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Diabetes Mangment II


What is the Normal Blood Glucose range in people without Diabetes? 60-120 mg/dL
What does Glucagon do? counter/balance out the effect of Insulin; increases Glucose release from the LIVER = increased Blood Sugar
When is Glucagon released? when Blood Glucose is too low
What is the COMMON problem of Diabetes, regardless of cause? TOO MUCH Blood Glucose
What are reasons for High Blood Glucose, Hyperglycemia? Insulin Deficiency Insulin Resistance Excess Production and Release of Glucose by LIVER
What are causes of Insulin Deficiency? Beta Cell of Pancreas failure Pancreas damage (one of the above with type 1) Type 2 Diabetes would have not enough Insulin to meet their needs, such as if Insulin were released too slowly after eating
Of what condition is Insulin Resistance an important cause? Type 2 DM
What causes Excess Production and Release of Glucose by the Liver? Insulin Deficiency or Resistance = body attempt to compensate for lack of Glucose in cells by making more available = Liver Production and Release of Glucose
Everyone with Type 1 DM and many with Type 2 DM need what? DAILY Medication Regular Physical Activity Healthy Food Choices Self-Monitoring of Blood Glucose
What are not generally indicated in Type 1 DM patients? Oral Diabetic Medications
What are the only current methods of Insulin Administration? Injection or Insulin Pump
When are Medications prescribed for Type 2 DM patients? when Lifestyle Changes alone are not sufficient to control Blood Glucose
What are examples of Healthy Lifestyle Habits for Type 2 DM patients to control their Blood Glucose? Meal planning Physical activity Maintaining Healthy Body Weight
What does Medication Selection for Type 2 DM depend on? Patient's: Clinical Presentation and Underlying Metabolic Defects (i.e. Significant Postprandial Hyperglycemia or Pancreas ability to produce Insulin)
Does someone's medication needs remain the same throughout their life? no, their needs may change over time; (i.e. as Diabetes progresses management often shifts form Lifestyle Changes alone too include one or more Oral Meds and/or Insulin)
Many people with Type 2 DM require what kind of therapy? Combination Therapy: two or more meds (oral or oral and Insulin) to control Blood Glucose Many need other Meds to control High Blood Psi, High Cholesterol, aid Weight loss or Smoking Cessation
What do Sulfonylureas do? LOWERS Blood Glucose by stimulating Pancreas to release Insulin (remember, if Beta cells are DEAD, they can't make Insulin, so don't bother giving this med to a Type 1)
What is the "nomenclature" for Sulfonylureas Generic names? "Gli/y- -ide"s and Diabinese/ChloropropamIDE (which is rarely used anymore) BLACK BOX WARNING - Biguanides have EXACTLY THE SAME NOMENCLATURE (but they are ALL Metformin)
What do Blood Glucose reducing medications (including Insulin) TYPICALLY increase the risk of (this is specifically taken from Sulfonylureas)? Hypoglycemia: ESPECIALLY if someone Skips a meal, Drinks too much Alcohol, or engaged in Physical Activity more Strenuous than usual
Sulfonylureas are CONTRAINDICATED in patients with what Allergy? allergy to Sulfa Drugs
What do Meglitinides do? Stimulate Pancreas to release Insulin in response to Eating a meal; reduce Postprandial Blood Glucose levels
What is the "nomenclature" for Meglitinide Generic names? "-glinide"
When are Meglitinides taken? about 15 minutes BEFORE each meal; usually taken 2-4 times/day, depending on person's meal pattern
When should Low Blood Sugar (Hypoglycemia) be treated? AT THE FIRST SIGN of low Blood Glucose
Which Meglitinide is especially inclined to increase the risk of Hypoglycemia? Repaglinide
What do Insulin Sensitizers do? Reduce Insulin Resistance (a MAJOR cause of Type 2 DM) = lower Glucose levles
