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N212 Exam2 DM

  1. Bolus Insulin (Prandial)
    • Rapid-Acting Insulin
    • Short-Acting Insulin
  2. Rapid-Acting Insulin
    • -For small eater
    • Brand/Generic:
    • NovoLOG/Insulin aspart
    • Apidra/Insulin glulisine
    • HumaLOG/Insulin lispro
    • Onset: 15min (Given while plate is hot)
    • Peak: 30-90min
    • Duration: 3-5hr
  3. Short-Acting Insulin
    • -For large eater
    • Generic: Regular
    • Brand:
    • Humulin R
    • Novolin R
    • Onset: 30-60min (Given 30 mins before eating)
    • Peak: 2-4hr (Check BS 2hrs, give more prn; watch out for hypoglycemia s/s- shakes and sweats)
    • Duration: 5-8hr
  4. Basal Insulin (continuous)
    • Intermediate-acting
    • Long-acting
  5. Intermediate Acting Insulin
    • -Common Basal Insulin
    • Generic: NPH
    • Brand:
    • Humulin N
    • Novolin N
    • Onset: 1-3hrs
    • Peak: 8hrs (Given 2x: Am & PM; or as ordered)
    • Duration: 12-16hrs
  6. Long-acting Insulin
    • -Expensive = as afforded
    • Brand/Generic:
    • Levemir/Insulin determir
    • Lantus/Insulin glargine
    • Onset: 1hr
    • Peak: Peak-less!!!
    • Duration: 20-26hrs (1qday)
  7. Basal/Bolus Mix
    • Pre-mixed NPH (intermediate) & Regular (short)
    • Pre-mixed insulin lispro protamine suspenion (intermediate) & insulin lispro (rapid)
    • Pre-mixed insulin aspart protamine suspension (intermediate) & insulin aspart (rapid)
  8. Pre-mixed NPH (intermediate) & Regular (short)
    • Brand/Generic:
    • Humilin(70/30) = 70% NPH & 30% Regular
    • Novolin(30/30) = "~~~~~~~~~~~~~~~~~"
    • Humulin (50/50) = 50% NPH & 50% Regular
    • Onset: 30-60min
    • Peak: varies
    • Duration: 10-16hr
  9. Pre-mixed insulin lispro protamine suspenion (intermediate) & insulin lispro (rapid)
    • Brand/Generic:
    • HumaLog Mix (75/25) = 75% insulin lispro protamine & 25% insulin lispro
    • HumaLog Mix (50/50) = 50% "~~~~" & 50% "~~"
    • Onset: 10-15min
    • Peak: varies
    • Duration: 10-16hrs
  10. Pre-mixed insulin aspart protamine suspension (intermediate) & insulin aspart (rapid)
    • Brand/Generic:
    • NovoLog Mix (70/30) = 70% Insulin aspart protamine & 30% insulin aspart
    • Onset: 5-15min
    • Peak: varies
    • Duration: 10-16hrs
  11. Fasting Blood Glucose (FBG) test
    • Normal range: <100 mg/dL [rises as age]
    • Impaired fasting glucose (IFG): <126 mg/dL
    • Procedure: Casual/Random Glucose check
    • Every: AC&HS (4qday)
    • Equipment: Acu-check
    • (Fasting defines as no caloric intake at least 8hrs)
    • (Casual as anytime w/o regard on time since last meal)
    • S/S diabetes: polyuria, polydipsia, unexplained weight loss
  12. (Oral) Glucose Tolerance Test (OGTT)
    • Normal: <140 mg/dL
    • Impaired glucose tolerance (IGT): <200 mg/dL
    • Procedure: NPO 8-12hr prior test, drink high glucose (75grams glucose in water), blood test 2hrs late, if result is high glucose level = potential diabetes
  13. Glycosylated hemoglobin (A1C) test (HbA1C)
    • Normal: 4-6%
    • Risk diabetes: 5.7-6.4%
    • Poor diabetes control: >8%
    • Procedure: Measures the amount of glycosylated hemoglobin (hemoglobin that is chemically linked to glucose) in blood. >6.5% = lab test using NGSP certified & standardized to DCCI assay
    • Check every: 3 mos.
