5070: DM MEDS

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97 Terms

1
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for a therapeutic approach to type 1 DM, what is a primary need?

insulin

2
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what is an adjunct therapy for type 1 diabetes?

amylin analog

3
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what is allo-transplantation?

what type of DM normally gets this?

islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person, usually someone with type 1 DM

islet cells transferred into the liver; infused into the portal vein, become resident in hepatic sinusoids

4
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when a person is undergoing islet cell transplantation, what is a precaution they must do in order to avoid rejection?

take immunosuppressive drugs

5
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when does auto-transplantation occur?

after total pancreatectomy in patients (who don’t have type 1 DM) with severe chronic pancreatitis that cannot be managed by other treatments

6
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what is the therapeutic approach for type 2 DM, what two things does it manage??

management of DM

management of co-morbidities

7
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what is the first line pharmalogical treatment for type 2 DM?

metformin

8
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what are secretagogues?

medications that increase insulin secretion

9
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what increases the risk of hypoglycemia when taking diabetes medications?

taking multiple diabetes medications

10
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what is the mechanism of action of insulin?

initiates glucose uptake into cells that are insulin-dependent

11
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what is the mechanism of action for amylin analogs?

slows gastric emptying, suppresses glucagon secretion, promotes satiety

12
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what hormone is typically co-secreted with insulin?

amylin

13
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what is the mechanism of GLP-1 receptor agonists (incretin GLP-1 mimetics)? x 4 things

promotes glucose-dependent insulin secretion

inhibits post-prandial glucagon release

slows gastric emptying

suppresses appetite

14
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what is the mechanism of combo GIP and GLP-1 receptor agonists?

effects are similar to GLP-1 receptor agonists, but act like both endogenous GIP and GLP-1

15
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what is the mechanism of biguanides?

increase sensitivity of insulin receptors, decrease liver gluconeogenesis

16
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what is the mechanism of sulfonylureas?

stimulate insulin release (secretagogue)

17
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what is the mechanism of meglitinides?

stimulate insulin release (secretagogue)

18
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what is the mechanism of a-glucosidase inhibitor?

inhibit enzymes at GI brush border, this inhibits absorption of ingested carbohydrates

19
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what is the mechanism of thiazolidinediones (TZDs)?

insulin sensitizers

20
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what is the mechanism of DPP-4 inhibitors?

slow incretin inactivation by DPP-4 enzyme, then stimulates glucose-dependent insulin release and inhibits post-prandial glucagon release

21
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what is the mechanism of SGLT2 inhibitors

reduce the reabsorption of glucose by the kidnesy

22
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what is the mechanism of oral GLP-1 receptor agonists?

promote glucose-dependents insulin secretion

inhibits post-prandial release of glucagon,

slows gastric emptying

suppresses appetite

23
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what can lipohypertrophy result in ?

unpredictable insulin absorption rates if the site continues to be used for insulin injection

24
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what can lipoatrophy result in?

unpredictable insulin absorption rates if site continues to be used for insulin injection

25
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when does lipohypertrophy occur?

what is the technical description for it?

when a person w DM injects insulin into the same spot over and over

buildup of fat due to lipogenic properties of insulin

26
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what does lipohypertrophy look like?

a lump in the skin

27
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what does lipoatrophy lead to?

leads to decreased subcutaneous fat in the area of injection

28
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what are 2 dangers of hypoglycemia?

syncope, can be fatal

29
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hypoglycemic levels ______ from person to person.

vary

30
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how many times more concentrated is U-500 insulin than U-100 insulin?

5 TIMES MORE CONCENTRATED

31
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how many units per mL are there in a U-100 bottle of insulin?

what size bottle does U-100 insulin normally come in?

100 units per mL

10 mL bottles

32
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how many units per mL are there in U-500 bottle of insulin?

what size bottle do U-500 insulin come in?

