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Injectable Drugs for Diabetes
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Injectable Drugs for Diabetes

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Questions and Answers

What is primarily responsible for the development of lipohypertrophy in insulin-treated patients?

  • Injecting insulin using a larger needle
  • Using long-acting insulins exclusively
  • Regularly alternating the injection sites
  • Injecting insulin into the same site repeatedly (correct)

    • What percentage of insulin is inactivated by the liver?

  • 70-80%
  • 20-50% (correct)
  • 5-10%
  • 90-100%

    • Which factor is most effective in reducing the risk of developing lipohypertrophy?

  • Using an insulin pen for all injections
  • Rotating the injection sites regularly (correct)
  • Using insulin syringes with larger capacity
  • Increasing the duration of insulin treatment

    • What is the unit interval marking on most insulin syringes?

    <p>1-2 unit intervals</p> Signup and view all the answers

    Which organ, aside from the liver, plays a key role in insulin metabolism?

    <p>Kidneys</p> Signup and view all the answers

    In patients with end-stage renal disease, how should insulin dosing be adjusted?

    <p>Decreased due to decreased clearance</p> Signup and view all the answers

    Which syringe size would be appropriate for delivering a dose of 50 units of insulin?

    <p>0.5 mL syringe</p> Signup and view all the answers

    What is the typical gauge range for needles used in insulin syringes?

    <p>28-32 gauge</p> Signup and view all the answers

    Which method of insulin administration is most commonly used in hospital settings for uncontrolled diabetes?

    <p>Intravenous infusion</p> Signup and view all the answers

    Where is the fastest absorption site for subcutaneous insulin injections?

    <p>Abdomen</p> Signup and view all the answers

    What is true about insulin pens and their needles?

    <p>Needles must be ordered separately for insulin pens</p> Signup and view all the answers

    What complication does rotating insulin injection sites help prevent?

    <p>Lipodystrophy</p> Signup and view all the answers

    Which of the following needle lengths is commonly used for insulin pen needles?

    <p>4-12.7 mm</p> Signup and view all the answers

    What describes lipoatrophy in diabetic patients?

    <p>Loss of subcutaneous fat at the injection site</p> Signup and view all the answers

    What is the relationship between the gauge number of an insulin pen needle and its thickness?

    <p>Higher gauge indicates thinner needle</p> Signup and view all the answers

    What is a primary cause of lipoatrophy in diabetic patients?

    <p>Repeated injections at the same site</p> Signup and view all the answers

    Which hormone is primarily secreted in response to low blood glucose levels?

    <p>Glucagon</p> Signup and view all the answers

    What is the main function of GLP-1 in relation to blood glucose regulation?

    <p>Inhibits gastric emptying and stimulates insulin secretion</p> Signup and view all the answers

    Which of the following is not a method used to produce insulin?

    <p>Synthetic analogs from human cells</p> Signup and view all the answers

    How does insulin primarily promote glucose storage in the liver?

    <p>By converting glucose to glycogen</p> Signup and view all the answers

    What role does DPP-4 play in the metabolism of GLP-1?

    <p>Breaks down GLP-1, therefore regulating its action</p> Signup and view all the answers

    What is a main reason recombinant insulin is preferred over animal-derived insulin?

    <p>It mimics human insulin more closely</p> Signup and view all the answers

    Which of the following is a direct effect of insulin on adipose tissue?

    <p>Decreases lipolysis</p> Signup and view all the answers

    Which component’s synthesis is increased by insulin, contributing to lipid storage?

    <p>Triglycerides</p> Signup and view all the answers

    Which transporter is crucial for glucose uptake in muscle and adipose tissue under the action of insulin?

    <p>GLUT4</p> Signup and view all the answers

    What effect does insulin have on the rate of protein synthesis in skeletal muscle?

    <p>Increases protein synthesis</p> Signup and view all the answers

    In which tissue does insulin primarily promote the storage of triglycerides?

    <p>Adipose tissue</p> Signup and view all the answers

    How does insulin influence protein catabolism within the body?

    <p>Decreases protein catabolism</p> Signup and view all the answers

    What is the effect of insulin on the synthesis of triglycerides and very low-density lipoproteins (VLDL)?

    <p>Increases both triglyceride and VLDL synthesis</p> Signup and view all the answers

    Identifying the organ, which is primarily involved in insulin-mediated glycogen synthesis?

    <p>Liver</p> Signup and view all the answers

    What role does insulin predominantly have in the liver?

    <p>To increase glycogen storage</p> Signup and view all the answers

    In the presence of insulin, what effect does it have on glycogen synthesis in skeletal muscle?

    <p>Increases glycogen synthesis</p> Signup and view all the answers

    What distinguishes short-acting insulin from long-acting insulin?

