Diabetes Management and Insulin Types Quiz

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Questions and Answers

What is the primary purpose of long-acting insulin?

To cover blood sugar needs for up to 24 hours. (correct)

To provide rapid spikes in blood sugar levels.

To be taken immediately before meals.

To lead to significant blood sugar fluctuations.

How long does ultra-long acting insulin typically last?

36 hours or longer. (correct)

Only 10 to 16 hours.

Up to 12 hours.

About 24 hours.

Why is Neutral Protamine Hagedorn (NPH) insulin considered less ideal?

It is taken only after meals.

It requires once-daily dosing and has a long duration.

It has no distinct peak or effective duration.

It has a distinct peak and a shorter duration of action. (correct)

What is the recommended timing for the intake of premixed insulin?

10 to 30 minutes before breakfast and dinner. Signup and view all the answers

What role does basal insulin play in blood glucose regulation?

It suppresses hepatic glucose production and maintains glycemic levels. Signup and view all the answers

What is the primary cause of Type 1 diabetes mellitus?

Autoimmune destruction of pancreatic β-cells Signup and view all the answers

What symptom is most commonly associated with Type 1 diabetes mellitus upon diagnosis?

Fatigue Signup and view all the answers

Which of the following correctly describes a typical characteristic of Type 2 diabetes mellitus?

Insulin resistance and relative deficiency of insulin Signup and view all the answers

What complication is most associated with chronic hyperglycemia in diabetes mellitus?

Diabetic ketoacidosis (DKA) Signup and view all the answers

Which of the following mechanisms contributes to insulin resistance in Type 2 diabetes?

Excessive hepatic glucose production Signup and view all the answers

What effect does amylin have in the context of diabetes?

Slows gastric emptying and suppresses glucagon secretion Signup and view all the answers

At what age is Type 2 diabetes mellitus most commonly diagnosed?

Age 45 years and above Signup and view all the answers

Which of the following conditions can arise from untreated diabetes mellitus?

Hyperosmolar hyperglycemic syndrome (HHS) Signup and view all the answers

What is the primary method of administration for most insulin products?

Subcutaneous injection Signup and view all the answers

Which insulin concentration is the most commonly used?

U-100 Signup and view all the answers

What is the duration of action for rapid-acting insulin?

2 to 4 hours Signup and view all the answers

U-500 regular insulin is primarily reserved for which type of patients?

Patients with extreme insulin resistance Signup and view all the answers

Which type of insulin has an onset time of approximately 15 minutes?

Rapid-acting inhaled insulin Signup and view all the answers

What is a key advantage of longer-acting insulins?

Less glucose variability Signup and view all the answers

How long does intermediate-acting insulin last?

12 to 18 hours Signup and view all the answers

Which insulin type is usually taken right before a meal?

Rapid-acting insulin Signup and view all the answers

What is the primary goal of treatment for diabetes mellitus?

Prevent or delay progression of long-term complications Signup and view all the answers

Which of the following symptoms is commonly associated with the initial presentation of diabetic ketoacidosis (DKA)?

Severe dehydration Signup and view all the answers

What is a characteristic feature of most patients diagnosed with type 2 diabetes mellitus?

They are often overweight or obese Signup and view all the answers

What test provides an average of blood sugar control over the past 2 to 3 months?

HbA1c test Signup and view all the answers

Which group of exogenous insulin includes insulin aspart and lispro?

Insulin Analogues Signup and view all the answers

What is a common complication that may be present at the time of diagnosis for patients with type 2 diabetes?

Myocardial infarction or stroke Signup and view all the answers

What disadvantage is associated with the use of insulin for managing diabetes mellitus?

Risk of hypoglycemia Signup and view all the answers

How is prediabetes characterized?

Abnormal blood glucose that does not meet diabetes thresholds Signup and view all the answers

Study Notes

Diabetes Mellitus (DM)

DM is a group of metabolic disorders characterized by chronically elevated blood glucose (BG), abnormal carbohydrate, fat, and protein metabolism
It affects the body's ability to produce and/or utilize insulin.
DM has categories including Type 1 and Type 2.
Without treatment DM can cause acute complications such as Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)
Chronic hyperglycemia can lead to microvascular, macrovascular and neuropathic complications.

