Insulin Types and Metformin Overview

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Questions and Answers

What is the duration of rapid acting insulin?

3-5 hours (correct)

18-24 hours

1-2 hours

5-7 hours

Which type of insulin can be administered through an IV?

Lispro

Humulin N

Lantus

Novolin R (correct)

What should be monitored to prevent hypoglycemia during the use of intermediate acting insulin?

Blood pressure

Glycated hemoglobin level

Heart rate

Mid-afternoon snacks (correct)

What is the peak action timeframe for short acting insulin?

2-3 hours Signup and view all the answers

Which of the following properties best distinguishes intermediate acting insulin?

Has a cloudy appearance Signup and view all the answers

What is the onset time for long acting insulin analogs such as glargine?

1 hour Signup and view all the answers

Which rapid acting insulin has an onset of about 15 minutes?

Apidra Signup and view all the answers

What is the primary reason protein is added to intermediate acting insulin?

Delay the absorption Signup and view all the answers

What is the primary mechanism of action for metformin?

It makes tissues more sensitive to insulin. Signup and view all the answers

Which statement about detemir (Levemir) is correct?

It provides basal coverage for up to 24 hours. Signup and view all the answers

What is a significant advantage of using metformin over other antihyperglycemic agents?

It has a low risk of hypoglycemia. Signup and view all the answers

What is a common side effect associated with metformin?

Metallic taste. Signup and view all the answers

Which of the following is a contraindication for metformin?

Severe liver disease. Signup and view all the answers

Which mechanism of action is correctly matched with its drug class?

Thiazolidinediones - inhibits glucose release from liver Signup and view all the answers

What nursing implication is critical for patients on metformin?

Hold the drug for at least 2 days before and after procedures that require contrast media. Signup and view all the answers

What is a significant disadvantage associated with Thiazolidinediones?

Possible liver toxicity requiring monitoring Signup and view all the answers

When should Insulin secretagogues ideally be taken?

Before breakfast Signup and view all the answers

What is the route of administration for detemir (Levemir)?

Subcutaneously at the same time daily. Signup and view all the answers

What kind of diabetes is metformin primarily used to treat?

Type 2 diabetes. Signup and view all the answers

Which of the following is an advantage of Thiazolidinediones?

Decreased risk of hypoglycemia when used alone Signup and view all the answers

What key characteristic differentiates detemir from other insulins in terms of infusion method?

It has no peak action. Signup and view all the answers

What is a common contraindication for using Thiazolidinediones?

Heart failure Signup and view all the answers

Which statement is false regarding metformin?

It is always injected subcutaneously. Signup and view all the answers

What should be monitored when a patient is taking Thiazolidinediones?

Serum transaminase levels Signup and view all the answers

Which of the following statements about Insulin secretagogues is accurate?

They induce insulin release from pancreatic beta cells Signup and view all the answers

What is a major concern when prescribing Thiazolidinediones due to their mechanism of action?

Liver damage Signup and view all the answers

Which effect is expected from the usage of Thiazolidinediones?

Normalization of blood glucose levels over time Signup and view all the answers

What is the expected timeline for the onset of action of Thiazolidinediones?

12 weeks Signup and view all the answers

What is the primary mechanism of action of acarbose?

Slows digestion of carbohydrates Signup and view all the answers

Which advantage does sitagliptin (Januvia) have over other diabetic medications?

Can be used with other oral drugs for better efficacy Signup and view all the answers

What is a major disadvantage of using acarbose?

GI side effects such as diarrhea and flatulence Signup and view all the answers

What is the primary mechanism of action for the amylin analog pramlintide?

Suppresses glucagon and slows gastric emptying Signup and view all the answers

What condition presents a contraindication for the use of GLP-1 incretin enhancers?

C-cell thyroid cancer Signup and view all the answers

How does the influence of incretin hormones benefit diabetic patients?

Decreases blood glucose levels post meals Signup and view all the answers

Which of the following is a disadvantage when using SGLT2 inhibitors like empagliflozin?

Not recommended for patients with a GFR less than 45 mL/min Signup and view all the answers

Which of the following routes is NOT commonly associated with GLP-1 incretin enhancers?

Intravenous Signup and view all the answers

What is a critical nursing implication when administering amylin analogs?

Take immediately before a meal Signup and view all the answers

What is a significant characteristic of DPP-4 inhibitors in relation to blood glucose levels?

They only function when glucose levels are elevated Signup and view all the answers

Why should diuretics not be administered along with SGLT2 inhibitors?

May lead to excessive volume depletion and dehydration Signup and view all the answers

What is a primary advantage of using semaglutide for diabetes management?