    <p>Onset of action</p> Signup and view all the answers

    Which concentration of insulin is most frequently utilized in treatment?

    <p>U-100</p> Signup and view all the answers

    Which insulin should be administered to optimize fasting blood glucose control?

    <p>Long-acting insulin</p> Signup and view all the answers

    At which blood glucose threshold does insulin secretion initiate from the pancreas?

    <p>140 mg/dL</p> Signup and view all the answers

    How soon after meal consumption does insulin secretion typically start in response to elevated glucose levels?

    <p>90 seconds</p> Signup and view all the answers

    Which among the following insulins is recognized as rapid-acting?

    <p>Humalog</p> Signup and view all the answers

    What type of insulin is designated as "basal" insulin?

    <p>Long-acting insulin</p> Signup and view all the answers

    Which insulin has the quickest onset of action?

    <p>Apidra</p> Signup and view all the answers

    What is the typical duration of effect for rapid-acting insulin once administered?

    <p>3-5 hours</p> Signup and view all the answers

    Which medication is an example of a rapid-acting insulin?

    <p>Apidra (insulin glulisine)</p> Signup and view all the answers

    How often is NPH insulin typically administered to patients?

    <p>Twice daily</p> Signup and view all the answers

    What is the onset time for rapid-acting insulins like Humalog or NovoLog?

    <p>10-30 minutes</p> Signup and view all the answers

    When is it recommended to administer rapid-acting insulin in relation to meals?

    <p>15 minutes before meals or immediately after</p> Signup and view all the answers

    What complication is commonly associated with the use of NPH insulin?

    <p>Hypoglycemia</p> Signup and view all the answers

    What forms can rapid-acting insulin be administered in?

    <p>Subcutaneous and intravenous (IV) infusion</p> Signup and view all the answers

    Which type of insulin has a milky appearance and needs to be rolled before injection?

    <p>NPH insulin</p> Signup and view all the answers

    When should rapid-acting insulin be injected to maximize its effectiveness before a meal?

    <p>15 minutes before a meal</p> Signup and view all the answers

    What is the approximate duration of action for rapid-acting insulin, such as NovoLog?

    <p>3-5 hours</p> Signup and view all the answers

    Which type of insulin is known as short-acting insulin?

    <p>Humulin R</p> Signup and view all the answers

    What is the onset of action for short-acting insulin, like Regular insulin?

    <p>30-60 minutes</p> Signup and view all the answers

    What is the recommended method of preparing NPH insulin before injection?

    <p>Gently roll the vial to distribute the suspension</p> Signup and view all the answers

    In the hospital setting, Regular insulin is primarily used for managing which condition?

    <p>Diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    Which insulin is classified as long-acting and mimics basal insulin production?

    <p>Lantus</p> Signup and view all the answers

    What characteristic of Tresiba is significant compared to other long-acting insulins?

    <p>It is peakless with a duration of action lasting up to 42 hours.</p> Signup and view all the answers

    Which insulin is known for having the longest duration of action among long-acting insulins?

    <p>Tresiba (insulin degludec)</p> Signup and view all the answers

    What is the primary reason for not mixing long-acting insulins with other types in the same syringe?

    <p>It alters the pharmacokinetics of long-acting insulin.</p> Signup and view all the answers

    For patients starting on Lantus, which starting dose is commonly recommended?

    <p>10 units or 0.1-0.2 units/kg at bedtime</p> Signup and view all the answers

    What is the typical duration of action for Toujeo (insulin glargine U-300)?

    <p>24-36 hours</p> Signup and view all the answers

    Which of the following conditions requires particularly frequent monitoring of blood glucose levels?

    <p>During pregnancy, when changing diabetes medications, and during illness</p> Signup and view all the answers

    If a patient's fasting blood glucose is consistently between 140-180 mg/dL, by how much should the basal insulin dose typically be adjusted?

    <p>Increase by 6 units</p> Signup and view all the answers

    What is a significant drawback of frequent blood glucose monitoring?

    <p>It can result in higher financial costs and emotional strain</p> Signup and view all the answers

    Which characteristic best defines the onset time for long-acting insulin in clinical practice?

    <p>It's not crucial for effective basal insulin therapy.</p> Signup and view all the answers

    Which of the following insulins should generally be avoided for mixing with Lantus due to potential inactivation?

    <p>Humalog</p> Signup and view all the answers

    To achieve stable glucose levels, how often should a patient on multiple daily injections of insulin perform blood glucose checks?

    <p>At least four times a day</p> Signup and view all the answers

    What is the primary purpose of bolus insulin in the context of diabetes management?

    <p>To manage the immediate blood glucose spikes that follow meals</p> Signup and view all the answers

    For basal insulin therapy, what dose adjustment is recommended if the fasting blood glucose increases past 200 mg/dL?

