Diabetes Types and Insulin Overview

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Questions and Answers

What is a key goal in the treatment of hypothyroidism?

To replace missing thyroid hormone (correct)

To monitor TSH continuously

To normalize thyroid hormone production

To minimize symptoms without medication

When should thyroid medication typically be taken to optimize absorption?

With calcium or iron supplements

Right before bedtime

At least 1 hour before eating (correct)

30-60 minutes after breakfast

Which of the following is true regarding TSH monitoring after initiating thyroid therapy?

TSH can be tested every 6-8 weeks after dosage changes (correct)

TSH should be monitored every 2 weeks indefinitely

TSH does not need to be monitored if symptoms improve

TSH levels should be stable before any monitoring is required

What is a potential risk associated with overtreatment of thyroid hormone?

Elevated heart rate Signup and view all the answers

What should patients be advised regarding food intake after taking thyroid medication?

They should avoid food for at least 30-60 minutes Signup and view all the answers

In which populations should dosages of thyroid medication be adjusted?

In elderly populations Signup and view all the answers

Which of the following medications should not be taken within 4 hours of thyroid medication?

Bile acid sequestrants Signup and view all the answers

What is a primary treatment goal for hyperthyroidism?

To normalize thyroid hormone production Signup and view all the answers

What is a potential consequence of long-term use of Synthroid?

Accelerated bone loss Signup and view all the answers

Which of the following medications may require an adjustment in dose when used with Synthroid?

Warfarin Signup and view all the answers

What should patients taking Synthroid avoid to prevent absorption issues?

Proton pump inhibitors Signup and view all the answers

What is a common adverse effect of testosterone therapy?

Worsening sleep apnea Signup and view all the answers

Which condition is a contraindication for testosterone therapy?

Coronary artery disease Signup and view all the answers

What indicates testosterone deficiency in males?

Male hypogonadism Signup and view all the answers

When should PDE-5 inhibitors be taken to ensure effectiveness?

At least 1 hour before intercourse Signup and view all the answers

Which of the following medications can cause thyroid dysfunction?

Lithium Signup and view all the answers

What is a common treatment for Type 1 Diabetes?

Life-long insulin therapy Signup and view all the answers

Which insulin type has an onset of 15-30 minutes?

Rapid acting Signup and view all the answers

Why is knowing the onset, peak, and duration of insulin important?

To adjust medication dosing accurately Signup and view all the answers

What major risk is associated with insulin therapy in patients?

Hypoglycemia Signup and view all the answers

Which statement about Type 2 Diabetes is true?

Oral agents are the first line of treatment. Signup and view all the answers

What is a common side effect indicating hypoglycemia?

Tachycardia Signup and view all the answers

What is a characteristic of intermediate acting insulin?

Duration lasting up to 24 hours Signup and view all the answers

Which method is NOT a route for insulin administration?

Oral Signup and view all the answers

Study Notes

Type 1 Diabetes

Autoimmune destruction of pancreatic beta cells
No insulin production
Typically diagnosed in individuals under 30

Type 2 Diabetes

Reduced tissue sensitivity to insulin
Elevated blood glucose levels over time
Pancreatic beta cell impairment and eventual death
Initial treatment: Oral agents
Later stages may require insulin

Insulin Types

Rapid Acting

Onset: 15-30 minutes (HumaLOG), 10-20 minutes (NovoLOG)
Peak: 0.5-2.5 hours (HumaLOG), 1-3 hours (NovoLOG)
Duration: 3-6 hours (HumaLOG), 3-5 hours (NovoLOG)
Clinical note: 15 minutes feels like 1 hour

Short Acting

Onset: 30-60 minutes (Humulin R, Novolin R)
Peak: 1-5 hours
Duration: 6-10 hours
Clinical note: Short staffed nurses went from 30 patients to 8

Intermediate Acting

Onset: 60-120 minutes (Humulin N, Novolin N, NPH)
Peak: 6-14 hours
Duration: 16-24 hours
Clinical note: Nurses play hero for 8 16-year-olds

Long Acting

Onset: 70 minutes (Glargine), 60-120 minutes (Detemir)
Peak: None (Glargine), 12-24 hours (Detemir)
Duration: 18-24 hours (Glargine), variable (Detemir)
Clinical note: The two long nursing shifts never peaked, but lasted 24 hours

Importance of Insulin Drug Levels

Knowledge of onset, peak, and duration aids in accurate medication adjustments
Type 1 diabetes patients do not produce endogenous insulin

Patient Education: Insulin

Greatest risk: Hypoglycemia
Monitor blood glucose and signs of hypoglycemia
Interactions: Beta-blockers and other hypoglycemic agents
Carry carb/protein snacks
Proper injection technique, dosing, timing, and rotation of sites

Routes of Insulin Administration

Cannot be absorbed in the stomach: requires injection, intravenous, or inhaler routes
Insulin pump delivers continuous basal insulin and bolus doses.
Pros: more accurate mimicry of body's insulin action, fewer injections, greater accuracy
Cons: Contains insulin, causes weight gain, can cause DKA if catheter comes out

Inhaler Insulin

Delivers powdered insulin to lungs
Faster absorption, peak, and metabolism than injections

Metformin Monitoring

Can decrease vitamin B12 and folic acid levels
Monitor B12 levels, particularly in those with anemia or peripheral neuropathy

Metformin-Induced Lactic Acidosis

Increased risk with alcohol, specific medications, age, surgery, and hypoxic states.

