NU 578
Unit 4 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 4 Study Guide
ENDOCRINE AND STEROIDS Ch. 48-49, 57-58
Metformin pg 408 – Biguanide
o Inhibits glucose production in liver. Reduces glucose absorption in the gut. Sensitizes receptors in
target tissue (fat/skeletal muscle) to increase glucose uptake.
o In contrast to sulfonylureas, metformin does not stimulate insulin release from the pancreas.
Therefore, metformin does not actively drive blood glucose levels down and poses little if any added
risk for hypoglycemia when used alone. Use is good in pts who skip meals. Can increase HDLs.
o Use: glycemic control, DM2 prevention, gestational diabetes, PCOS
o SE: GI disturbance most common. Lactic acidosis is potentially fatal but rare and highest risk in renal
pts (BBW). Decreases absorption of B12 (peripheral neuropathy) and folic acid (spina bifida, NTDs).
Can interact with contrast for radiology so stop 48 hours prior to contrast use.
o CI: Renal dz, liver dz, severe infection, hx of LA, ETOH, hypoxemia, HFx
o Monitoring: for lactic acidosis. A1C.
o Max dose: peds-2000mg, adults-2500mg
Sulfonylureas pg 409
o Use: Act primarily by stimulating the release of insulin from pancreatic islets. If the pancreas is
incapable of insulin synthesis, sulfonylureas will be ineffective—which is why they do not work in
patients with type 1 diabetes.
o SE: hypoglycemia (regardless of what the glucose level is—high, normal, or low—sulfonylureas will
make it go lower). Hypoglycemic rxns more likely in pts with kidney/liver dz because they are
eliminated by hepatic metabolism and renal excretion.
DPP-4 Inhibitors (sitagliptin) – pg 412
o Use: Monotherapy or second-line therapy as add-on to metformin tx in DM2 with changes in
diet/exercise.
o SE: URTI, ha, nasal/throat inflammation, pancreatitis, HST rxns (angioedema, SJS, anaphylaxis), fluid
imbalance so risky in pts with heart dz
o DI/CI: none, including pregnancy
SGLT-2 Inhibitors (canagliflozin, empagliflozin) pg 413
o Block reabsorption of filtered glucose in kidneys causing glucosuria
o Very helpful for DM, HFx, and renal dysfunction
o Canagliflozin pg 413
Inhibits SGLT-2 in kidney and so it reduces the reabsorption of glucose, thereby increasing urinary
glucose excretion.
SE: female genital fungal infections, UTIs, and increased urination. In older adults, can lead to
ortho HoTN and dizziness, especially when combined with diuretics.
DI: Admin with ripampin, phenutoin, phenobarb (Uridine 5-DGT inducers) can decrease efficacy.
o Empagliflozin
Inhibits SGLT-2 in kidney and so it reduces the reabsorption of glucose, thereby increasing urinary
glucose excretion.
Hepatic metabolism with renal/fecal excretion
GLP-1 Receptor Agonists (exenatide, semaglutide, terzepatide) pg 414
o Activates receptors for GLP-1- slowing gastric emptying, inhibits glucagon, suppresses appetite, and
stimulates glucose-dependent release of insulin
o Exenatide pg 414
Use: DM2
, Unit 4 Study Guide
SE: N/v/d, hypoglycemia which can be worsened when combined with sulfonulurea, pancreatitis,
injection-site rxn, renal impairment, HST rxns
o Terzepatide – likely to lose more weight than the others
Nateglinide - meglitinide pg 406
Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release by
pancreas.
SE: hypoglycemia, weight gain
Acarbose pg 411 – A-glucosidase inhibitor
o Delays absorption of dietary CHOs and thereby reduces rise in postprandial BG.
o Use: in DM2 in conjunction with diet and exercise program. May be used alone or in combo with
insulin, metformin, or sulfonylurea.
o SE: flatulence, cramps, abdominal distention, diarrhea d/t bacterial fermentation of unabsorbed CHO
in colon. Anemia d/t decreased absorption of Fe. No risk of hypoglycemia unless combined with
insulin or sulfonylurea (tx with glucose, not sucrose). Long-term high-dose therapy can cause
reversible liver dysfunction (monitor LFTs every 3 months for 1st year then periodically after).