    • A1C% - mg/dL - mmo/L
    • 6 - 126 - 7
    • 7 - 154 - 8.6
    • 8 - 183 - 10.2
    • 9 - 212 - 11.8
    • 10 - 240 - 13.4
    • 11 - 269 - 14.9
    • 12 - 298 - 16.5
  14. Secretagogus
    • Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • 2nd-Gen Sulfonylurea Agents
    • Glipizide (Glucotrol)
    • Glimepiride (Amaryl)
  15. Glipizide (Glucotrol)
    • Secretagogus: Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • 2nd-Gen Sulfonylurea Agents
    • Route: Oral
    • S/E: hypoglycemia, weight gain, interacts w/ many drugs
  16. Glimepiride (Amaryl)
    • Secretagogus: Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • 2nd-Gen Sulfonylurea Agents
    • Route: oral
    • S/E: hypoglycemia
  17. Meglitinide Analogs
    • Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • Repaglinide (Prandin)
    • Nateglinide (Starlix)
    • Biguinides: Metaformin (Glucophage)****
  18. Repaglinide (Prandin)
    • Meglitinide Analogs:Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • Route: Oral
    • S/E: Hypoglycemia
  19. Nateglinide (Starlix)
    • Meglitinide Analogs:Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • Route: Oral
    • S/E: Hypoglycemia
  20. Biguinides: Metaformin (Glucophage)****
    • Meglitinide Analogs:Lower fasting plasma (blood) glucose lvl by triggering release of insulin from beta cells
    • Route: Oral
    • S/E: Abd discomfort (diarrhea, nausea, vomit, flatulence, indigestion), lactic acidosis, interact w/ contrast material & can induce acute kidney injury
  21. Insulin Sensitizers
    • Don't increase insulin secretion. Decrease liver glucose production, reducing fasting plasma (blood) glucose release, & improve insulin receptors sensitivity. TDZs also increase cellular utilization of glucose.
    • Thiazolidinediones (TZDs):
    • Pioglitazone (Actos)
    • Rosiglitazone (Avandia)
  22. Pioglitazone (Actos): a Thiazolidinediones (TZDs)
    • Insulin Sensitizers: Don't increase insulin secretion. Decrease liver glucose production, reducing fasting plasma (blood) glucose release, & improve insulin receptors sensitivity. TDZs also increase cellular utilization of glucose.
    • Route: Oral
    • S/E + risk for:
    • Heart-related death; not to be used by pt w/ symptomatic heart failure
    • bone fracture & macular edema
    • liver impairment
    • bladder cancer
  23. Rosiglitazone (Avandia): a Thiazolidinediones (TZDs)
    • Insulin Sensitizers: Don't increase insulin secretion. Decrease liver glucose production, reducing fasting plasma (blood) glucose release, & improve insulin receptors sensitivity. TDZs also increase cellular utilization of glucose.