Alpha-glucosidase Inhibitors

Delay carbohydrate digestion and absorption
Used as an adjunct therapy for T1DM or T2DM with exercise and diet changes.
Side effects: GI upset

Effectiveness of Sulfonylureas

Stimulate insulin secretion and increase tissue sensitivity
Effective as long as pancreas produces insulin, less effective as T2DM progresses

Sulfonylureas Interactions

Alcohol: Increases adverse effects
Beta-adrenergic blockers: Increase risk of hypoglycemia
Tagamet (Cimetidine): May increase sulfonylurea levels and risk of hypoglycemia

Diabetic Medications and Weight

Insulin and sulfonylureas can cause weight gain
Metformin, DPP-4 inhibitors, and GLP-1 inhibitors can cause weight loss
Glipizide does not cause weight gain or loss

Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors

Newest diabetes drug
Protects the heart and kidneys in type 2 diabetes

Approved to Reduce Risk of Major CV Events

Used in patients with atherosclerotic cardiovascular heart disease, established HF, and or diabetic kidney disease.

Glitazones Warning

May cause or exacerbate heart failure
Severe liver injury with Rezulin (removed from market) but reversible when stopped
Newer agents have lower incidence

Hypothyroidism

Treatment goal: Replace missing thyroid hormone
Undertreatment: Lethargy, fatigue, weight gain, skin changes, cold sensitivity, constipation
Overtreatment: Heart palpitations, elevated HR, trouble sleeping, sweating, anxiety, diarrhea, weight loss, bone loss

Patient Education: Bisphosphonates

Take with calcium and vitamin D for maximum effectiveness
Remain upright for 30-60 minutes
Take with a full glass of water (avoid possible throat and esophagus damage)
Inform dentist of medication use

Monoclonal Antibodies

Inhibit osteoclasts, decreasing bone resorption and increasing bone mass
Serious side effects include severe infection (abdomen, urinary tract, ears), dermatologic reactions, back pain and musculoskeletal pain, atypical femur fractures, hypocalcemia

PDE-5 Inhibitors

Take 1 hour before intercourse, no more than once daily
Medication may be more effective with testosterone therapy
Contraindications: Concurrent nitrates use

Hormonal Replacement Therapy (Contraindications)

History of venous thromboembolism

Corticosteroids

Treatment for rheumatoid arthritis (RA)
Anti-inflammatory and immunosuppressive effects
Use lowest effective dose

HPA Suppression

Occurs when high cortisol/hormone levels disrupt normal feedback and decrease endogenous hormone production.
Risk increases with 7+ days, should be withdrawn slowly

Systemic Corticosteroids

Tapering not needed if 5 days or less of less than 40mg/day. Corticosteroids use: can cause hypothalamic pituitary adrenal (HPA) suppression
Impact glucose metabolism: causes hyperglycemia.
Impacts immune response: increases infection rates

Methotrexate

Decreases inflammation caused by cell degradation by-products
Contraindications: Pregnancy, breastfeeding, leukopenia

BBW - Remicade

Serious infections and malignancy

BBW - Leflunomide

Embryo-fetal toxicity and hepatotoxicity

Plaquenil

QT interval prolongation

BBW - Tumor Necrosis Factor Inhibitors

Increased serious infection and malignancy risk

Stimulants for Weight Loss

Lead to insomnia, increased blood pressure, restlessness, drug dependence, and withdrawal symptoms

Orlistat (Alli)

Deficiencies in fat-soluble vitamins (ADEK) possible due to decreased GI tract fat absorption
Contraindications: Pregnancy, malabsorption syndrome, cholestasis

Contrave

Affects neurotransmitters in the hypothalamus
MOA: Decreases appetite, regulates appetite
Can cause opioid withdrawal and increased blood pressure and heart rate
Increased risk for neuropsychiatric effects

BBW - Suicidal Thinking (Contrave /other)

Potential for suicidal thoughts or actions

Saxenda

Slows gastric emptying, decreases food intake, increases beta-cell growth and replication
Side effects: Increased heart rate, headache, hypoglycemia, gastrointestinal distress.
BBW: Risk of medullary thyroid cancer

Bariatric Surgery

Altered absorption of oral medication

Pregnancy Considerations (all drugs)

Weight loss drugs not recommended, consult if pregnant or plan to become so

Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with a doctor or other qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

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Description

Explore the fundamentals of Type 1 and Type 2 diabetes, including their mechanisms and treatments. This quiz covers the different types of insulin, their onset, peak, and duration of action. Test your knowledge and understand the critical aspects of diabetes management.