Insulin pg 401, 405
o Produced by B cells of pancreas that reside in the islets of Langerhans. Principal stimulus for insulin
release is a rise in BG.
o Use: DM1, DM2, gestational diabetes,
o SE pg 406: hypoglycemia (<70) so treat with fast PO sugar or IV glucose. Pt ed is to keep candy on
them, diabetic bracelet
o Dose must be increased during infection, stress, obesity, growth spurt, pregnancy after 1 st trimester
o Dose must be decreased for missed meal or meal low in CHO, exercise, or during 1 st trimester
o DI: hypoglycemic agents, thiazide, glucocorticoids, sympathomimetics, B-blockers (mast symptoms of
hypoglycemia)
Insulin use, duration; understanding of basal vs bolus insulin; when is each type used?
o Table 48.9 pg 402 – Insulin types and time of action after SQ injection
o Rapid acting pg 402
Administered with meals to control postprandial rise in BG. To control BG between meals and at
bedtime, use with an intermediate- or long-acting agent in people with type 1 diabetes.
Lispro, aspart, glulisine
o Short acting pg 403
Regular insulin can be injected before meals to control postprandial hyperglycemia and (2)
infused subcutaneously via insulin pump to provide basal glycemic control
o Intermediate duration pg 403
Because onset is delayed, NPH insulin cannot be administered at mealtime to control
postprandial hyperglycemia. Rather, the drug is injected 2-3 times daily to provide glycemic
control between meals and during the night.
Allergic rxns are possible due to protamine being a foreign protein.
Of the three longer-acting insulins in current use, only NPH can be mixed with short-acting
insulins (i.e., regular, lispro, aspart, and glulisine insulins). The short-acting insulin should be
drawn into the syringe first to avoid contaminating the stock vial of the short-acting insulin with
NPH insulin.
Unit 4 Study Guide
Key Concepts & Exam Review
University of South Alabama.
This document provides a focused
study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help students reinforce
understanding, identify weak areas, and prepare confidently for
the assessment.
, Unit 4 Study Guide
ENDOCRINE AND STEROIDS Ch. 48-49, 57-58
Metformin pg 408 – Biguanide
o Inhibits glucose production in liver. Reduces glucose absorption in the gut. Sensitizes receptors in
target tissue (fat/skeletal muscle) to increase glucose uptake.
o In contrast to sulfonylureas, metformin does not stimulate insulin release from the pancreas.
Therefore, metformin does not actively drive blood glucose levels down and poses little if any added
risk for hypoglycemia when used alone. Use is good in pts who skip meals. Can increase HDLs.
o Use: glycemic control, DM2 prevention, gestational diabetes, PCOS
o SE: GI disturbance most common. Lactic acidosis is potentially fatal but rare and highest risk in renal
pts (BBW). Decreases absorption of B12 (peripheral neuropathy) and folic acid (spina bifida, NTDs).
Can interact with contrast for radiology so stop 48 hours prior to contrast use.
o CI: Renal dz, liver dz, severe infection, hx of LA, ETOH, hypoxemia, HFx
o Monitoring: for lactic acidosis. A1C.
o Max dose: peds-2000mg, adults-2500mg
Sulfonylureas pg 409
o Use: Act primarily by stimulating the release of insulin from pancreatic islets. If the pancreas is
incapable of insulin synthesis, sulfonylureas will be ineffective—which is why they do not work in
patients with type 1 diabetes.
o SE: hypoglycemia (regardless of what the glucose level is—high, normal, or low—sulfonylureas will
make it go lower). Hypoglycemic rxns more likely in pts with kidney/liver dz because they are
eliminated by hepatic metabolism and renal excretion.