Type 1 DM

(5%-10% of cases) Characterized by the pancreas not producing insulin
Usually due to autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency.
Occurs in children and adolescents but can occur at any age.
Amylin (a hormone co-secreted from beta cells with insulin), is deficient in patients with Type 1 DM

Type 2 DM

(90%-95% of cases)
The age of onset is ≥45 years
Insulin resistance:
- Excess hepatic glucose production -↓ skeletal muscle uptake of glucose -↑ lipolysis and F.A production.
- Impairment in insulin secretion, Beta cell mass and function are reduced.
Incretin effects: GLP-1 & GIP are released, to stimulate insulin secretion and suppress glucagon release.
The condition is progressive.

Clinical Presentation Type 1

Patients often exhibit symptoms in the days or weeks preceding the diagnosis.
Common initial symptoms include polyuria, polydipsia, polyphagia, weight loss, fatigue, and lethargy.
Individuals are often thin and are prone to develop DKA in the absence of an adequate insulin supply.
Symptom onset can sometimes be triggered by infection, trauma, or psychological stress.

Clinical Presentation Type 2

Many patients are asymptomatic or have only mild fatigue at the time of diagnosis.
Patients with Type 2 DM are often found incidentally during routine lab. testing.
Complications such as myocardial infarction and stroke, may be present at the time of diagnosis.
Hemoglobin A1c (HbA1c) is an important blood test that provides an average blood glucose over the past 2-3 months.
Most patients are overweight or obese with an elevated waist-to-hip ratio

Diagnosis

Diagnostic criteria vary but involve a combination of parameters testing fasting blood glucose (FPG), a two-hour post-load plasma glucose (oral glucose tolerance test) and glycosylated hemoglobin A1C (A1C).
Prediabetes is a condition of abnormal BG but does not meet thresholds to define DM.

Goals of Treatment

The primary goal is preventing or delaying the progression of long-term microvascular and macrovascular complications of hyperglycemia.
Additional goals involve alleviating symptoms, minimizing hypoglycemia, minimizing treatment burden, and maintaining quality of life.
Appropriate glycemic targets for non-pregnant adults with diabetes are detailed in a table.

Insulin

Endogenous insulin moves glucose out of the bloodstream into the cells, lowering serum glucose levels.
Two main groups of exogenous insulin are human insulins and insulin analogues.
Insulin's main advantage is achieving a wide range of glucose targets.
Disadvantages include an increased risk of hypoglycemia, a need for injections, weight gain, and treatment burden.

Insulin Administration

Most insulin products are administered subcutaneously (SC).
An exception is inhaled human insulin, a dry powder of regular insulin absorbed through the lungs.
Various methods for insulin administration exist (syringe, pen, pump, inhaler)

Insulin Concentration & Pharmacokinetics

The most common insulin concentration is 100 units/mL (U-100).
More concentrated insulins (e.g., U-200, U-300, U-500) may be required in patients needing larger doses
Insulin products are characterized by their onset, peak, and duration of action.

Types of Insulin

Insulin can be broadly classified by the rate of onset and duration for achieving the desired effect.
Rapid-acting, regular/short-acting, intermediate-acting, and long-acting are distinct types of insulin based on its differing onset and duration.
Acarbose is an inhibitor of alpha-glucosidase enzymes, used to slow glucose absorption, reducing postprandial glucose levels.

Basal Insulin

This type of insulin is also background insulin.
It helps regulate blood glucose levels between meals and during the night.
Common forms of basal insulin include NPH and glargine.

Bolus Insulin

Bolus insulin, or prandial insulin, is given to cover meals and is short or rapid-acting.
The insulin dose is taken to control and address elevated blood glucose levels.
Types of bolus insulins include Insulin Aspart, Lispro, and Glulisine.

Rapid-acting Insulins

Rapid-acting insulins offer a faster onset and shorter duration of action compared to regular insulins;
Ultra-rapid acting insulins provide an even faster onset.