    <p>Increase by 8 units</p> Signup and view all the answers

    When is the most appropriate time to administer bolus insulin in relation to meals?

    <p>15-30 minutes before a meal to align with digestive processes</p> Signup and view all the answers

    What adjustment should be made to the insulin dose if hypoglycemia occurs without a clear cause?

    <p>Reduce by 4 units or 10-20%</p> Signup and view all the answers

    Which insulin type represents the composition of Humalog Mix 75/25?

    <p>75% insulin lispro protamine / 25% insulin lispro</p> Signup and view all the answers

    How effective are combination insulin products in managing blood glucose levels?

    <p>Effective for both fasting and postprandial glucose levels</p> Signup and view all the answers

    What type of agents are involved in Glargine/Lixisenatide combination insulin therapy?

    <p>Long-acting insulin with a GLP-1 receptor agonist</p> Signup and view all the answers

    Inhaled insulin (Afrezza) is primarily utilized for managing which aspect of diabetes?

    <p>Managing postprandial hyperglycemia</p> Signup and view all the answers

    What is a significant contraindication for the use of inhaled insulin?

    <p>Patients with COPD or asthma</p> Signup and view all the answers

    What boxed warning is associated with inhaled insulin?

    <p>Acute bronchospasm in patients with asthma or COPD</p> Signup and view all the answers

    Which of the following conditions does inhaled insulin primarily target?

    <p>Postprandial hyperglycemia</p> Signup and view all the answers

    What is the most frequent adverse effect experienced by patients undergoing insulin therapy?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which complication is related to the appearance of fatty tissue in patients on insulin therapy?

    <p>Lipohypertrophy</p> Signup and view all the answers

    Which factor can impact how quickly insulin is absorbed after injection?

    <p>All of the above</p> Signup and view all the answers

    What is the ideal injection site that provides the most effective and rapid insulin absorption?

    <p>Abdomen</p> Signup and view all the answers

    To what extent should insulin injection sites be rotated during therapy?

    <p>To avoid lipodystrophy</p> Signup and view all the answers

    What is the primary aim of basal insulin therapy?

    <p>Maintain stable glucose levels between meals and during fasting</p> Signup and view all the answers

    Which type of insulin is utilized for controlling blood sugar spikes following meals?

    <p>Rapid-acting insulin</p> Signup and view all the answers

    What describes the action of basal insulin?

    <p>Continuous release to control fasting glucose</p> Signup and view all the answers

    Which type of insulin provides a continuous, steady release of insulin to maintain blood glucose levels between meals?

    <p>Basal insulin</p> Signup and view all the answers

    What key benefit does frequent blood glucose monitoring offer to patients with diabetes?

    <p>It helps patients track how diet and exercise impact blood sugar levels.</p> Signup and view all the answers

    Which insulin type is primarily utilized to manage glucose spikes during meals?

    <p>Rapid-acting insulin</p> Signup and view all the answers

    During which circumstances is it most essential to monitor blood glucose levels?

    <p>During an illness or while fasting</p> Signup and view all the answers

    What psychological downside may result from frequent blood glucose monitoring?

    <p>Depression due to constant focus on diabetes management</p> Signup and view all the answers

    How does bolus insulin function in the insulin therapy regimen?

    <p>It covers immediate glucose needs during meals.</p> Signup and view all the answers

    Which of the following is NOT a requirement or consideration regarding blood glucose monitoring?

    <p>Preventing diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    What is a primary reason for incorporating basal and bolus insulin in diabetes management?

    <p>To stabilize blood glucose levels throughout the entire day</p> Signup and view all the answers

    How frequently should the catheter site be changed when using an insulin pump?

    <p>Every 3 days</p> Signup and view all the answers

    What is a primary advantage of using continuous glucose monitoring (CGM) over traditional blood glucose testing?

    <p>Provides real-time glucose readings</p> Signup and view all the answers

    Which term refers to the amount of time an individual's glucose levels stay within the target range?

    <p>Time in range (TIR)</p> Signup and view all the answers

    Which type of continuous glucose monitoring (CGM) system allows for intermittent scanning of glucose levels?

    <p>Intermittent scanned CGM (isCGM)</p> Signup and view all the answers

    What does the acronym TAR indicate in the context of glucose management?

    <p>Time above range</p> Signup and view all the answers

    Which key benefit has been linked to the use of continuous glucose monitoring (CGM) in diabetic patients?

    <p>Improved glycemic control without increasing hypoglycemia risk</p> Signup and view all the answers

    What insight does tracking 'time in range' (TIR) provide for diabetes management?

    <p>Assesses the effectiveness of insulin therapy over time</p> Signup and view all the answers

    Which of these glucose monitoring systems requires less frequent calibration than traditional fingerstick tests?

