191. Which of the following drugs used in the treatment of type 2 diabetes mellitus delays glucose absorption from the gastrointestinal tract? A. tolbutamide B. metformin C. rosiglitazone D. lispro insulin E. acarbose
needs to be taken with long acting prep for type 1 diabetics or type 2 in which insulin secretion cannot be maintained.
Conventional insulin treatment: 1-2 injections a day is what type of insulin
Rapid or intermediate acting insulin. NPH + lispro or aspart
Continuous sub q insulin: insulin pump. only what type of insulin can be used
Only lispro or regular insulin can be used.
Intensive insulin treatment: usually used with frequent monitoring of insulin as needed. Example is
regular insulin by itself or regular insulin with intermediate or long acting insulin (with overnight difficulty have to use long acting with regular)
other name for lispro
take with meals 5 units
take at night time 20 units
Which of the following medications should not be restarted after surgery under general anesthesia until at least 48 hours after the procedure? Sulfonylurea B. Levamir C. Metformin D. Humalog
metformin, iabetic patients have increased risk for decreased kidney dysfunction post-operatively, due to general anesthesia. Metformin should be discontinued the morning of surgery and withheld for 48 hours
other name for aspart
another name for glargine
another name for detemir
What is the function of a biguanide?
Antihyperglycemic (not hypoglycemic)
What are the only FDA-approved drugs for treating diabetic neuropathy?
duloxetine (Cymbalta) pregabalin (Lyrica)
two groups of oral glucose agents?
Biguanides & Sulfonylureas
will not cause hypoglycemia, ￼lactic acidosis or significant weight gain.
Reduce intestinal carbohydrate absorption
Bind to β-cell receptors stimulating insulin release
huge deep ulcers that are due to auto-immune diseases
Uncontrolled diabetic is
if start with a Wagner 3, and treat and it gets smaller: what is it now?
still a wagner 3
what is considered diabetic for nonfasting glucose? fasting glucose? HbA1C?
>200mg/dl, >126, >6.5
diabetic medication that causes EDEMA
How many hours prior to surgery should you discontinue Metformin?
48 hours. All other hypoglycemic drugs you discontinue 24 hours in advance.
What is the only form of insulin you should discontinue prior to surgery?
Aspart, Novolog, Apidra or Lispro - because you’re supposed to take them with meals
take less than an hour to act. Last 6-8 hours
what are the types of IV insulin?
477. IDDM pt in hospital, NPO before surgery, which insulin to use for continuous IV?
NPH, regular, lantis, etc
479. What do you do f/diabetic pt pre op oral diabetic drug?
If oral-controlled, hold oral meds and cover with SSI(crozer)
480. What type of insulin do you give a type 1 DM before surgery?
38-year-old patient with diabetes mellitus is in the preoperative holding area and surgery has been delayed for 2 hours. One-half of the patient’s prescribed AM NPH insulin dose was administered at 7:00 AM. It is now 9:30 AM and the patient suddenly becomes disoriented and begins to perspire profusely. Which of the following actions would be most appropriate? (A) Obtain an electrocardiogram (EKG). (B) Perform a finger-stick blood glucose evaluation. (C) Administer the remaining half of the patient’s prescribed AM NPH insulin. (D) Administer midazolam 2 mg to the patient.
B Blood glucose levels should be measured preoperatively and postoperatively. The need for additional measurements is determined by the duration and magnitude of surgery and the stability of the diabetes. Signs of hypoglycemia include tachycardia, hypertension, and diaphoresis.
child taking lantus going to have surgery what is his sliding scale
Sliding scale – controversial – basically see what patients glucose level is BEFORE meal and then give them units of insulin. However post-food glucose may be huge! Therefore trial and error method – give 5 units Lispro, see post-food glucose! If reached 900, try 10 units etc etc
what would u most likely not use in type 2 diabetic?
For diabetic patients, who gets diabetic ketoacidosis and who gets diabetic coma?
Type I (IDDM) DKA Type II (NIDDM) coma
What are signs of hypoglycemia?
Nervousness, tachycardia, diaphoresis, nausea, headache, confusion, tremor, seizures, coma
What are signs of hyperglycemia?
Polyuria, polydipsia, weight loss
A 56-year-old diabetic man has been admitted for unstable angina. He is maintained on glimepiride, metformin and rosiglitazone for his diabetes. He has been started on aspirin, metoprolol, nitrates and enoxaparin. His creatinine is normal at 0.7 mg dl. He is planned to undergo coronary angiography in two days. Which of the following is the most important action to take prior to his angiography?
Metformin is a biguanide that accumulates in patients with renal insufficiency. There has been a concern about the development of lactic acidosis with the use of metformin. It is within the standard of care to stop metformin 48 hours prior to the use of iodinated radio- contrast material because of the of the concern that the contrast material may cause renal insufficiency and the metformin will accumulate and cause lactic acidosis. Hydration, bicarbonate and N-acetyl cysteine are used to prevent worsening of renal insufficiency in those who have a baseline abnormality in renal function. This patient’s creatinine is normal and these interventions are not necessary. Low-dose dopamine is clinically useless
PIMP: Any time your want to raise insulin, want to raise C peptide levels
which causes incr in insulin release caused by Ca2+