DPP-4 Inhibitors (sitagliptin) – pg 412
o Use: Monotherapy or second-line therapy as add-on to metformin tx in DM2 with changes in
diet/exercise.
o SE: URTI, ha, nasal/throat inflammation, pancreatitis, HST rxns (angioedema, SJS, anaphylaxis), fluid
imbalance so risky in pts with heart dz
o DI/CI: none, including pregnancy
SGLT-2 Inhibitors (canagliflozin, empagliflozin) pg 413
o Block reabsorption of filtered glucose in kidneys causing glucosuria
o Very helpful for DM, HFx, and renal dysfunction
o Canagliflozin pg 413
Inhibits SGLT-2 in kidney and so it reduces the reabsorption of glucose, thereby increasing urinary
glucose excretion.
SE: female genital fungal infections, UTIs, and increased urination. In older adults, can lead to
ortho HoTN and dizziness, especially when combined with diuretics.
DI: Admin with ripampin, phenutoin, phenobarb (Uridine 5-DGT inducers) can decrease efficacy.
o Empagliflozin
Inhibits SGLT-2 in kidney and so it reduces the reabsorption of glucose, thereby increasing urinary
glucose excretion.
Hepatic metabolism with renal/fecal excretion
GLP-1 Receptor Agonists (exenatide, semaglutide, terzepatide) pg 414
o Activates receptors for GLP-1- slowing gastric emptying, inhibits glucagon, suppresses appetite, and
stimulates glucose-dependent release of insulin
o Exenatide pg 414
Use: DM2
, Unit 4 Study Guide
SE: N/v/d, hypoglycemia which can be worsened when combined with sulfonulurea, pancreatitis,
injection-site rxn, renal impairment, HST rxns
o Terzepatide – likely to lose more weight than the others
Nateglinide - meglitinide pg 406
Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release by
pancreas.
SE: hypoglycemia, weight gain
Acarbose pg 411 – A-glucosidase inhibitor
o Delays absorption of dietary CHOs and thereby reduces rise in postprandial BG.
o Use: in DM2 in conjunction with diet and exercise program. May be used alone or in combo with
insulin, metformin, or sulfonylurea.
o SE: flatulence, cramps, abdominal distention, diarrhea d/t bacterial fermentation of unabsorbed CHO
in colon. Anemia d/t decreased absorption of Fe. No risk of hypoglycemia unless combined with
insulin or sulfonylurea (tx with glucose, not sucrose). Long-term high-dose therapy can cause
reversible liver dysfunction (monitor LFTs every 3 months for 1st year then periodically after).
Insulin pg 401, 405
o Produced by B cells of pancreas that reside in the islets of Langerhans. Principal stimulus for insulin
release is a rise in BG.
o Use: DM1, DM2, gestational diabetes,
o SE pg 406: hypoglycemia (<70) so treat with fast PO sugar or IV glucose. Pt ed is to keep candy on
them, diabetic bracelet
o Dose must be increased during infection, stress, obesity, growth spurt, pregnancy after 1 st trimester
o Dose must be decreased for missed meal or meal low in CHO, exercise, or during 1 st trimester
o DI: hypoglycemic agents, thiazide, glucocorticoids, sympathomimetics, B-blockers (mast symptoms of
hypoglycemia)
Insulin use, duration; understanding of basal vs bolus insulin; when is each type used?
o Table 48.9 pg 402 – Insulin types and time of action after SQ injection
o Rapid acting pg 402
Administered with meals to control postprandial rise in BG. To control BG between meals and at
bedtime, use with an intermediate- or long-acting agent in people with type 1 diabetes.
Lispro, aspart, glulisine
o Short acting pg 403
Regular insulin can be injected before meals to control postprandial hyperglycemia and (2)
infused subcutaneously via insulin pump to provide basal glycemic control
o Intermediate duration pg 403
Because onset is delayed, NPH insulin cannot be administered at mealtime to control
postprandial hyperglycemia. Rather, the drug is injected 2-3 times daily to provide glycemic
control between meals and during the night.
Allergic rxns are possible due to protamine being a foreign protein.
Of the three longer-acting insulins in current use, only NPH can be mixed with short-acting
insulins (i.e., regular, lispro, aspart, and glulisine insulins). The short-acting insulin should be
drawn into the syringe first to avoid contaminating the stock vial of the short-acting insulin with
NPH insulin.