    <p>Continuous glucose monitoring (CGM)</p> Signup and view all the answers

    What is the potential disadvantage of insulin pump therapy that users need to consider?

    <p>Increased risk of catheter site infections</p> Signup and view all the answers

    Which condition is primarily monitored through more frequent blood glucose checks during pregnancy?

    <p>Gestational diabetes</p> Signup and view all the answers

    What role does rapid-acting insulin play in insulin pump therapy?

    <p>It is used for both basal and bolus delivery.</p> Signup and view all the answers

    What is a key function of continuous subcutaneous insulin infusion (CSII) devices?

    <p>To administer basal and bolus insulin based on real-time glucose levels</p> Signup and view all the answers

    In what scenario is it necessary to switch from oral medication to insulin treatment?

    <p>Only when fasting or during a serious illness</p> Signup and view all the answers

    Which profession may require heightened blood glucose monitoring to mitigate hypoglycemia risks?

    <p>Truck driver</p> Signup and view all the answers

    What type of insulin is primarily utilized in insulin pumps to leverage its rapid action?

    <p>Rapid-acting insulin</p> Signup and view all the answers

    Which of the following statements about using an insulin pump is incorrect?

    <p>It completely eliminates the need for insulin dosage adjustments.</p> Signup and view all the answers

    Which function does GLP-1 NOT perform in glucose metabolism?

    <p>Increases hepatic glucose production</p> Signup and view all the answers

    What is the primary enzymatic action of DPP-4 in relation to GLP-1?

    <p>Degrades GLP-1, reducing its activity</p> Signup and view all the answers

    What does continuous glucose monitoring (CGM) primarily provide for diabetes management?

    <p>Real-time glucose levels and trends throughout the day</p> Signup and view all the answers

    Which of the following is an unintended consequence of GLP-1 agonist therapy in diabetes management?

    <p>Increased appetite</p> Signup and view all the answers

    What parameter in CGM indicates the percentage of time glucose levels are kept within a target range?

    <p>Time in range (TIR)</p> Signup and view all the answers

    What is the approximate percentage reduction in hemoglobin A1C associated with GLP-1 agonist therapy?

    <p>1%</p> Signup and view all the answers

    Which group of patients is indicated to gain the most benefit from continuous glucose monitoring?

    <p>Patients using multiple daily insulin injections</p> Signup and view all the answers

    In managing type 2 diabetes, which effect do GLP-1 agonists NOT have?

    <p>Increasing hepatic glucose production</p> Signup and view all the answers

    What is a critical factor to ensure when ordering supplies for self-monitoring blood glucose (SMBG)?

    <p>Test strips should be compatible with the glucose meter</p> Signup and view all the answers

    Why is it crucial for patients to have an adequate supply of test strips for SMBG?

    <p>To enable frequent testing and improve glycemic control</p> Signup and view all the answers

    Which environmental factor can influence the accuracy of blood glucose test strips?

    <p>Storage temperature</p> Signup and view all the answers

    What is the immediate action to take when treating hypoglycemia in a diabetic patient?

    <p>Provide a carbohydrate-rich snack</p> Signup and view all the answers

    What should be assessed as a first priority in the management of hypoglycemia?

    <p>Identifying causes of recurrent hypoglycemia</p> Signup and view all the answers

    What is the primary action of glucagon during severe hypoglycemia?

    <p>It stimulates the liver to release stored glucose</p> Signup and view all the answers

    What should be done if there is no clear cause of hypoglycemia regarding insulin dosage?

    <p>Reduce the dose by 4 units or 10-20%</p> Signup and view all the answers

    Which factor primarily leads to insulin-induced hypoglycemia in patients?

    <p>Skipping meals after insulin administration</p> Signup and view all the answers

    What is the recommended glucagon dose for children under 6 years of age or weighing less than 25 kg?

    <p>0.5 mg</p> Signup and view all the answers

    How soon can the glucagon dose be repeated if the initial dose does not work?

    <p>15-20 minutes later</p> Signup and view all the answers

    When is intranasal glucagon considered the best option for hypoglycemia treatment?

    <p>When IV access is unavailable</p> Signup and view all the answers

    What is the typical onset time for the effects of glucagon after administration?

    <p>10-20 minutes</p> Signup and view all the answers

    Which route(s) can glucagon be administered effectively?

    <p>Intravenous (IV), intramuscular (IM), and subcutaneous (SC)</p> Signup and view all the answers

    Which GLP-1 agonist is derived from the saliva of the Gila monster lizard?

    <p>Exenatide (Byetta®)</p> Signup and view all the answers

    Which GLP-1 agonist has been proven to reduce major cardiovascular events in type 2 diabetes?

    <p>Liraglutide (Victoza®)</p> Signup and view all the answers

    What is the oral form of semaglutide used for the treatment of type 2 diabetes?

