Insulin Regimens and Effects

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Questions and Answers

What is one of the primary mechanisms of action of metformin?

Increases intestinal absorption of glucose

Increases hepatic glucose production

Decreases hepatic glucose production (correct)

Decreases peripheral glucose uptake

Which of the following is a severe adverse effect associated with metformin?

Weight gain

Insulin resistance

Lactic acidosis (correct)

Hyperkalemia

Which condition is a contraindication for the use of metformin?

Normal kidney function

Mild renal impairment

Controlled hypertension

Severe renal impairment (correct)

What is the recommended initial approach when prescribing metformin to geriatric patients?

Start with a low dose and titrate slowly Signup and view all the answers

What should be done regarding the dose of metformin for a patient who was treated for hypothyroidism prior to pregnancy?

Increase the dose by 20-50% Signup and view all the answers

Which insulin regimen is most effective in improving long-term outcomes and reducing HgA1c?

Continuous subcutaneous administration via an insulin pump Signup and view all the answers

What is a significant consequence of a lack of insulin in the body?

Ketoacidosis Signup and view all the answers

What primary function does basal insulin serve in glucose metabolism?

Suppresses hepatic glucose production Signup and view all the answers

Which type of insulin is classified as 'bolus' and has a quicker onset?

Regular insulin Signup and view all the answers

What is the typical percentage breakdown of basal and bolus insulin for a newly diagnosed type 1 diabetic?

50% basal, 50% bolus Signup and view all the answers

What is the initial daily insulin dose when starting treatment for a newly diagnosed diabetic, in U/kg?

0.5 U/kg Signup and view all the answers

What is the duration of action for insulin glargine?

20 to more than 24 hours Signup and view all the answers

What factor can significantly influence the insulin dosing requirement?

Carbohydrate intake Signup and view all the answers

Which of the following factors is NOT important for effective bolus insulin management?

Avoidance of insulin site rotation Signup and view all the answers

Which site of injection is generally recommended to avoid lipohypertrophy?

Subcutaneous abdomen Signup and view all the answers

What is a major reason for avoiding intramuscular (IM) insulin injections?

Unpredictable absorption levels Signup and view all the answers

Which of the following factors is associated with Type II diabetes?

Insulin resistance Signup and view all the answers

Which lifestyle factor is NOT typically linked to the management of Type II diabetes?

Strict adherence to a high-sugar diet Signup and view all the answers

What condition is least likely to affect the effectiveness of insulin in Type II diabetes?

Obsession with exercise Signup and view all the answers

What is an essential factor to consider regarding carbohydrate consumption when administering bolus insulin?

Estimation of dietary fat and protein should also be considered. Signup and view all the answers

Which aspect should NOT influence the administration of prandial insulin?

Cost of insulin Signup and view all the answers

Study Notes

Insulin Regimens and Adverse Effects

Insulin regimens, such as basal-bolus and intensive insulin replacement, can improve long-term outcomes by lowering HgA1c.
Intensive regimens involve multiple daily injections or continuous subcutaneous administration via a pump.
Lack of insulin can lead to adverse effects like hyperglycemia, ketoacidosis (acidic blood, fruity breath, weight loss, high triglycerides), and tissue catabolism.

Basal Insulin

Basal insulin suppresses hepatic glucose production, maintaining near-normal blood sugar levels during fasting.
Appropriate doses of basal insulin are crucial for managing blood glucose levels.

Bolus Insulin

Bolus insulin (prandial/premeal) is used to cover extra glucose requirements after meals, minimizing post-meal blood sugar fluctuations.

Long-Acting Insulins

Long-acting insulin analogs, such as glargine, detemir, and degludec, provide a flatter, more consistent plasma level over a longer duration.

Short-Acting Insulins

Short-acting insulin analogs, like lispro, aspart, and glulisine, have a quicker onset, peak, and shorter duration of action, and are usually associated with less weight gain and lower hypoglycemia risk.

Insulin Onset and Duration

Lispro insulin has an onset of 15-30 minutes.
Insulin glargine has a duration of action of 20 to more than 24 hours.

Type 1 Diabetes Basal Insulin/Bolus Percentage

50% basal and 50% bolus is the general percentage of basal and bolus insulin for newly diagnosed Type 1 diabetics.

Factors Affecting Insulin Dosing

Carbohydrate intake, pregnancy, puberty, and illness can affect insulin dosing requirements. These factors need to be considered when adjusting insulin dosage.

