory guidance includes? |
D. long acting insulin dosing should be increased |
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a teen with type 2 diabetes taking metformin may have difficulty maintaining glycemic control if also taking? |
D. depro provera |
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a 3 year old with type 1 DM has transitioned from injections to use of an insulin pump. which insulin is the choice for use in an insulin pump? |
C. Insulin lispro |
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the most important lab studies to obtain prior to beginning an adolescent should include? |
A. liver and kidney fxn tests |
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the predominant risk factor for children and teens developing type 2 diabetes is? |
D. Obesity |
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type 1 diabetes is identified by? |
A. clinical symptoms polyuria, polydipsia, polyphagia B. weight loss C. fasting lab documenting BG of 126 or random BG of 200 |
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14y/o with type 1 DM presents in primary care office with c/o belly hurts. to make sure this is not caused by diabetes, test? |
B. urine or blood for ketones |
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which of the following negatively impacts ability to manage DM in toddler/preschooler? |
A. parents ability to tolerate child discomfort |
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kindergartener with DM who is not allowed to participate with eating food provided in class to celebrate the letter P is a violation of what federal law? |
B. Individuals with Diabilities Act |
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basal insulin is? |
A. Glargine (Lantus) |
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insulin to carb ratio is used to? |
A. calculate dose of rapid onset insulin |
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to prevent long term complications the provider will? |
A. insist on specialty care with peds endocrine every 3 months B. encourage glycemic control that is age appropriate C. identify and address missing parenting skills |
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presented in PCP office with strep and fever? |
D. Test for blood or urine ketones and anticipate increased insulin needs with illness |
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Mody, the most common drug used is? |
B. Glimperide (amaryl) |
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15 year old with 8 yr history of poorly controlled T1DM, presents in clinic with c/o frequent low BG. tiffany has noticed this over the last 6-8 weeks and reports no change in her daily activity. |
B. obtain in clinic urinary pregnancy test |
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always give ___ don't skip for illness or srugery |
lantus |
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can have sz on ____ |
levemir |
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levemir is not as smooth as lantus but there is no..? |
sting on injection |
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you have to have ____ in your body for glucagon to wrok |
sugar |
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you should not take your ____ if you can't eat or drink as normal. |
metformin |