500 units of insulin per mL

20 mL bottles

33
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what is U-500 insulin typically used for ?

about how much insulin per day would this person take?

people requiring large doses of insulin

200 units/day or more

34
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U-500 insulin has what fraction liquid volume of U-100 insulin?

1/5th

35
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do all insulin pens inject the same dose?

no

36
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what color are U-500 syringes?

what color are U-100 syringes?

green

orange

37
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TRUE OR FALE:

insulin pens should not be used for more than one patients

TRUE

38
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what are three examples of RAPID-ACTING insulin?

aspart

lispro

glulisine

39
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what is an example of SHORT-ACTING insulin?

regular/human

40
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what are 2 examples of INTERMEDIATE-ACTING insulin?

NPH

detemir (lower doses)

41
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what are 2 examples of LONG-ACTING insulins?

What is one examples of ultra-long acting insulin?

glargine, detemir (higher doses)

degludec

42
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at 0.2 units/kg, what is the duration of detemir?

12 hours

43
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at 0.4 units/kg, what is the duration of detemir?

20-24 hours

44
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what route should insulin be administered through ??

subQ

45
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what types of insulin can be administered IV?

short-acting (regular) and all rapid acting

46
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what is the only type of intermediate and long-acting insulins that can be mixed in the same syringe with rapid/short-acting insulins?

ONLY NPH

47
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what does injection of insulin IM result in?

much more rapid absorption of insulin

48
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where should we avoid injecting insulin?

why is this?

directly around the navel

absorption can be erratic and unpredictable

49
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when choosing an insulin injection site, we should rotate these sites in order to avoid ……

lipohypertrophy and lipoatrophy

50
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what are 6 reasons to increase insulin dose?

increased calories, obesity, adolescent growth spurt

infection, stress, 2nd trimester pregnancy

51
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what are 3 reasons for decreasing insulin dose?

exercise (generally speaking)

1st trimester, immediately post-partum

52
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how many times should blood glucose be monitored in a day?

what if the BG is very uncontrolled?

2-5 times

more frequently

53
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what does the basal/bolus method of insulin therapy do?

attempts to mimic the natural insulin secretion rhythms of the pancreas

54
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what is the definition of basal insulin therapy

the steady, low level of insulin constantly secreted by the pancreas

55
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what is the definition of bolus insulin therapy

the spikes in insulin secretion stimulated by glucose ingestion, especially at meals

56
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what does a normal pancreas’ insulin secretion look like?

basal secretion at low level, and bolus when there is a meal

57
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when is basal insulin injected

bedtime

58
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when is basal insulin also known as?

what does bolus insulin require the person to count?

nutritional insulin

carbs

59
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when is correction insulin often given and why?

mealtimes to account for the actual blood glucose reading prior to the meal

60
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while type 1 diabetics are inpatient, they might require a ______ dose of insulin, compared to what they generally take?

higher dose

61
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a person with type 2 DM who aren’t insulin dependent might need what while in the hospital?

insulin dose

62
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what does illness promote increase circulation of that would cause someone to need insulin? x 2 things

circulating glucose and free fatty acids

63
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what kind of insulin does a correction dose use?

what is a typical correction dose?

rapid or short acting

1-3 units for each 50 mg/dL over 150 mg/dL, based on their insulin sensitivity

64
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are sliding scale insulin regimines recommended for inpatient hospital settings?

no, strongly discouraged

65
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what is an example of a closed-loop system of glucose monitoring?

how do they do this?

minimed

use data from CGM, use an algorithm to automatically adjust basal insulin

66
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what is the somogyi effect of insulin therapy?

undetected hypoglycemia followed by rebound hyperglycemia in AM

67
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what is the process of somogyi effect of insulin therapy?

low 1-3 am blood glucose, may be 2/2 PM intermediate (NPH) dose peak

inc. glucose production in liver activated by counter-insulin hormones with AM hyperglycemia

68
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how to diagnose somogyi effect of insulin therapy?