    <p>Rybelsus®</p> Signup and view all the answers

    Which form of semaglutide is approved for weight management in patients with obesity?

    <p>Wegovy®</p> Signup and view all the answers

    Which cardiovascular effect is associated with GLP-1 agonist therapy?

    <p>Decreased triglyceride levels by 20% or more</p> Signup and view all the answers

    GLP-1 agonists improve endothelial function by promoting which mechanism?

    <p>Vasodilation</p> Signup and view all the answers

    What is the dual action mechanism of tirzepatide (Mounjaro®)?

    <p>GLP-1 receptor agonist and GIP receptor agonist</p> Signup and view all the answers

    Which markers of cardiovascular health are reduced by GLP-1 agonists?

    <p>LDL cholesterol</p> Signup and view all the answers

    What is the primary indication for GLP-1 agonist therapy?

    <p>Type 2 diabetes only</p> Signup and view all the answers

    Which of the following medications can be combined with GLP-1 agonists for enhanced postprandial glucose control?

    <p>Metformin and basal insulin</p> Signup and view all the answers

    What side effect is most frequently reported by patients using GLP-1 agonists?

    <p>Nausea</p> Signup and view all the answers

    Which scenario necessitates the avoidance of GLP-1 agonist therapy?

    <p>A patient diagnosed with gastroparesis</p> Signup and view all the answers

    Which of the following describes a serious potential adverse effect of GLP-1 agonists?

    <p>Pancreatitis</p> Signup and view all the answers

    What percentage of patients may experience nausea as a common side effect of GLP-1 agonists?

    <p>11-50%</p> Signup and view all the answers

    In patients with a history of pancreatitis, what is the recommended course of action regarding GLP-1 agonist therapy?

    <p>Avoid use entirely</p> Signup and view all the answers

    Which GLP-1 agonist requires caution in patients with renal insufficiency due to potential gastrointestinal issues?

    <p>Exenatide</p> Signup and view all the answers

    What is the primary action of pramlintide in relation to gastric emptying and glucose levels?

    <p>It slows gastric emptying and reduces postprandial glucose spikes.</p> Signup and view all the answers

    What method of administration is correct for pramlintide?

    <p>Subcutaneous (SC) injection</p> Signup and view all the answers

    In insulin-treated patients, which modification is advisable when initiating pramlintide therapy?

    <p>Decrease mealtime insulin doses by 50%</p> Signup and view all the answers

    What is a significant effect of pramlintide aside from its impact on glucose levels?

    <p>Reduces caloric intake and may lead to weight loss</p> Signup and view all the answers

    Which of the following is a common side effect experienced by patients undergoing pramlintide therapy?

    <p>Severe hypoglycemia</p> Signup and view all the answers

    What should be monitored closely to minimize hypoglycemia risk after starting pramlintide therapy?

    <p>Blood glucose levels after meals</p> Signup and view all the answers

    Pramlintide is specifically indicated for which patient population?

    <p>Patients with type 1 and type 2 diabetes who are already using insulin</p> Signup and view all the answers

    Which of the following strategies is NOT recommended for minimizing hypoglycemia risk during pramlintide therapy?

    <p>Administer pramlintide only during night time</p> Signup and view all the answers

    Study Notes

    Growth at Insulin Injection Sites

    • Lipohypertrophy is the growth of tissue at insulin injection sites, commonly due to repeated needle use in the same area.
    • Scarring and inflammation can occur with repeated insulin injections, impacting absorption and efficacy.

    Factors Contributing to Lipohypertrophy

    • Repeatedly injecting insulin at the same site significantly contributes to the development of lipohypertrophy.
    • The type of needle (short versus long) and injection frequency do not significantly contribute to this condition.

    Risk Reduction Strategies

    • Rotating injection sites regularly reduces the risk of developing lipohypertrophy.

    Insulin Syringe Size

    • Insulin syringes are typically marked in 1-2 unit intervals for precision in dosing.
    • A 0.5 mL syringe is suitable for administering a 50-unit dose.
    • The common needle gauge for insulin syringes is between 28-32 gauge.

    Insulin Pen Needle Size

    • Insulin pen needles must be ordered separately and are not typically included with the pen.
    • Common needle lengths for insulin pen needles range from 4-12.7 mm.
    • A higher gauge number indicates a thinner needle.

    Insulin Effects on the Body

    • GLUT4 is the primary transporter for insulin-mediated glucose uptake in skeletal muscle and adipose tissue.
    • Insulin increases protein synthesis and promotes triglyceride storage in adipose tissue.
    • It decreases protein catabolism and increases both triglyceride and VLDL synthesis.
    • Insulin’s primary role in the liver is to enhance glucose storage as glycogen.

