Chapter 50 Antidiabetic Medications: Insulin and Oral Agents

What is Type I Diabetes Mellitus?

A condition with no beta-cell function where the body does not produce insulin, requiring treatment with insulin.

What is Type II Diabetes Mellitus?

A condition characterized by cellular insulin resistance or insufficient insulin secretion, often linked to genetics and obesity.

What are the common symptoms of diabetes?

Polyuria (excessive urination), polyphagia (increased appetite), and polydipsia (excessive thirst).

What is the mechanism of action (MOA) of Lispro insulin?

A rapid-acting insulin that mimics endogenous insulin to lower blood glucose by promoting cellular uptake of glucose.

What are the pharmacokinetics of Lispro insulin?

Onset is rapid, peak is early, and duration is short.

When should Lispro insulin be administered?

Shortly before meals, with food present to avoid rapid, severe hypoglycemia.

What is the primary use of Regular insulin?

It is the only insulin that can be given IV and is used for sliding scales.

What is the appearance of NPH insulin?

It has a cloudy appearance and should be rolled to mix.

What is the MOA of Metformin?

A biguanide that decreases hepatic glucose production, decreases intestinal absorption of glucose, and increases insulin sensitivity in peripheral tissues.

What are the common side effects of Metformin?

Gastrointestinal upset (diarrhea, abdominal pain, gas, metallic taste, nausea/vomiting) and risk of lactic acidosis.

What should be done before a procedure involving IV iodine contrast dye for a patient on Metformin?

Hold Metformin to prevent acute renal failure and severe lactic acidosis.

What is the MOA of Glipizide and Glyburide?

Second-generation sulfonylureas that stimulate pancreatic beta cells to secrete more insulin and increase peripheral tissue response to insulin.

What are the side effects of Glipizide and Glyburide?

Hypoglycemia and weight gain.

In which conditions are Glipizide and Glyburide contraindicated?

DKA, pregnancy, and severe liver or kidney disease.

What is the importance of educating patients on alcohol consumption while on Glipizide and Glyburide?

Alcohol can increase the risk of hypoglycemia.

What is the duration of action for long-acting insulin like Glargine and Detemir?

They have a gradual onset with no peak and provide extended duration.

What is a key point regarding the mixing of insulins?

Always draw clear (Regular) before cloudy (NPH) when mixing insulins.

What should be done with unopened vials of insulin?

They should be refrigerated.

What is the significance of rotating injection sites for insulin?

To prevent lipodystrophy.