What is the "nomenclature" for Insulin Sensitizers Generic names? "-glitazone"
What is another name for Insulin Sensitizers? Thia-Zaolidine-Diones (thiazolidinediones or TZDs)
What is a rare Adverse Effect of Insulin Sensitizers (TZDs)? Serious Liver damage; need blood tests to check liver function before med started, Q 2 months for first year, and periodically thereafter; tell Doctor if have Liver Disease or if experiencing S/S of Liver problems
What are S/S of Liver problems for patient to report when taking Insulin Sensitizers (TZDs)? Unexplained Tiredness, Dark Urine, Skin Yellowing
What are possible Insulin Sensitizer (TZD) Side Effects? Tiredness, Weight Gain, Hand and Feet Swelling
For what reason should someone taking an Insulin Sensitizer (TZD) contact the Health Care Team IMMEDIATELY? if they are experiencing unusually Rapid Increase in Weight, Swelling, or SOB
What do Biguanides do? reduce LIVER Glucose production and Reduce Insulin Resistance = Lower Blood Glucose
What are the Biguanides? METFORMIN (by any other name): Glucophage (XR), also combination pills: Glucovance, Metaglip, and Avdamet
In what kind of cells does Metformin decrease Insulin Resistance? muscle and fat cells
How might people's Weight be affected by Metformin therapy? some people might experience Slight Weight Loss
Does Metformin increase the risk of Hypoglycemia? Metformin by itself DOES NOT increase the risk of Hypoglycemia
When DOES Metformin Increase the risk of Hypoglycemia? when it is used in Combination therapy (and it OFTEN is) with a SULFONYLUREA
What are the two different types of med that Metformin can be Combined with in Combination Therapy? Metformin can be combined with a Sulfonylurea or Insulin Sensitizer
Definition: "Glucovance" Metformin Combination Therapy from combination of Metformin and Glyburide (Sulfonylurea)
Definition: "Metaglip" Metformin Combination Therapy from combination of Metformin and Glipizide (Sulfonylurea) (think "GLIP" MetaGLIP/GLIPizide
Definition: "Avandamet" Metformin Combination Therapy from combination of Metformin and Rosiglitazone (Insulin Sensitizer)
What is a Side Effect associated with Metformin in some people? Diarrhea or Upset Stomach; often goes away in time
How might Metformin's side effect be decreased? Diarrhea/Upset Stomach can be decreased by taking the drug with Food OR begin therapy with Low dose and Gradually Titrate up, as Tolerated, to an Effective dose
What is a RARE Adverse Effect of Metformin? Lactic Acidosis
Definition: "Lactic Acidosis" DANGEROUS, potentially FATAL buildup of Lactic Acid in the Blood
Metformin is CONTRAINDICATED in patients with what kind of conditions D/T increased likeliness of developing Lactic Acidosis? patients with Kidney problems, Liver disease, who take Medication for Heart Failure
Consuming what increases the Risk of Lactic Acidosis when taking Metformin? Alcohol
What test might a Physician recommend BEFORE beginning Metformin Therapy? checking Kidney function with a CREATININE test
What do DPP-IV Inhibitors do? Increase Insulin production/release, Decrease LIVER Sugar Production
What is the "Nomenclature" for DPP-IV Generic names? "S- -agliptin"
What do SGLT Inhibitors do? STOP Glucose reabsorption in Kidney = INCREASED Glucose excretion in Urine
What is the "Nomenclature" for SGLT Inhibitor Generic names? "-agliflozin"
What are the Side Effects of SGLT Inhibitors? UTI/Yeast Infection (excessive sugar in urine) Dehydration/Drop in BP when standing (possibly sugar drawing excess water out in urine) Low Blood Sugar when combined with other Diabetes meds
What do GLP Agonists do? SLOW Gut glucose Absorption; Increase Insulin release (by Increasing Beta Cell Mass - which produce Insulin); Decreases Insulin Resistance