Weight loss benefits Signup and view all the answers

What is a potential side effect of pramlintide that patients should be monitored for?

Nausea and injection site reactions Signup and view all the answers

What common side effect should patients be wary of when taking acarbose?

Flatulence Signup and view all the answers

What is the primary use of DPP-4 inhibitors in diabetes treatment?

To lower blood glucose dependent on the glucose level Signup and view all the answers

Study Notes

Rapid Acting Insulin Analogs

Lispro (Humalog), aspart (NovoLog), glulisine (Apidra)
Ideal for bolus (meal time and high glucose)
Onset: about 15 minutes, peak: 30-90 minutes, duration: 3-5 hours
Routes: subcutaneous or insulin pump

Short Acting Insulin (Regular)

Humulin R, novolin R, actrapid
Clear
Onset: 30-60 minutes, peak: 2-3 hours, duration: 5-7 hours
Routes: subcutaneous or IV (only type of insulin given intravenously)

Intermediate Acting Insulin

Homulin N, novolin N (NPH)
Cloudy
Onset: 1-1.5 hours, peak: 8-12 hours, duration: 18-24 hours
Routes: subcutaneous only
Can be mixed with regular insulin

Long Acting Insulin Analogs

Glargine (Lantus), detemir (Levemir)
Provides basal dose
Onset: 1 hour, peak: none, duration: up to 24 hours
Routes: Subcutaneous daily

Metformin (Glucophage)

First-line treatment for type 2 diabetes
Mechanism of action:
- Makes tissues more sensitive to insulin
- Decreases intestinal glucose absorption
Routes: oral
Advantages:
- Insulin sensitization
- Low risk of hypoglycemia
- Does not cause weight gain
Disadvantages:
- GI side effects (nausea, metallic taste, flatulence, diarrhea)
Contraindications:
- Black box warning for rare lactic acidosis (liver disease)
Nursing implications:
- Periodic tests of renal and liver function
- Hold drug at least 2 days before and 2 days after procedures that require contrast media
- Hold on day of surgery
- Outcome: normalized blood glucose levels, improvement in HbA1c

Rosiglitazone (Avandia)

Not first-line therapy, may be last resort medicine
Mechanism of action: inhibits release of glucose from liver
Routes: oral
Advantages:
- Decrease risk of hypoglycemia when given alone
Disadvantages:
- Slow onset of action (12 weeks)
- Possible liver toxicity (monitor serum transaminase level)
Contraindications:
- Black box warning for heart failure

Acarbose (Precose)

Second generation sulfonylurea
Mechanism of action: slows digestion of carbohydrates
Routes: oral
Advantages:
- Decrease risk of hypoglycemia when used alone
- Works best with insulin or sulfonylurea
Disadvantages:
- GI side effects (diarrhea, flatulence)

Sitagliptin (Januvia)

DPP-4 inhibitor
Mechanism of action: increases incretin (GLP-1) = decreased glucose in blood
Routes: oral
Advantages:
- Oral drug
- Monotherapy, combined with other oral drugs
- Works only when blood glucose is elevated

Semaglutide (Wegovy), Dulaglutide (Trulicity)

Incretin enhancer: glucagon-like peptide (GLP-1)
Mechanism of action: lowers post-meal glucose spikes
Routes: oral (semaglutide), others are injections
Advantages:
- “Helper hormone”
- Weight loss
Disadvantages:
- GI side effects: nausea, hypoglycemia, injection
Contraindications:
- Black box warning for c cell thyroid cancer

Pramlintide (Symlin)

Amylin analog
Mechanism of action: decreases glucose appearance after meals, slows gastric emptying, suppresses glucagon, regulates food intake
Routes: injection with insulin
Advantages:
- Regulates post-prandial blood glucose ‘spikes’
Disadvantages:
- Subcutaneous injection
Contraindications:
- Black box warning for severe hypoglycemia within 3 hours
Nursing implications:
- Take immediately before meals
- Do not take if meal skipped
- Can be given at the same time as insulin but not in the same syringe

Empagliflozin (Invokana)

SGLT2 inhibitor (glifozin)
Mechanism of action: blocks renal glucose reabsorption
Disadvantages:
- Don’t give diuretics
Contraindications:
- Not for patients with a GFR less than 45 mL/min
Nursing implications:
- Monitor for burning, irritation, or swelling at the injection site

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Description

This quiz covers various types of insulin, including rapid, short, intermediate, and long-acting insulins, along with their characteristics and administration routes. Additionally, it discusses Metformin, a first-line treatment for type 2 diabetes, focusing on its mechanism of action and effects on insulin sensitivity. Test your knowledge on these essential diabetes management therapies.