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17 Cards in this Set

  • Front
  • Back
Normal Blood Glucose and HbA1c
Preprandial Glucose <100 mg/dL
2 Hours Postprandial <140 mg/dL
HbA1c <6%
Very Short Acting Insulin
Lispro (or Aspart, Glulisine, Inhaled Regular)
Onset 15-30 min Peak 1-2 hr
mimics physiologic(post-prandial)

reduced postprandial glucose levels, increase in HDL cholesterol, decreased postprandial triglycerides, and improved vascular endothelial function
Regular Insulin
Short onset 0.5–1 hr peak 2–4 hr

ok for meal time management
(or Lente)
Intermediate onset 1–4 hr peak 6–10 hr

good for right before bedtime if not using Glargine- prevents "dawn" phenonmenon
(or Detemir)
Very long 22 hr (duration) NO peak

mimics basal level of insulin
Premixed insulins
50/50 or 70/30- based on the percentages of NPH (intermediate) and Regular (short-acting) insulin in the mixture.

Although the preparations are considered convenient and less expensive, glycemic control is extremely difficult with these mixtures.
New protocols for Type I
Glargine = constant, basal source of insulin
Lispro = bolus at mealtimes

0.5 units/kg body wt w/ 40% basal and 60% short-acting split between three meals

better mimic physiologic secretion of insulin but is $$
“dawn phenomenon”
Physiologic- increased need for insulin in the early morning hours to prevent a rise in glucose levels brought on by a spike in growth hormone released during Stage 4 of REM sleep. The rise in GH during the night stimulates gluconeogenesis and increases insulin resistance.
GLP-1 (Incretins)
helps islet cells work better with greater release of insulin; decrease glucagon, improve satiety, decrease gastric emptying, decrease appetite, and promote formation beta cells

Is broken down by DPP-4
Incretin like drugs
1. GLP-1 Analogs (IV only)-may caue weight loss

2. DPP-IV inhibitors (oral)- sitagliptin/Januvia

modulate insulin sectretion, decrease glucagon, increase setiety, increase Beta cell neogenosis

very $$ since they are new
Somogyi Effect
3am Hypoglycemia- due to mealtime NPH which is peaking
Glyburide, etc
Improve Insulin sectretion-Type II only oral

K-ATPase channel blocker- opens Ca channel to release insulin granules
"NPH-like" for people with some Beta Function
weight gain and hypoglycemia
Try NOT to use but they do decrease HbA1c levels by 1-2%
class Biguanides- Type II oral
Reduces HbA1c by 1.5-2.0%

Decreases Insulin resistance in the liver (helps to block gluconeogenisis)

* may result in weight loss!
Nateg/Repag- Type II oral

similar mechanism to Sulf. but more "lispro-like"
weight gain
Pioglutizone, etc
Type II oral

PPAR-gamma-RXR binds in nucleus to increase transcription in fat cells-
causing decreased insulin resistance in muscles
decreases HbA1c by 1.0-1.5%
takes 3-6 wks to reach max effect
Causes weight gain
Alpha-Glucosidase inhibitors
acarbose, miglitol- Type II oral

dampens glucose peaks after meals- slows gastric emptying and gut absorption

not very efficacious and cause severe gas
Type II diabetes treatment plan
1) Treat cardiovascular risk factors- aspirin and screen for complications in eye and kidney. Educate patients in glucose monitoring, exercise, proper diet.
2) Add oral agents- Metformin ± Nateg/Repag ± TZD
3) Add suppertime glargine insulin
4) Switch to Lispro or Aspart at meals + suppertime glargine ± Metformin ± TZD (remove the Sulf/Megli)
5) In order to reduce postprandial glucose, switch to a GLP-1 analogue or a DDP-4 inhibitor