Insulin and non-oral Diabetes Therapies

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giddyupp
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70566
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Insulin and non-oral Diabetes Therapies
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2011-03-03 21:17:43
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Insulin non oral Diabetes Therapies PHPR523 Test4
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Insulin and non-oral Diabetes Therapies
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  1. What is the MOA of insulin?
    • Stimulates entry of glucose into cells
    • Promotes storage of glucose as glycogen in muscle and liver cells
  2. What is the method of action of GLP-1 receptor agonists?
    • Stimulates glucose-dependent insulin secretion
    • Inhibits glucagon secretion after meals
    • Slows rate of gastric emptying
    • Increases satiety
  3. What is the MOA of Pramlintide?
    • Amylin agonist
    • Reduces PPG levels
    • Supresses glucagon secretion
    • Enhances satiety
  4. What is the onset of action of the various insulin products?
    • Rapid acting: 5-15 min
    • Short acting: 30-60 min
    • Intermediate acting: 2-4h
    • Long acting: 2-4h (Levemir) or 3-8h (Lantus)
  5. What is the time to peak of the various insulin products?
    • Rapid acting: 30-90 min
    • Short acting: 2-3h
    • Intermediate acting: 4-10h
    • Long acting: no peak
  6. What is the duration of action of the various insulin products?
    • Rapid acting: <5h
    • Short acting: 5-8h
    • Intermediate acting: 10-16h
    • Long acting: 12-24h (Levemir) or 20-24h (Lantus)
  7. What type of injectable therapy is used for Type I diabetes?
    • Basal bolus insulin (but need less than Type II d/t no/less insulin resistance)
    • Pramlintide can be dosed with bolus doses
  8. What is the place in therapy for basal insulin in Type II diabetes?
    • When A1c is > 10%
    • When Orals are not enough
    • Use NPH, Lantus, or Levemir
  9. What is the place in therapy for intensive insulin therapy in Type II diabetes?
    • When oral and basal insulin are not enough
    • Lantus or Levemir + Aspart, Lispro, or Glulisine (NOT regular)
  10. What is the place in therapy for GLP-1 agonists?
    Can be added to Metformin in Type II DM
  11. What is the place in therapy for Pramlintide?
    Dosed with bolus doses in Type I and Type II DM
  12. How is insulin therapy monitored?
    • Basal-bolus:
    • Fasting, pre-prandial, 2h post-prandial (6x/d)
    • Fasting, pre-prandial, hs (4x/d)
    • Fasting, 2h post-prandial (4x/d)
    • Premixed:
    • Fasting, pre-dinner
    • Basal:
    • Fasting (minimum)
  13. How is basal-bolus insulin therapy adjusted?
    • High fasting: increase basal dose
    • Meal time: base on either 2h post-prandial or next meals pre-prandial (ie, if pre-dinner is high, dose more at lunch)
  14. How is premixed insulin therapy adjusted?
    • High Fasting: increase pre-dinner dose
    • High pre-dinner: increase fasting dose
  15. How is basal insulin therapy adjusted?
    High Fasting: increase HS basal dose
  16. What are the SE of insulin?
    • Hypoglycemia
    • Wt gain
  17. What are the SE of GLP-1 agonists?
    • NV (start low and never start above 5mg with Byetta)
    • Hypoglycemia when combined with orals
    • BBW (Liraglutide may cause Thyroid C-cell tumors)
    • Take Byetta (Exenatide) 60 min before meals BID
    • Take Liraglutide without regard to meals
    • Wt loss
  18. What are the SE of Pramlintide?
    • NV
    • Hypoglycemia (decrease insulin dose by 50% when starting Pramlintide)
    • Dosed along with bolus dose immediately before major meals
    • Wt loss

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