    Regulation of Blood Glucose

    • Glucagon, secreted by alpha cells in the pancreas, plays a role in glucose regulation.
    • GLP-1 hormone helps attenuate glucose spikes after meals and breaks down through DPP-4 enzyme.

    Indications for Insulin Therapy

    • Insulin therapy is indicated for Type 1, Type 2, secondary diabetes, and gestational diabetes.
    • Modern insulin is produced using recombinant DNA technology, reducing the risk of allergic reactions compared to animal-based insulin.

    Insulin Degradation and Metabolism

    • The liver deactivates around 20-50% of insulin, while the kidneys also play a crucial role in insulin metabolism.
    • In end-stage renal disease, insulin dosing should be decreased due to reduced clearance.

    Insulin Administration and Absorption

    • Intravenous insulin is typically used for patients with uncontrolled diabetes in a hospital setting.
    • The abdomen provides the most rapid absorption for subcutaneous insulin injections.
    • Rotating injection sites helps prevent lipodystrophy complications.

    Lipoatrophy and Lipohypertrophy

    • Lipoatrophy is characterized by loss of subcutaneous fat at injection sites, often due to repeated injections in the same location.
    • Newer insulin analogs have been associated with a decreased incidence of lipoatrophy.

    Types of Insulin

    • Short-acting insulin is distinguished by its onset of action compared to long-acting insulin.
    • U-100 concentration is the most commonly used insulin concentration.
    • Long-acting insulin is utilized to control fasting blood glucose levels.

    Endogenous Insulin Production

    • The pancreas releases insulin at a blood glucose level of approximately 140 mg/dL.
    • Insulin secretion begins about 90 seconds after increased blood glucose levels post-meal.
    • Insulin production is responsive to food intake and blood glucose levels rather than being constant.

    Common Types of Insulin

    • Humalog is a rapid-acting insulin example.
    • Rapid-acting insulin is typically used during mealtimes to manage postprandial glucose levels.
    • Long-acting insulin, like Lantus, is categorized as "basal" insulin.

    Rapid-Acting Insulin

    • Apidra is the insulin with the fastest onset of action.
    • Rapid-acting insulin should be injected 15 minutes before meals.
    • The duration of action for rapid-acting insulin like NovoLog is approximately 3-5 hours.

    Short-Acting Insulin

    • Humulin R is recognized as a short-acting insulin.
    • Regular insulin, a short-acting type, has an onset of action within 30-60 minutes.
    • Regular insulin is frequently administered intravenously in hospital settings for managing Diabetic Ketoacidosis (DKA).

    Intermediate-Acting Insulin (NPH)

    • Humulin N is classified as intermediate-acting insulin.
    • NPH insulin requires gentle rolling of the vial to distribute the suspension before injection.
    • Intermediate-acting insulin like NPH typically reaches peak effect within 4-10 hours.

    Long-Acting Insulin

    • Lantus is a long-acting insulin that is considered "peakless," mimicking basal insulin production.
    • Tresiba has the longest duration of action among long-acting insulins, lasting up to 42 hours.
    • Mixing long-acting insulins like Lantus or Tresiba with other insulins can inactivate them.

    NPH Insulin (Additional)

    • NPH insulin has a milky appearance and requires gentle rolling before injection.
    • It is typically administered twice daily.
    • A common complication associated with NPH insulin is hypoglycemia.

    Rapid-Acting Insulin - Vial & Pen Forms

    • Apidra, or insulin glulisine, is a notable example of rapid-acting insulin.
    • The typical onset of action for rapid-acting insulins like Humalog or NovoLog is 10-30 minutes.
    • Rapid-acting insulin generally has a duration of 3-5 hours in the body.
    • It should be administered 15 minutes before meals or immediately after.
    • Rapid-acting insulin is primarily used for postprandial glucose control.
    • It can be administered subcutaneously (e.g., via an insulin pump) or via intravenous infusion.

    Insulin Titration and Adjustment

    • In case of hypoglycemia during basal insulin titration with no clear cause, reduce the insulin dose by 4 units or 10-20%.

    Combination Insulin Products

    • Humalog Mix 75/25 typically contains 75% insulin lispro protamine and 25% insulin lispro.
    • Combination products help control both fasting and postprandial blood glucose levels.
    • Glargine/Lixisenatide therapy combines long-acting insulin with a GLP-1 receptor agonist.

    Inhaled Insulin (Afrezza)

    • Afrezza primarily targets postprandial hyperglycemia.
    • Major contraindication includes COPD or asthma.
    • Carries a boxed warning for acute bronchospasm in patients with asthma or COPD.

    Insulin Adverse Effects

    • Most common adverse effect of insulin therapy is hypoglycemia.
    • Lipohypertrophy, an insulin-related complication, is associated with excess weight gain.
    • Preventing insulin-induced hypoglycemia can be achieved by ensuring proper meal timing for insulin administration.