    • Route: Oral
    • S/E + risk for:
    • Heart-related death; not to be used by pt w/ symptomatic heart failure
    • bone fracture & macular edema
    • liver impairment
  24. Alpha-Glucosidase Inhibitors
    • Prevent after-meal hyperglycemia by inhibiting enzymes in intestinal tract, reducing rate of digestion of starches, & delaying absorption of carbohydrate from small intestine
    • Acarbose (Precose)
    • Miglitose (Glyset)
  25. Acarbose (Precose)
    • Alpha-Glucosidase Inhibitors: Prevent after-meal hyperglycemia by inhibiting enzymes in intestinal tract, reducing rate of digestion of starches, & delaying absorption of carbohydrate from small intestine
    • Route: Oral
    • S/E:
    • abd discomfort (diarrhea, nausea, vomit, flatulence, bloating, indigestion)
    • elevates serum transaminase lvl & reduce liver function
    • drug accumulates in pt w/ kidney impairment
  26. Miglitose (Glyset)
    • Alpha-Glucosidase Inhibitors: Prevent after-meal hyperglycemia by inhibiting enzymes in intestinal tract, reducing rate of digestion of starches, & delaying absorption of carbohydrate from small intestine
    • Route: Oral
    • S/E:
    • abd discomfort (diarrhea, nausea, vomit, flatulence, bloating, indigestion)
    • elevates serum transaminase lvl & reduce liver function
    • drug accumulates in pt w/ kidney impairment
  27. Incretin Mimetics (GLP-1 agonists)
    • Acts like natural "gut" hormones that work w/ insulin to lower plasma (blood) glucose lvl. They lower glucagon secretion from pancreas = reduced liver glucose production. Also reduce blood glucose lvl by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Albiglutide (Tanzeum)
    • Exenatide (Byetta)****
    • Exentide extended release (Bydureon)
    • Liraglutide (Victoza)
  28. Albiglutide (Tanzeum)
    • Incretin Mimetics (GLP-1 agonists): Acts like natural "gut" hormones that work w/ insulin to lower plasma (blood) glucose lvl. They lower glucagon secretion from pancreas = reduced liver glucose production. Also reduce blood glucose lvl by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: SQ injection (1qweek)
    • S/E + risk:
    • pancreatitis
    • thyroid cancer
  29. Exenatide (Byetta)***
    • Incretin Mimetics (GLP-1 agonists): Acts like natural "gut" hormones that work w/ insulin to lower plasma (blood) glucose lvl. They lower glucagon secretion from pancreas = reduced liver glucose production. Also reduce blood glucose lvl by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: SQ injection
    • S/E + risk:
    • pancreatitis
    • hypersensitivity reactions, including Steven-Johnson syndrome
  30. Exentide extended release (Bydureon)
    • Incretin Mimetics (GLP-1 agonists): Acts like natural "gut" hormones that work w/ insulin to lower plasma (blood) glucose lvl. They lower glucagon secretion from pancreas = reduced liver glucose production. Also reduce blood glucose lvl by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: SQ injection (1qweek)
    • S/E + risk:
    • pancreatitis
    • thyroid cancer
  31. Liraglutide (Victoza)
    • Incretin Mimetics (GLP-1 agonists): Acts like natural "gut" hormones that work w/ insulin to lower plasma (blood) glucose lvl. They lower glucagon secretion from pancreas = reduced liver glucose production. Also reduce blood glucose lvl by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: SQ injection (1qweek)
    • S/E + risk:
    • pancreatitis
    • thyroid cancer
  32. DPP-4 Inhibitors
    • DPP-4 is an enzyme that breaks down natural gut hormones (GLP-1 & GIP). DPP-4 inhibitors + amount of natural substances that work w/ insulin to lower glucagon secretion form pancreas = reduced liver glucose production. Also reduce blood glucose levels by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Sitagliptin (Januvia)***
    • Saxagliptin (Onglyza)
    • Linagliptin (Tradjenta)
    • Alogliptinn (Nesina)
  33. Sitagliptin (Januvia)***
    • DPP-4 Inhibitors: DPP-4 is an enzyme that breaks down natural gut hormones (GLP-1 & GIP). DPP-4 inhibitors + amount of natural substances that work w/ insulin to lower glucagon secretion form pancreas = reduced liver glucose production. Also reduce blood glucose levels by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: Oral
    • S/E + risk for: pancreatitis
  34. Saxagliptin (Onglyza)
    • DPP-4 Inhibitors: DPP-4 is an enzyme that breaks down natural gut hormones (GLP-1 & GIP). DPP-4 inhibitors + amount of natural substances that work w/ insulin to lower glucagon secretion form pancreas = reduced liver glucose production. Also reduce blood glucose levels by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: Oral
    • S/E + risk for: pancreatitis
  35. Linagliptin (Tradjenta)
    • DPP-4 Inhibitors: DPP-4 is an enzyme that breaks down natural gut hormones (GLP-1 & GIP). DPP-4 inhibitors + amount of natural substances that work w/ insulin to lower glucagon secretion form pancreas = reduced liver glucose production. Also reduce blood glucose levels by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: Oral
    • S/E + risk for: pancreatitis
  36. Alogliptinn (Nesina)
    • DPP-4 Inhibitors: DPP-4 is an enzyme that breaks down natural gut hormones (GLP-1 & GIP). DPP-4 inhibitors + amount of natural substances that work w/ insulin to lower glucagon secretion form pancreas = reduced liver glucose production. Also reduce blood glucose levels by delaying gastric emptying, slowing rate of nutrient absorption into blood, & reducing food intake.