Adverse Effects

Hypoglycemia is the most common adverse effect, Insulin also causes a dose-dependent weight gain, predominantly truncal fat.
Injection site reactions, such as redness, pain, itching, urticaria, edema, and inflammation can occur.
Lipoatrophy or lipo-hypertrophy (a lump of fatty tissue) can develop under the skin with improper injection site rotation.
Inhaled human insulin is contraindicated in patients with COPD and asthma.
The risk of hypoglycemia is reduced when GLP1RAs are administered with Metformin, or a TZD.

Biguanides (Metformin)

Oral medication for type 2 diabetes.
Reduces hepatic glucose production and enhances insulin sensitivity in peripheral tissues (muscle).
Enables glucose uptake into muscle cells.
1st-line pharmacotherapy for type 2 DM (unless CI or intolerability)
Initial therapy is at a low dose (typically 500 mg) with meals.
Dosage is progressively increased (in 500-mg increments) over several weeks.

Advantages of Metformin

Reduces A1C levels by 1.5%–2% and FPG levels by 60–80 mg/dL in drug-naïve patients.
Reduces plasma triglycerides (TG) and LDL-C by 8%–15% and may moderately increase HDL-C levels.
Does not cause weight gain, may lead to a modest weight loss
Relatively low risk of hypoglycemia.

Disadvantages of Metformin

Frequently causes GI side effects (diarrhea, abdominal discomfort).
Metallic taste and may decrease vitamin B12 levels.
Contraindicated in renal insufficiency (eGFR <30 mL/min/1.73 m2).

Thiazolidinediones (TZDs) (Pioglitazone, Rosiglitazone)

Agents for reducing insulin resistance.
Enhance insulin sensitivity in muscle, liver, and fat tissues
Improve glycemic control in patients with type 2 diabetes.
Both can achieve an A1C reduction of 1%–1.5% and a FPG reduction of 60–70 mg/dL (3.3–3.9 mmol/L)
The maximum effect may not appear until 4–6 weeks of treatment.
Taken orally once daily with or without food.
TZDs can be used in combination with metformin and other commonly prescribed medications for type 2 DM.

Disadvantages of TZDs

Fluid retention (peripheral edema), heart failure, and osteoporosis are common side effects .
Pioglitazone is linked to reduced plasma triglycerides (TG and LDL-C) while Rosiglitazone may increase LDL-C
Weight gain (4 kg or more) is frequently reported
TZDs are associated with an increased risk of fractures, especially in postmenopausal women.

Alpha-glucosidase Inhibitors

Acarbose and Miglitol are used to slow glucose absorption from the intestines.
Reducing postprandial glucose (PPG) levels.
A1C lowering is modest.
Commonly reported side effects include flatulence, abdominal pain, and diarrhea.
Contraindicated in patients with cirrhosis, colonic ulcers, intestinal disease, or diabetic ketoacidosis.

Amylin Analogs (Pramlintide)

Synthetic amylin analog that reduces glucagon secretion
Slows gastric emptying
Increases satiety
Decreases postprandial glucose (PPG)
First non-insulin agent approved for type 1 DM.
Lowering both PPG levels and A1C levels, with reductions of 0.6% in type 2 and 0.4%–0.5% in type 1.
Often used as adjunctive therapy for patients with type 1 and 2 who are not adequately controlling postprandial blood glucose.

Glucagon-like Peptide 1 Receptor Agonists

Class of incretins (GLP-1RAs).
Stimulate insulin secretion, suppress glucagon secretion
Decrease hepatic glucose output.
Decrease gastric emptying and promote satiety.
Weight loss (1–3 kg) is a common side effect.
Available as both short-acting (exenatide, lixisenatide) and long-acting (dulaglutide, exenatide XR, liraglutide, semaglutide)
The most common side effects include nausea, vomiting, and diarrhea, injection site reactions, hypersensitivity reactions (including anaphylaxis).

GLP-1 RAs Precautions

GLP-1RAs are not frequently recommended as first-line therapy.
Used as second-line therapy in patients with established atherosclerotic disease, CKD and require careful monitoring if using with other diabetes medications such as, sulfonylureas, or insulin.

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Description

Test your knowledge on diabetes management and the various types of insulin. This quiz covers key topics such as the purposes of long-acting insulin, characteristics of Type 1 and Type 2 diabetes, and complications associated with chronic hyperglycemia. Challenge yourself and deepen your understanding of these critical concepts in diabetes care.