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Questions and Answers

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

Increases insulin secretion from the pancreas

Lowers blood pressure

Increases hepatic glucose production

Decreases intestinal absorption of glucose (correct)

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

Hypoglycemia

Severe headache

Lactic acidosis (correct)

Increased appetite and weight gain

What is a contraindication for the use of metformin?

Severe renal impairment (correct)

Impaired liver function

Mild renal impairment

Hypothyroidism

In older adults, what is an important consideration when prescribing metformin?

They are more prone to adverse drug events Signup and view all the answers

What adjustment should be made to metformin dosage for a patient who is pregnant?

Increase the dose by 20-50% if treated before pregnancy Signup and view all the answers

What factor should be considered when timing bolus insulin?

Pharmacokinetics of formulation Signup and view all the answers

Which method can help estimate carbohydrate consumption more effectively during insulin administration?

Carbohydrate counting Signup and view all the answers

What is a reason for rotating insulin injection sites?

To prevent lipohypertrophy Signup and view all the answers

Which of the following is NOT a lifestyle factor associated with Type II diabetes?

High caffeine consumption Signup and view all the answers

What is a potential impact of injecting insulin intramuscularly (IM)?

Unpredictable absorption rates Signup and view all the answers

In Type II diabetes, which of the following is associated with impaired insulin sensitivity?

Overweight patients Signup and view all the answers

What should be avoided when administering insulin intramuscularly?

Injecting into a high activity area Signup and view all the answers

For effective insulin administration, what should be monitored?

Anticipated physical activity Signup and view all the answers

What insulin regimen is known to effectively lower HgA1c?

Basal bolus Signup and view all the answers

What is a consequence of not having insulin in the body?

Ketoacidosis Signup and view all the answers

What function does basal insulin serve?

Suppresses hepatic glucose production Signup and view all the answers

What is the primary purpose of bolus insulin in a basal bolus program?

To cover extra glucose from meals Signup and view all the answers

Which type of insulin is classified as long-acting or basal?

Insulin detemir Signup and view all the answers

What is the typical duration of action for insulin glargine?

20 to over 24 hours Signup and view all the answers

In a newly diagnosed type 1 diabetic, what is the typical distribution of basal and bolus insulin needed?

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

What is the starting dose of insulin in U/kg for a newly diagnosed diabetic?

0.5 U/kg Signup and view all the answers

What effect does metformin have on hepatic glucose production?

Decreases hepatic glucose production Signup and view all the answers

What is a potential severe adverse effect of metformin related to gastrointestinal issues?

Nausea and vomiting Signup and view all the answers

What condition may be exacerbated by the use of metformin in older adults?

Lactic acidosis Signup and view all the answers

What medication interaction must be considered when prescribing metformin?

Drugs that induce renal impairment Signup and view all the answers

What is a key adjustment in metformin dosage for patients who become pregnant?

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

Which of the following is a potential effect of hyperglycemia due to lack of insulin?

Weight loss Signup and view all the answers

What is the primary function of basal insulin?

Suppress hepatic glucose production Signup and view all the answers

What characterizes short-acting insulin compared to long-acting insulin?

Quicker onset and shorter duration Signup and view all the answers

What is the typical duration of action for insulin degludec?

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

In newly diagnosed type 1 diabetics, what is the recommended distribution of insulin between basal and bolus?

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

Which insulin is classified as a rapid-acting analog?

Insulin lispro Signup and view all the answers

What is one factor that can increase the required dose of insulin?

Pregnancy Signup and view all the answers

What is the starting dose of insulin for a newly diagnosed diabetic patient in U/Kg?

0.5 U/kg Signup and view all the answers

What is a crucial factor to consider when administering bolus insulin to manage postprandial glucose levels?

Well-timed administration Signup and view all the answers

Which of the following factors is NOT typically associated with Type II diabetes?

Increased physical activity Signup and view all the answers

What is the most significant reason to avoid intramuscular (IM) injection of insulin?

It results in unpredictable absorption levels Signup and view all the answers

What lifestyle factor is essential for managing Type II diabetes effectively?