    • Route: Oral
    • S/E + risk for:
    • pancreatitis
    • Kazano (alogliptin/metaformin combination) carries black box warning for lactic acidosis)
  37. Amylin Analogs
    • Similar to amylin, a naturally occurring hormone produced by beta cells in pancreas that is co-secreted w/ insulin & lowers blood glucose lvl by delaying gastric emptying & triggering satiety
    • Pramlintide (Symlin)***
  38. Pramlintide (Symlin)***
    • Amylin Analogs: Similar to amylin, a naturally occurring hormone produced by beta cells in pancreas that is co-secreted w/ insulin & lowers blood glucose lvl by delaying gastric emptying & triggering satiety
    • Route: SQ injections
    • S/E:
    • severe hypoglycemia
    • nausea & vomiting
  39. Fixed combinations
    • There are many fixed combo of oral drug available
    • S/E of combo drugs are same as for each component of combo
    • When drug has s/e of hypoglycemia is combined w/ drug that does not alone produce hypoglycemia, development of hypoglycemia is still very much a risk for combo agents
  40. Carbs
    • Responsible for postmeal glucose
    • Recommend: 45% calorie from carb/ 130g carb qday
  41. Dietary Fat/Cholesterol
    • Same as reduce risk for cardiovascular disease
    • Fat quality is more important in lipid control than fat quantity
    • Recommend:
    • Limit fat intake 20-35% of daily cal intake
    • Choose mono-unsaturated & poly-unsaturated fats (vs saturated fats & trans fats)
    • Have 2+ servings of fatty fish qweek (except commercial fried fish) to provide n-3 poly-unsaturated fatty acids
    • Trans fat: + risk cardiovascular disease (margarine, fried)
  42. Protein
    • Recommend: 15-20% of total diet calories
    • Some higher % to substitute from carbohydrates, to maintain satiety & control blood glucose lvl
    • High protein improve insulin response, but doesn't prevent hypoglycemia
  43. Fiber
    • Improves carbohydrate metabolism & lowers cholesterol levels
    • Recommend: 25g women, 38g men.
  44. Sucrose, Fructose, non-nutritive sweeteners (NNS)
    • Sucrose: doesn't + blood glucose more than equal amounts of other starches
    • Intake of sucrose & sucrose-containing food by DM pt doesn't need to be restricted out of concern for causing hyperglycemia
    • Sucrose can be in meal as long as adequately covered w/ insulin or other glucose lowering agents
    • Avoid: sugar sweetened beverages (SSBs); high-fructose corn syrup (+ triglycerides & other lipids)
    • NNS: desirable since it doesn't disturb blood glucose control
    • Free fructose: found in fruit doesn't appear to alter lipid metabolism like high-fructose corn syrup does
  45. Alcohol
    • Affects blood glucose, but not by moderate use
    • Raises blood triglycerides
    • Potential for alcohol-hypoglycemia, instruct pt w/ DM to ingest alcohol only w/ or shortly after meals
  46. Retinopathy
    • Avoid:
    • Vigorous or resistance exercise
    • Valsalva maneuver: Breath holding while bearing down
Author
Leon
ID
311151
Card Set
N212 Exam2 DM
Description
Meds
Updated

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