Insulin Regimens and Their Effects
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Questions and Answers

Which of the following mechanisms is a primary action of metformin?

  • Interferes with glucose absorption in the stomach
  • Increases hepatic glucose production
  • Decreases intestinal absorption of glucose (correct)
  • Inhibits insulin secretion from the pancreas

    • What severe adverse effect of metformin is most closely associated with kidney impairment?

  • Flatulence
  • Dyspepsia
  • Hypoglycemia
  • Lactic acidosis (correct)

    • What is one essential factor to consider when determining bolus insulin dosing?

  • The color of the insulin vial
  • The time of day insulin is typically used
  • The patient's mood at the time of injection
  • Postprandial glucose levels (correct)

    • What is a notable consequence of long-term metformin therapy regarding vitamin absorption?

    <p>Leads to Vitamin B12 deficiency</p> Signup and view all the answers

    Which insulin injection site is recommended for optimal absorption?

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

    When prescribing metformin to elderly patients, what consideration should be prioritized?

    <p>Initiate at a lower dose and titrate</p> Signup and view all the answers

    What condition is a contraindication for the use of metformin concerning renal function?

    <p>Creatinine clearance (CrCl) &lt; 30 mL/min</p> Signup and view all the answers

    What should be avoided to ensure predictable insulin absorption?

    <p>Intramuscular injections</p> Signup and view all the answers

    Which lifestyle factor is NOT associated with Type II diabetes?

    <p>High physical activity levels</p> Signup and view all the answers

    Which of the following complications is NOT associated with untreated thyroid hormone deficiency in pregnancy?

    <p>Increased fetal size</p> Signup and view all the answers

    What characteristic is associated with insulin resistance in Type II diabetes?

    <p>Decreased insulin secretion by pancreas</p> Signup and view all the answers

    What percentage increase in metformin dose is recommended during pregnancy if already on treatment?

    <p>20-50%</p> Signup and view all the answers

    Which of the following is a common gastrointestinal adverse effect of metformin?

    <p>Abdominal pain</p> Signup and view all the answers

    Which of the following formulations of insulin is considered rapid-acting?

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

    What is a key consideration for patients over 65 years old when starting metformin?

    <p>Begin with a low dose and observe for symptoms</p> Signup and view all the answers

    In the context of bolus insulin, which factor relates to the carbohydrate consumption?

    <p>Estimates of fat content should be considered</p> Signup and view all the answers

    Which physiological aspect significantly influences the effect of intramuscular insulin injection?

    <p>The patient's level of physical activity</p> Signup and view all the answers

    What adverse effect is particularly significant for patients with a prior history of excessive alcohol use while on metformin?

    <p>Increased lactic acid production</p> Signup and view all the answers

    What common misconception exists regarding Type II diabetes in lean patients?

    <p>They possess reduced beta-cell function</p> Signup and view all the answers

    What is a consequence of not rotating insulin injection sites?

    <p>Liphodystrophy development</p> Signup and view all the answers

    What outcome is associated with a basal-bolus insulin regimen?

    <p>Improved long-term outcomes and reduced A1C</p> Signup and view all the answers

    Which of the following effects can result from a lack of insulin?

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

    What is the role of basal insulin in diabetes management?

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

    What is the primary function of bolus insulin?

    <p>To cover carbohydrate intake after meals</p> Signup and view all the answers

    Which insulin is classified as long-acting and provides a constant level of plasma insulin?

    <p>Insulin detemir</p> Signup and view all the answers

    Which of the following insulins has the fastest onset of action?

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

    During the stabilization phase, what is the typical total daily dose of insulin required per kg of body weight?

    <p>0.4-1 U/kg</p> Signup and view all the answers

    What factors should be considered when determining insulin dosing?

    <p>Carbohydrate intake and metabolic state</p> Signup and view all the answers

    What characteristic defines rapid-acting insulin?

    <p>Less chance of weight gain and low A1C</p> Signup and view all the answers

    Which of the following statements about insulin glargine is true?

    <p>It maintains effects beyond 24 hours.</p> Signup and view all the answers

    What is a characteristic of hypothyroidism?

    <p>Increased risk of heart problems</p> Signup and view all the answers

    Which biochemical marker indicates hyperthyroidism?