Diabetes self-management education Signup and view all the answers

Which site is most commonly recommended for subcutaneous insulin injection?

Abdomen Signup and view all the answers

In Type II diabetes, which of the following is a common issue regarding B-cells?

B-cells function is often impaired Signup and view all the answers

Which carbohydrate consideration should be factored in when administering bolus insulin?

The estimated carbohydrate consumption Signup and view all the answers

What effect does rotating insulin injection sites have?

Prevents lipohypertrophy Signup and view all the answers

Study Notes

Insulin Regimens and Adverse Effects

Insulin regimens, such as basal-bolus and intensive insulin, can improve long-term outcomes by reducing HbA1c levels. Intensive regimens involve multiple daily injections or continuous subcutaneous administration via an insulin pump.
Lack of insulin can lead to hyperglycemia, ketoacidosis (acidity in the blood, fruity breath), weight loss, and elevated lipids and triglycerides. Tissue breakdown and high triglycerides are also potential outcomes.

Basal Insulin Purpose

Basal insulin, when used in appropriate doses, suppresses the liver's glucose production, maintaining near-normal blood sugar levels during fasting.

Bolus Insulin Purpose

Bolus insulin (usually prandial or pre-meal) addresses the additional glucose requirements after meals, decreasing post-meal blood sugar fluctuations.

Long-Acting Insulins

Long-acting insulin analogs include glargine (1000 and 300 units/mL), detemir, and degludec (100 and 200 units/mL), known for their extended durations of action and consistent blood sugar levels.

Short-Acting Insulins

Short-acting insulin analogs, such as lispro, aspart, and glulisine, have quicker onset and peak action times, shorter durations, and generally lower weight gain and less risk of hypoglycemia.

Insulin Onset and Duration

Lispro insulin onset is 15 to 30 minutes.
Insulin glargine duration is 20 to more than 24 hours

Type 1 Diabetic Insulin Dosing

The general percentage of basal to bolus insulin needed in a newly diagnosed type 1 diabetic is 50% each.

Insulin Dosing Factors

Factors influencing insulin dosing include carbohydrate intake, pregnancy, puberty, illnesses, and medical conditions.

Insulin Dosing Adjustments

Daily insulin doses may need adjustment when a patient is sick or has certain medical conditions.

Insulin Injection Sites

Insulin injections are typically subcutaneous, with rotation of injection sites to prevent lipohypertrophy. Avoiding intramuscular injections is recommended.

Type 2 Diabetes Risk Factors

Insulin resistance, impaired insulin secretion, elevated hepatic glucose production, insufficient beta cell function, and obesity (especially in type 2 diabetes) are common risk factors (frequently termed insulin resistance).

Metformin Mechanism of Action

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

Metformin Side effects

Gastrointestinal side effects (nausea, vomiting, flatulence), lactic acidosis (risk increased when renal impairment is present), vitamin B12 deficiency are noted ADEs for metformin.

SGLT2 Inhibitors Mechanism of Action

SGLT2 inhibitors block the reabsorption of glucose in the kidneys, leading to increased glucose excretion in urine.

Potential ADE of SGLT2 Inhibitors

Acute kidney injury (risk related to increased osmotic diuresis), volume contraction, hypotension, and an elevated risk of genitourinary infections (such as UTIs) are among potential adverse effects associated with SGLT2 inhibitors.

GLP-1 Receptor Agonists

These medications enhance glucose-dependent insulin secretion, slow gastric emptying, and reduce postprandial glucagon.

Topical Corticosteroids Potency

Based on potency (lowest to highest): hydrocortisone, triamcinolone, clobetasol.

Indications for High-Dose Topical Steroids

Acute flare-ups of skin conditions and prevention.

Hypothyroidism Treatment Medications

Levothyroxine (synthetic T4)
Liothyronine (synthetic T3)
Desiccated thyroid (natural thyroid)

Hypothyroidism/Hyperthyroidism Lab Values

TSH (mU/L): 0.4-4.5
Free T4 (ng/dL): 0.9-2.3
Total T4 (µg/dL): 5.0-11.0
Free T3 (pg/mL): 2.3-4.2

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