PC707-Endocrine-Module 8 Exam with 100% Verified and Updated Solutions

PC707-Endocrine-Module 8 Exam with 100% Verified and Updated Solutions Is insulin required for type 1 diabetes? - answer-yes--there is autoimmune pancreatic beta cell destruction and unable to produce endogenous insulin* What is the typical therapy for a type 1 diabetic: - answer-life long insulin* -basal insulin -boluses of short-acting insulin to provide coverage for meals and snacks Symptoms of diabetes mellitus: - answer-involuntary weight loss -polyuria -polydipsia -polyphagia Symptoms of ketoacidosis: - answer-dehydration -abdominal pain -vomiting -decreased level of consciousness Symptoms of hypoglycemia: - answer-dizziness, H/A, fatigue, weakness, shakiness, tachycardia, sweating, hunger, confusion Type 2 diabetes mellitus: - answer-genetically predetermined & environmentally modified* -reduced tissue sensitivity to insulin* -euglycemia occurs due to body's response to hyperglycemia--causing hyperinsulinemia* -long term insulin resistance can cause beta cell destruction* What are the treatment options for type 2 diabetes: - answer-first line--exercise & diabetic diet -oral hypoglycemics -insulin What is first line preferred pharmacologic treatment for type 2 diabetes? - answer- glucophage (Metformin) Is tight control of diabetes recommended? - answer-No -increased risk of hypoglycemia and mortality -do not lower A1C levels quickly or too low in those at high risk of CV events--may cause CV events* -do not aim for tight glucose control in the elderly Early treatment for type 2 diabetes with metformin has been shown to: - answer-decrease mortality and diabetic related complications Insulin must be given by SQ injection or IV infusion because: - answer-it is not bioavailable orally because it is a protein & is digested in the stomach* Types of insulin: - answer-Rapid acting -Short acting -Intermediate acting -Long acting (basal) -Combination Rapid acting insulin: - answer-works immediately (onset 5-15 minutes) -peak within 45 minutes-3 hours -duration 3-5 hours -can be used in insulin pumps as "boluses" for meals -administered with meals* -Ex: lispro (Humalog), aspart (Novolog), glulisine (Apidra) Short acting insulin: - answer-onset 15-30 minutes -peak 2-4 hours -duration 5-8 hours -Ex: Regular, Humulin R, Novolin R Intermediate acting insulin: - answer-onset 1-2 hours -peak 4-12 hours -duration 18-24 hours -Ex: NPH, Humulin N, Novolin N Long acting insulin (basal): - answer-given once daily--but can be given BID if needed* -onset 1-2 hours -duration 24 hours -detemir (Levemir) peaks in 4 hours -glargine (Lantus) has NO peak* -do not mix Lantus with other insulins Intermediate/combo insulin preparations: - answer-Novolog mix (70/30) -Humalog mix (75/25) -Humalog mix (50/50) -Humulin mix (70/30) -Novolin mix (70/30) --->onset 30 minutes --->peak 30 min-12 hours --->duration up to 24 hours Why should alcohol be avoided with use of insulin? - answer-can increase risk of hypoglycemia Complications of insulin: - answer-hypoglycemia -hypokalemia -lipohypertrophy (accumulation of SQ fat) -weight gain What is a good treatment option for a type 2 diabetic that is not responding to multiple dose injections of insulin? - answer-insulin pump -delivers steady measured "basal" continuous dose -delivers "boluses" per patient around mealtimes -maintains good control of blood sugar (improving HgA1C) -patient can exercise without having to eat large amount of carbs -type 1 diabetics will ALWAYS use the basal + bolus -can cause weight gain -expensive -potential DKA if catheter comes out without notice* What is an insulin inhaler? - answer-delivers insulin via nebulizer directly into the lungs -faster peak concentrations in the serum -rapid metabolism than injectables What are the drug interactions with insulin? - answer-hypoglycemic agents (potentiates hypoglycemic effect) -drugs that cause hyperglycemia will cause a need for increase in insulin requirements (thiazides, oral steroids, sympathomimetics) -beta blockers (can mask signs and symptoms of hypoglycemia) Types of oral hypoglycemics: - answer-biguanides -sulfonylureas -meglitidines -alpha-glucosidase inhibitors -thiazolidinediones -gliptins (DPP-4 inhibitors) Biguanides: - answer-oral hypoglycemic -inhibits glucose production by the liver (gluconeogenesis) & liver breakdown of glycogen into glucose (glycolosis) -enhances tissue receptor sensitivity to insulin -does not "actively" reduce glucose levels--hypoglycemia is NOT a concern* -can be combined with other age