    <p>Low TSH and high T4</p> Signup and view all the answers

    What differentiates subclinical hypothyroidism from hypothyroidism?

    <p>Normal thyroid hormone levels</p> Signup and view all the answers

    In the context of euthyroidism, which statement is true?

    <p>Thyroid gland produces adequate hormones</p> Signup and view all the answers

    What symptom is commonly associated with hyperthyroidism?

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

    Which condition is characterized by low levels of T4 and elevated TSH?

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

    What physiological mechanism underlies the increased TSH levels in subclinical hypothyroidism?

    <p>Low thyroid hormone production</p> Signup and view all the answers

    Which of the following best describes the mechanism of action for levothyroxine?

    <p>It restores thyroid hormone levels in the body</p> Signup and view all the answers

    What is a potential risk for patients with untreated subclinical hypothyroidism?

    <p>Increased risk of coronary heart disease</p> Signup and view all the answers

    Which of these symptoms is NOT typically associated with hypothyroidism?

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

    What is the goal TSH level when treating geriatric patients with hypothyroidism?

    <p>Higher end of normal</p> Signup and view all the answers

    Which treatment approach is recommended for pediatric patients diagnosed with hypothyroidism?

    <p>Base the dose on weight at various stages</p> Signup and view all the answers

    What is a significant risk associated with untreated hypothyroidism during pregnancy?

    <p>Increased risk of miscarriage</p> Signup and view all the answers

    What initial strategy should be employed when starting hypothyroidism medication in elderly patients?

    <p>Start with a low dose and titrate based on symptoms and TSH</p> Signup and view all the answers

    What is the recommended newborn dose of Levothyroxine (L4) for treating hypothyroidism?

    <p>10-17 mcg/kg/day</p> Signup and view all the answers

    In pregnancy, how much should the dose of hypothyroidism medication be increased if the patient was treated prior to pregnancy?

    <p>20-50%</p> Signup and view all the answers

    How frequently should TSH be monitored during hypothyroidism treatment?

    <p>Every 6-8 weeks</p> Signup and view all the answers

    What condition most commonly leads to acquired hypothyroidism in patients?

    <p>Autoimmune thyroiditis</p> Signup and view all the answers

    What potential adverse effect is the elderly population particularly prone to when treated for hypothyroidism?

    <p>Cardiac arrhythmias</p> Signup and view all the answers

    What is the primary method used to adjust the dose of hypothyroidism medication in geriatric patients?

    <p>Symptom improvement and TSH levels</p> Signup and view all the answers

    What characterizes hyperthyroidism?

    <p>Elevated T3 and T4 levels with suppressed TSH</p> Signup and view all the answers

    Which symptom is most commonly associated with hypothyroidism?

    <p>Cold intolerance</p> Signup and view all the answers

    Which biochemical marker is indicative of subclinical hypothyroidism?

    <p>Normal T4 with elevated TSH</p> Signup and view all the answers

    What is the definition of euthyroidism?

    <p>Normal thyroid function with balanced hormone levels</p> Signup and view all the answers

    What notable symptom is typically associated with hyperthyroidism that can also relate to hypothyroidism?

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

    What role does levothyroxine play in thyroid hormone regulation?

    <p>Restores thyroid hormone levels by supplementing T4</p> Signup and view all the answers

    What is a characteristic of subclinical hypothyroidism?

    <p>High TSH but normal thyroid hormone levels</p> Signup and view all the answers

    What symptom might suggest that a patient is experiencing hyperthyroidism?

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

    Which of these statements correctly describes hypothyroidism?

    <p>Associated with fatigue, weight gain, and cold intolerance</p> Signup and view all the answers

    What biochemical markers would indicate hyperthyroidism?

    <p>Low TSH with elevated T3 and T4</p> Signup and view all the answers

    What is the goal range for TSH levels when treating geriatric patients with hypothyroidism?

    <p>The higher end of normal</p> Signup and view all the answers

    How frequently should TSH levels be monitored in patients receiving treatment for hypothyroidism?

    <p>Every 6-8 weeks</p> Signup and view all the answers

    What is the recommended initial dose of Levothyroxine (L4) for newborns with hypothyroidism?