confirm with 3 am Blood glucose

would expect to see hypoglycemia if effect is happening

69
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what is the dawn phenomenon of insulin therapy?

what is the result of this?

rise in BG between 2-8 am 2/2 riske in counter-insulin hormones that are normally release, even by people without DM

patient is hyperglycemic in AM

70
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what is required to be done for diagnosis of Dawn Phenomenon of insulin therapy

check BG at 3 am

if hyperglycemia at 3 am, Dawn Phenomenon is more likely

71
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if you check a patient’s blood glucose at 3 am and it is euglycemic, what is necessary to be done?

more detective work

BG checks at different times needed

72
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TRUE OR FALSE

insulin and monitoring supplies are expensive

true

73
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unopened vials/pens of insulin should be stored where?

refridgerator

never freeze

74
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how long is room temperature storage of insulin that is already open?

1 month

75
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what should we always check before injecting insulin?

blood glucose level

76
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when a patient is sick, what should they continue to be diligent about monitoring and using?

blood glucose

using insulin

77
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metformin is considered for prevention of progression from prediabetes to type 2 dm in people with what characteristics?

25-59 yr olds w BMI >35

higher fasting plasma glucose

higher A1c

those with prior gestational DM

78
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prior and after radiologic procedures with IV dye, what should be done with metformin administration?

why do we do this?

d/c 48 hrs prior and after IV dye

to give time to assess post-procedure renal function

79
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if the patient develops contrast dye-induced nephropathy, metformin would cause what to happen?

what does this condition have?

metformin accumulates and could cause lactic acidosis

high fatality rate

80
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what are 4 risk factors for lactic acidosis?

severe kidney disease

severe liver disease

alcohol use disorder

heart failure

81
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what is the general rule regarding lactic acidosis?

what population of patients is this important for ?

make sure patients are urinating normally after a procedure involving iodinated contrast dye

important for patients with CKD and other risk factors

82
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what is the mechanism of glipizide?

does it require glucose to work?

blocks ATP-sensitive potassium channels, stimulates insulin release

no

83
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what does the ADA recommend as the preferred pharma agent to treat DM during pregnancy?

insulin

84
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what are the 2 types of secretagogues?

what do they do?

sulfonylureas and meglitinides

they stimulate insulin regardless of food intake

85
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when should you take secretagogues?

30 min before or with meals

86
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if a patient is N/V/A, what should they do regarding their secretagogue dose ?

what should they do during this time?

skip it until able to eat again

monitor BG closely, call the prescriber if BG goes high and remains high

87
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if a patient is NPO, vomiting, or unable to eat, what should we do regarding administration of secretagogues?

hold these medications

88
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what do incretin hormones found in the gut (such as GLP-1) normally increase?

insulin synthesis and release, and also inhibit glucagon

89
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what does the DPP-4 enzyme normally do to incretins?

inactivate them

90
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what is the mechanism of action of sitagliptin?

what does this do in the body?

inhibits DPP-4 enzyme and prevents inactivation of endogenous incretins

this increases and prolongs action of incretins, increases insulin and decreases post-prandial glucagon

91
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with the drug sitagliptin, why is the risk of hypoglycemia low when used alone?

the drug extends the action of incretins, which require the presence of glucose to increase insulin secretion

92
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when the SGLT2 receptor is blocked, what happens to the glucose in the body?

glucose is excreted in urine rather than returned to circulation

93
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what drug blocks SGLT2 receptors

dapagliflozin

94
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in patients with type 2 dm who need medication to intensify glycemic control, what class of medication is recommended to try first and why?

GLP-1 receptor agonis

lower risk of hypoglycemia than insulin

95
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what does endogenous GLP-1 do in the pancreas? x 2 things

promotes glucose-dependent insulin secretion

inhibits glucagon secretion

96
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how does endogenous GIP work in the pancreas? x 1 thing

promotes glucose-dependent insulin secretion

97
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what are the two incretins in the body?

GIP and GLP-1