What is the "Nomenclature" for GLP Agonist Generic names? "-tide"
How are GLP Agonists administered? SQ Injection
What do people taking Insulin need to understand? Time/activity profiles of the Insulin types they take to ensure SAFE and EFFECTIVE use
How are Insulins grouped? according to their Time/Action profiles
What are the three "parts" of the Time/Action profiles by which Insulins are grouped? Onset of Action - How soon Insulin start working to Lower Blood Glucose Peak Time - when Insulin reaches Maximum Effect Duration - how long Insulin continues to work in the body
What (six things) needs to be taken into account when determining a patient's Insulin Regimen? Body Weight, Build, level of Physical Activity, Daily Food intake, Use of other Medicines, and General Health
What is often needed to meet individual Insulin needs? "mixed dose" or combination of Shorter-acting and Longer-acting Insulins
Excess Insulin of what type can cause Hypoglycemia? ANY TYPE OF INSULIN can cause Hypoglycemia
What can help avoid Hypoglycemia and maintain Blood Glucose within target ranges? Self-Monitor Blood Glucose and Pattern Management Skills (know how to treat Hypoglycemia in case it happens)
What is Insulin available in (for injecting)? Vials, Cartridges, and Disposable Prefilled Insulin Pens
What type of Insulin requires a prescription? Insulin Analogues
Do most types of Insulin require a prescription? NO
What should you advise patients who use Insulin and plan to travel out of State? Check on the availability of Insulin at their destination BEFORE departure
What is the "Nomenclature" for RAPID Insulin Brand names? "-a/olog" x 2 and Apidra
What is the Start and Peak Time for RAPID Insulin (about how long dose it last)? Start: 15 minutes Peak: 30-90 minutes Lasts about 4 hours
What is the "Nomenclature" for SHORT Insulin Brand names? "- alin R" x 2
What is the Start and Peak Time for SHORT Insulin? Start: 30 minutes Peaks: 3 hours
What is the "Nomenclature" for INTERMEDIATE Insulin Brand names? "-a/olin R" x 2
What is the Start, Peak, and End Time for INTERMEDIATE Insulin? Start: 1-3 hours Peaks 4-9 hours ENDS: 14-20 hours
What is the "Nomenclature" for LONG Insulin Brand names? Starts with "L" x 2 (Lantus and Levemir)
What is the TIME for LONG Insulin (no Peak, just duration)? 24 hours
When should RAPID Insulin be taken? JUST BEFORE Eating (about 10-15 minutes beforehand; "JUST AS THE PLATE IS SET")
What is the purpose of RAPID Insulin? reduce Postprandial Blood Glucose
What kind of Insulin are RAPID Insulins? HUMAN Insulin analogues
What are the RAPID Insulins? "HAN/lag" Humalog (Insulin lispro), Apidra (Insulin glulisine), and Novolog (Insulin aspart)
What may occur if RAPID Insulin is taken MORE than 15 minutes BEFORE eating? Hypoglycemia, because Glucose sources have not been consumed in time to replace blood sugar that has been sent into the cells by Insulin
What form is RAPID Insulin available in (not solely but as bonus)? Premixed forms
Definition: "Humalog Mix 75/25" 75% Insulin lispro Protamine Suspension (INTERMEDIATE Insulin) and 25% lispro (RAPID Insulin) Combines rapid onset with duration of action of INTERMEDIATE Insulin
Definition: "Novolog Mix 70/30" 70% Insulin aspart Protamine Suspension (INTERMEDIATE Insulin) and 30% aspart (RAPID Insulin) Combines rapid onset with duration of action of INTERMEDIATE Insulin
What do Premixed RAPID Insulins contain (mixed as of in with two different kinds of Insulin)? approximately 2/3-3/4 INTERMEDIATE "Protamine Suspension" (of an Insulin named the same thing as a RAPID) + approximately 1/4-1/3 RAPID Insulin (same one as is in the Protamine Suspension)
Are RAPID Insulin suitable for use in Insulin Pump Therapy? RAPID Insulins are suitable for use in Insulin Pump Therapy
Slide 13
Created by: HESTONA001