COA Exam 2: Diabetes, Insulin, T2DM Tx

What is diabetes the leading cause of?

blindness, kidney failure, and non-traumatic amputations

What is Type 1 Diabetes?

primary beta cell destruction leads to absolute insulin deficiency

How do patients with T1DM manage their blood sugar?

Patient is absolutely insulin deficient and will die without insulin injections

What is Type 2 Diabetes?

insulin resistance with insulin excess, patient is not insulin deficient at diagnosis

How do patients with T2DM manage their blood sugar?

Patient may require insulin to normalize glucoses, but they will not become ketotic without it

What is considered hyperglycemia with fasting glucoses?

greater than 125

What is considered hyperglycemia with postprandial glucoses?

greater than 200

What is considered hyperglycemia with plasma glucose?

greater than 200 any time of day

What are risk factors for DM?

obesity, alcoholism, genetics, sedentary lifestyle

What are symptoms of DM?

weight loss, fatigue, confusion, non-healing wounds

What diagnostics are used for DM?

fasting glucose levels, hemoglobin A1C

What is the treatment for DM?

drug replacement, oral agents for Type 2, insulin for Type 1

What is a normal A1C?

less than 5.7%

What is the goal for A1C?

less than 7%

What level of A1C requires further action?

greater than 8%

What is the best case scenario for treatment of T1DM?

patient is on an insulin pump or a combination of long acting and short acting insulin

What are the three rapid acting insulins?

Lispro, Aspart, Glulisine

What is the onset of rapid acting insulin?

5-15 minutes

When is the peak for rapid acting insulin?

1-2 hours

What is the duration for rapid acting insulin?

3-5 hours

What is the short acting insulin?

regular insulin

What is the onset of Regular insulin?

30-60 minutes

When is the peak for Regular insulin?

2-4 hours

What is the duration of Regular insulin?

6-8 hours

What is the intermediate acting insulin?

NPH

What is the onset for NPH?

2-4 hours

When is the peak of NPH?

6-10 hours

What is the duration of NPH?

10-16 hours

What are the two long acting insulins?

Glargine and Detemir

What is the onset of long acting insulin?

1-2 hours

When is the peak of long acting insulins?

No peak

What is the duration of long acting insulins?

up to 24 hours

What is 70/30 Insulin?

70% NPH, 30% regular

What is Humulin 50/50?

50% NPH, 50% Regular

What is Humalog 50/50?

50% NPH, 50% lispro

What is Humalog 75/25?

75% NPH, 25% lispro

What is NovaLog 70/30?

70% NPH, 30% Aspart

What are advantages of rapid acting insulin?

better control of postprandial, less risk of night hypoglycemia

What are Sulfonylureas?

glipizide, glyburide, glimepiride

What is the action of Sulfonyureas?

stimulates pancreatic beta cells to secrete more insulin and increases sensitivity

What are Biguanides?

Metformin (Glucophage)

What is the action of Biguanides (Metformin)?

decreases over production of glucose by liver and increases binding of insulin complex

What are Secretagogues (Meglitinides)?

Starlix, Prandin

What is the action of Secretagogues (Meglitinides)?

stimulates beta cells to release insulin in a time limited fashion

What are Alpha-Glucosidase Inhibitors?

Acarbose, Miglitol

What is the action of Alpha-Glucosidase Inhibitors?

Slows CHO digestion and delays glucose absorption

What are Thiazolidinediones?

Pioglitazone, Rosiglitazone

What is the action of Thiazolidindiones?

reduces insulin resistance and increases insulin receptors on cell membranes