    Insulin Absorption Factors

    • Rate of insulin absorption can be affected by insulin concentration, needle length, and injection site rotation.
    • The abdomen is the injection site associated with the most consistent and rapid absorption.
    • Rotating injection sites is important to prevent tissue reactions like lipodystrophy.

    Insulin Therapy Goals

    • Primary goal of basal insulin therapy is to maintain glucose control between meals and overnight.
    • Rapid-acting insulin is used for bolus therapy to manage postprandial glucose levels.
    • Basal insulin aims for a continuous release of insulin to control fasting glucose levels.

    Long-Acting Insulin Properties

    • Lantus (insulin glargine) is classified as long-acting insulin with a duration of 20-24 hours.
    • Mixing long-acting insulins with other types in the same syringe can inactivate the long-acting insulin.
    • Toujeo (insulin glargine U-300) has a longer duration of action, lasting 24-36 hours, whereas Tresiba (insulin degludec) can last up to 42 hours.

    Blood Glucose Monitoring

    • Frequent blood glucose monitoring is essential during pregnancy, when starting or changing medications, and during illness.
    • A downside of frequent monitoring can include high costs and potential for patient depression.
    • Patients on multiple daily injections should check blood glucose at least four times a day (qACHS).

    Bolus vs. Basal Insulin

    • Bolus insulin is used to manage glucose spikes after meals and snacks, while basal insulin controls glucose levels between meals and overnight.
    • Bolus insulin should be administered 15-30 minutes before a meal for effective glucose control.

    Insulin Therapy Overview

    • NPH Insulin: Used in diabetes management; rapid-acting counterparts like insulin lispro are available.
    • Insulin Pump Catheter Site: Should be changed every 3 days to maintain effectiveness and hygiene.

    Continuous Glucose Monitoring (CGM)

    • Real-Time Readings: CGM provides immediate glucose levels, improving management accuracy over traditional fingerstick methods.
    • Key Measure TIR: Time in Range (TIR) indicates the effectiveness of glucose management and insulin therapy.
    • Device Types: Intermittent scanned CGM (isCGM) involves scanning for glucose levels, unlike real-time CGM which continuously displays readings.
    • Tracking TIR Benefits: Offers insights into the effectiveness of insulin treatments over time.
    • Parameter TAR: Stands for Time Above Range, showing periods of elevated glucose levels.
    • CGM Advantage: Enhances glycemic control without increasing the risk of hypoglycemia.

    Insulin Types and Functions

    • Basal Insulin: Primarily controls fasting blood glucose levels, providing steady insulin release throughout the day.
    • Rapid-Acting Insulin: Commonly used to cover mealtime glucose spikes, addressing post-meal increases.
    • Combination Use: A dual approach of basal and bolus insulin supports stable blood glucose between meals and during eating.

    Blood Glucose Monitoring Benefits

    • Frequent Monitoring: Aids in tracking how lifestyle choices affect blood sugar levels rather than reducing insulin dependency.
    • Motivation Factor: Immediate feedback from monitoring can encourage better lifestyle decisions.
    • Psychological Considerations: Constant monitoring may lead to depression due to an increased focus on diabetes management.

    When to Monitor Blood Glucose

    • Critical Situations: Essential to monitor blood glucose while fasting or during illness to prevent complications.
    • Pregnancy Monitoring: Increased vigilance is necessary to detect gestational diabetes and minimize risks.
    • Occupational Needs: Certain professions, like truck driving, require heightened monitoring to avoid hypoglycemia-related incidents.

    Insulin Pump Therapy

    • Flexibility: Insulin pumps offer greater flexibility in managing meals and activities compared to traditional methods.
    • Insulin Type: Rapid-acting insulin is utilized for both basal and bolus delivery in pump therapy.
    • Potential Risks: Increased risk of catheter site infections remains a concern with pump use.

    Insulin Pump Mechanics

    • CSII Function: Continuous subcutaneous insulin infusion (CSII) delivers tailored basal and bolus doses based on self-monitoring of blood glucose.
    • Insulin Approval for Pumps: Insulin lispro is specifically approved for pump use due to its favorable pharmacokinetics, making it ideal for real-time insulin delivery.

    Continuous Glucose Monitoring (CGM)

    • CGM provides real-time glucose levels and trends, aiding in diabetes management.
    • The percentage of time glucose levels are within the target range is referred to as Time in Range (TIR).
    • Particularly beneficial for patients using multiple daily insulin injections, enhancing their monitoring capabilities.

    Monitoring Blood Glucose (Test Strips)

    • Test strips must be compatible with the glucose meter to ensure accurate readings.
    • Ensuring an adequate supply of test strips improves patient compliance and glycemic control.
    • Accuracy of blood glucose test strips can be significantly affected by storage temperature.

