Diabetes and Insulin: Types, Actions, and Treatments

What is diabetes mellitus?

A disorder of carbohydrate metabolism involving insulin deficiency, insulin resistance, or both, leading to hyperglycemia.

What are the two major types of diabetes?

Type I (insulin-dependent diabetes mellitus, IDDM) and Type II (non-insulin-dependent diabetes mellitus, NIDDM).

Which type of diabetes usually begins in childhood?

Type I diabetes.

Which type of diabetes usually develops after age 30?

Type II diabetes.

How is Type I diabetes commonly treated?

Insulin replacement therapy.

How is Type II diabetes commonly treated?

Diet, oral hypoglycemic agents, and sometimes insulin.

What is insulin?

A hormone made by beta cells in the pancreas.

What is insulin's main function?

It allows glucose to enter cells for energy and decreases glucose production by the liver.

Why can't insulin be taken as a pill?

Stomach acid destroys it.

What is the primary action of insulin?

To promote the entry of glucose into cells.

What emergency condition can insulin treat?

Acute ketoacidosis.

What are the three major classes of insulin?

Rapid/short-acting, intermediate-acting, and long-acting.

Examples of rapid-acting insulin?

Humalog, NovoLog, and Apidra.

What is the onset of rapid-acting insulin?

10-15 minutes.

What is the peak of rapid-acting insulin?

30-90 minutes.

What is the duration of rapid-acting insulin?

3-4 hours.

When does Regular insulin start working?

30-60 minutes after injection.

When does Regular insulin peak?

2-4 hours.

How long does Regular insulin last?

6-9 hours.

What type of insulin is NPH?

Intermediate-acting insulin.

What does NPH stand for?

Neutral Protamine Hagedorn.

When does NPH peak?

About 4-8 hours after injection.

How long does NPH last?

About 13 hours on average.

Examples of long-acting insulin?

Lantus (glargine) and Levemir (detemir).

What is unique about Lantus?

It lasts about 24 hours and has almost no peak.

What is unique about Levemir?

Basal insulin lasting up to 24 hours; some patients need twice-daily dosing.

Which injection site provides the most consistent absorption?

The abdomen.

What should patients using insulin practice?

Rotation of injection sites.

Which insulin is drawn into the syringe first when mixing Regular and NPH?

Regular insulin.

What increases insulin absorption?

Exercise and increased temperature (hot baths, showers, hot tubs).

What is the most dangerous adverse effect of insulin?

Hypoglycemia.

Severe hypoglycemia can lead to what?

Convulsions, coma, and death.

What are other insulin adverse effects?

Tachycardia, sweating, drowsiness, and confusion.

Who usually receives oral antidiabetic drugs?

Patients with Type II diabetes.

What are the five major oral antidiabetic classes?

Sulfonylureas, Biguanides, Alpha-glucosidase inhibitors, Meglitinides, and Thiazolidinediones.

Example of a Biguanide?

Metformin (Glucophage).

Example of a Meglitinide?

Repaglinide (Prandin).

Examples of Thiazolidinediones?

Pioglitazone (Actos) and Rosiglitazone (Avandia).

Examples of Alpha-glucosidase inhibitors?

Acarbose (Precose) and Miglitol (Glyset).

Examples of second-generation Sulfonylureas?

Glipizide and Glyburide.

How do oral antidiabetic drugs work?

They stimulate insulin secretion and increase insulin receptor sensitivity.

When are oral antidiabetic drugs indicated?

Type II diabetes not controlled by diet and exercise alone.

What are common adverse effects of oral antidiabetic drugs?

Nausea, vomiting, headache, blurred vision, sedation, confusion, anxiety, nightmares, and tachycardia.

What insulin is considered 'cloudy'?

NPH insulin.

What insulin is considered the first true basal insulin?

Lantus (insulin glargine).

What insulin has the least risk of nighttime hypoglycemia?

Lantus because it has no significant peak.

What concentration is standard U.S. insulin?

U-100 insulin (100 units/mL).

What are the three insulin activity measurements you should know?

Onset, peak, and duration.