    <p>10-17 mcg/kg/day</p> Signup and view all the answers

    Which adverse effect is the elderly population particularly prone to when treated for hypothyroidism?

    <p>Adverse drug events (ADE)</p> Signup and view all the answers

    What increase in hypothyroidism medication dose is recommended during pregnancy if a patient was treated prior to pregnancy?

    <p>20-50%</p> Signup and view all the answers

    What condition often leads to acquired hypothyroidism in patients?

    <p>Autoimmune thyroiditis</p> Signup and view all the answers

    At what age range should pediatric patients be treated for hypothyroidism with a dose of 5-7 mcg/kg/day?

    <p>Children aged 6 months to 1 year</p> Signup and view all the answers

    What treatment approach should be employed when starting hypothyroidism medication in elderly patients?

    <p>Start with a low dose and titrate</p> Signup and view all the answers

    What is recommended for pediatric patients over 12 years regarding hypothyroidism treatment?

    <p>Switch to adult dosing</p> Signup and view all the answers

    Study Notes

    Insulin Regimens and Adverse Effects

    • Intensive insulin regimens (multiple daily injections or insulin pump) improve long-term outcomes and lower HbA1c.
    • Lack of insulin can lead to hyperglycemia, ketoacidosis (acidic blood, fruity breath, weight loss, high triglycerides), and tissue catabolism.
    • Inadequate insulin can result in elevated blood sugar, acidic blood, loss of weight, and high blood lipids.

    Basal Insulin

    • Basal insulin suppresses hepatic glucose production, maintaining near-normal fasting blood sugar.
    • Used in appropriate doses.

    Bolus Insulin

    • Bolus insulin (prandial/premeal) compensates for extra glucose requirements after meals to reduce postprandial glucose excursions.

    Long-Acting Insulins

    • Long-acting insulin analogs like glargine, detemir, and degludec provide flatter, more constant plasma levels.
    • These insulins can be given once daily.

    Short-Acting Insulins

    • Rapid-acting insulin analogs (e.g., lispro, aspart, glulisine) have quicker onset and peak action, with a shorter duration and less weight gain and hypoglycemia.

    Insulin Onset and Duration

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

    Insulin Considerations for Dosing

    • Carbohydrate intake, pregnancy, puberty, and illness influence insulin doses.
    • Patients should adjust their insulin during times of illness.
    • Dosage is 0.5 U/kg when starting, then 0.4-1 U/kg when stabilized.

    Insulin Injection Sites

    • Subcutaneous injection sites include the abdomen, thighs, buttocks, and upper arms.
    • Rotating injection sites minimizes lipohypertrophy.
    • Avoid intramuscular (IM) injections.

    Type 2 Diabetes Factors

    • Factors associated with type 2 diabetes include insulin resistance, impaired insulin secretion, elevated glucose production by the liver, and issues with beta-cell function.
    • Overweight patients (majority have type 2) and impairment of target cells (muscle sensitivity) contribute to this type.

    Metformin MOA and ADE

    • Metformin decreases hepatic glucose production, reduces intestinal absorption, and increases insulin sensitivity.
    • Common side effects include gastrointestinal issues (nausea, diarrhea, flatulence) and lactic acidosis (increased risk in impaired kidney function or liver).
    • Metformin can benefit people with Type 2 Diabetes.

    SGLT2 Inhibitors

    • SGLT2 inhibitors increase glucose excretion through the urine, thus lowering blood glucose.
    • Associated adverse effects can include renal injury, volume contraction, and increased risk of infections (genitourinary).
    • These drugs can cause dehydration and blood pressure drops.

    GLP-1 Receptor Agonists

    • GLP-1 receptor agonists affect glucose metabolism by increasing insulin secretion, slowing gastric emptying, and decreasing glucagon secretion.
    • They can have positive impacts on weight control.

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    Related Documents

    Insulin Regimen Past Paper PDF
    Thyroid Exam Notes PDF

    Description

    This quiz covers various insulin regimens including intensive, basal, and bolus insulin. It discusses the role of long-acting and short-acting insulins, their onset, duration, and potential adverse effects. Test your knowledge on insulin management for better glycemic control.

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