    Hypoglycemia

    • The first step in treating hypoglycemia involves identifying and addressing its underlying cause.
    • A common cause of insulin-induced hypoglycemia is skipping meals after insulin administration.
    • In cases without a clear cause for hypoglycemia, reducing the insulin dose by 4 units or 10-20% is recommended.

    Glucagon in Hypoglycemia

    • Glucagon works by stimulating the liver to release stored glucose, crucial in treating severe hypoglycemia.
    • The onset time for glucagon’s effects is typically between 10-20 minutes after administration.
    • For children under 6 years or weighing less than 25 kg, the recommended glucagon dose for hypoglycemia is 0.5 mg.

    Glucagon Administration

    • Glucagon can be administered intravenously (IV), intramuscularly (IM), or subcutaneously (SC).
    • Intranasal glucagon is considered when IV access is unavailable for hypoglycemia treatment.
    • If a patient shows no response to the initial glucagon dose, it can be repeated after 15-20 minutes.

    Incretins Overview

    • GLP-1 (glucagon-like peptide-1) plays a crucial role in glucose metabolism by stimulating insulin secretion and inhibiting glucagon release.
    • The enzyme DPP-4 (dipeptidyl peptidase-4) breaks down GLP-1, diminishing its activity in the body.
    • GLP-1 agonists are utilized in diabetes management to decrease food intake and promote satiety.

    GLP-1 Agonists (Mechanism of Action)

    • GLP-1 agonists manage blood glucose levels by increasing insulin secretion and decreasing glucagon secretion.
    • A major benefit of GLP-1 agonist therapy is weight loss, contrasting with many diabetes medications that may cause weight gain.
    • GLP-1 agonists have been shown to reduce hemoglobin A1C by approximately 1%.

    GLP-1 Agonists Overview

    • Exenatide (Byetta®) is derived from the saliva of the Gila monster lizard.
    • Liraglutide (Victoza®) has proven effectiveness in reducing major cardiovascular events and mortality in type 2 diabetes patients.
    • Dulaglutide (Trulicity®) is a once-weekly GLP-1 agonist effective for type 2 diabetes and cardiovascular risk reduction.

    Semaglutide Variants

    • Rybelsus® is the oral form of semaglutide used for the treatment of type 2 diabetes.
    • Wegovy® is approved for weight management in patients with obesity and cardiovascular disease.
    • Tirzepatide (Mounjaro®) acts as both a GLP-1 receptor agonist and a GIP receptor agonist.

    Cardiovascular Benefits of GLP-1 Agonists

    • GLP-1 agonists are associated with decreased triglyceride levels by 20% or more.
    • They improve endothelial function primarily through vasodilation.
    • C-reactive protein (CRP), a marker of cardiovascular health, is reduced by GLP-1 agonists.

    Indications for GLP-1 Agonists

    • GLP-1 agonists are indicated for the management of type 2 diabetes only.
    • They can be combined with basal insulin and metformin to help manage postprandial glucose control.
    • A significant benefit of GLP-1 agonists is the reduction of postprandial glucose levels in type 2 diabetes patients.

    Adverse Effects of GLP-1 Agonists

    • Nausea is the most commonly reported gastrointestinal side effect of GLP-1 agonist therapy.
    • Approximately 11-50% of patients may experience nausea as a side effect.
    • Pancreatitis is a rare but serious adverse effect associated with GLP-1 agonists.

    Contraindications for GLP-1 Agonists

    • Gastroparesis is a contraindication for GLP-1 agonist therapy.
    • Patients with a history of pancreatitis should avoid GLP-1 agonists.
    • Caution is advised when using Exenatide in patients with renal insufficiency due to potential gastrointestinal side effects.

    Amylin Analog (Pramlintide)

    • Pramlintide (Symlin®) is an amylin analog that primarily slows gastric emptying, reducing postprandial glucose spikes.
    • Administration method is via subcutaneous (SC) injection, not oral or through IV.
    • Pramlintide assists in reducing caloric intake, potentially leading to weight loss.

    Pramlintide Side Effects

    • Common side effect includes severe hypoglycemia, especially in insulin-treated patients.
    • When starting pramlintide therapy in insulin users, mealtime insulin doses should be decreased by 50% to mitigate hypoglycemia risk.
    • Monitoring blood glucose levels closely after meals is advised to manage and minimize hypoglycemic events during initiation of therapy.

    Indications for Pramlintide

    • Indicated for patients with type 1 and type 2 diabetes who are currently using insulin.
    • Not approved for use in gestational diabetes, type 2 diabetes without insulin, or prediabetes patients.

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    Description

    Test your knowledge on the effects of insulin injection practices, such as tissue growth and lipohypertrophy. This quiz covers the implications of repeated injections, inflammation, and site management in insulin-treated patients.

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