Total Daily Insulin Dose

Initial total daily insulin dose when starting is 0.5 U/kg. While stabilized, typical doses are between 0.4-1 U/kg.

Bolus Insulin Considerations

Factors like pre-meal glucose levels, carbohydrate consumption, and anticipated activity (e.g., exercise) should be considered when determining bolus insulin doses

Insulin Injection Sites

Insulin is injected subcutaneously. Rotating injection sites helps prevent lipohypertrophy. Intramuscular (IM) injection is generally avoided.

Type 2 Diabetes Risk Factors

Insulin resistance, impaired insulin secretion, elevated liver glucose production, reduced effectiveness of insulin on target cells, and overweight/obesity are all factors associated with Type 2 diabetes.
Lean individuals can also develop Type 2 diabetes.

Metformin Mechanism of Action

Metformin reduces hepatic glucose production, decreases intestinal glucose absorption, and improves insulin sensitivity.

Metformin Adverse Effects

Gastrointestinal issues (nausea, vomiting, diarrhea) and lactic acidosis are potential side effects, especially with kidney problems, high doses, or severe illness.

SGLT2 Inhibitors Mechanism and Adverse Effects

SGLT2 inhibitors increase glucose excretion in the urine.
Potential adverse effects include volume depletion (leading to hypotension) and increased risk of urinary tract infections, especially in individuals with uncontrolled blood sugar.

GLP-1 Receptor Agonists (RAs)

Enhance glucose-dependent insulin secretion.
Slow gastric emptying, decreasing food intake.
Reduce postprandial glucagon.

Glucagon and Liver Glucose Production

Decreased glucagon production results in decreased liver glucose production.

Thiazolidinediones (TZDs)

Insulin sensitizers in fat, muscle, and the liver.

Sulfonylureas Adverse Effect

Hypoglycemia is a serious adverse effect associated with sulfonylureas

GERD Treatment

Antacids provide faster relief, while PPIs provide longer-lasting effects. H2 antagonists are an intermediary option.

PPI Use in Elderly

Prolonged PPI use in the elderly can lead to osteoporosis.

Sucralfate Mechanism of Action

Sucralfate forms a paste that protects ulcers and the stomach lining from peptic acid, pepsin, and bile.

Topical Corticosteroids Potency

Topical corticosteroid potency varies greatly. It is important to understand the potency scale and choose appropriate strength based on the area being treated.

Topical Corticosteroid Contraindications

Infections, pre-existing skin conditions, areas of impaired wound healing etc . should be considered during topical corticosteroid use.

Oral Acne Medication

Oral antibiotics like tetracycline, used as treatment for severe acne.

Thyroid Hormone Levels and Hypo/Hyperthyroidism

Understanding normal Thyroid-Stimulating Hormone (TSH), thyroxine (T4), free T4 (FT4), triiodothyronine (T3) levels is important in assessing and managing hypo- and hyperthyroidism.

Levothyroxine MOA

Levothyroxine is a synthetic form of T4, used to replace deficient thyroid hormones

Hypothyroidism Treatment

Levothyroxine is often the first-line treatment of hypothyroidism.

Hyperthyroidism Treatment

Treatments include antithyroid medications (methimazole, propylthiouracil) and in some cases ablation of thyroid tissue

Thyroid Storm

Thyroid storm is a life-threatening condition characterized by extreme thyrotoxicosis. Treatments are aggressive and involve hospitalization.

Common ADEs with Topical Corticosteroids

Purpura, striae, telangiectasia, and focal hypertrichosis can be common side effects.

Topical Corticosteroid Potency

Topical corticosteroid potency varies widely. Choosing the appropriate strength is crucial to minimizing potential side effects, while managing the condition effectively.

Isotretinoin Monitoring

Isotretinoin treatment involves rigorous monitoring of pregnancy, liver function, and other potential side effects.

Hypothyroidism Lab Values

High TSH and low T4 values indicate hypothyroidism.

Levothyroxine Mechanism of Action

Synthetic T4 hormone replacement is a mechanism of action for treating hypothyroidism.

Special Populations and Hypothyroidism Dosing

Elderly and pregnant women require close monitoring and adjustments to their hypothyroidism dose.

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Description

Explore the different insulin regimens including basal-bolus and their effects on blood sugar levels. Understand how insulin works to prevent complications like hyperglycemia and ketoacidosis. This quiz covers various types of insulin and their administration methods.