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What is the first line treatment for Type 2 Diabetes?
- Meal planning for blood glucose control, weight loss and exercise
- Dietary measures: monitor caloric intake, balance ration of fats/carbohydrates/protein
- Losing weight and increasing activity may help lower body’s resistance to insulin
- Exercise also reduces glucose levels by taking glucose from blood and using it for energy
- Oral hyperglycemic agents are primarily used if these other measures do not work
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What is Euglycemic?
normal blood glucose levels
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What are the two treatments available to patients that are cost effective for Type 2 Diabetes? Why?
- Losing weight and increasing activity may help lower body’s resistance to insulin
- They don't cost any money to exercise and you gotta eat just make better choices.
- Stop smoking (that would save you money LOTS of it)
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What group of medications is the first line or initial drug given to patients with Type 2 Diabetes name two generic and brand name. Identify “generation”.
- Second generation: Sulfonylureas - stimulate insulin secretion form the bata cells of pancreas.
- Amaryl (glimepiride)
- Glucotrol,(glipizide)
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What type of drug is Glucophage (Metformin)?
What are its onset, peak half-life and duration?
- Class - Biguanides
- Onset of action: UNKNOWN
- Peak: 1–3 hours
- Half-life: 1 ½ - 5 hours
- Duration: 6-20 hours
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What is the big difference between Repaglinide (Prandin) and Glucophage (Metformin)?
- Meglitinides - Action similar to sulfonylureas Increase insulin secretion from pancreas *most effective within one hour of taking
- Biguanides - Decrease production of glucose
- Increase uptake of glucose by tissues
- Does NOT increase insulin secretion from pancreas (does not cause hypoglycemia)
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Which drugs are the gene regulators and insulin sensitizers?
- Thiazolidinediones known as insulin sensitizers decrease insulin resistance.
- They Decrease insulin resistance
- Are known as “insulin sensitizing drugs”
- Increase glucose uptake and use in skeletal muscleInhibit glucose and triglyceride production in liver
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Which drug class is given to patients that do not get adequate glucose control with Biguanides (Metformin) r Sulfonylurea’s (Diabeta)?
Alpha-glucosidase inhibitors
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What drug class is Precose?
- Alpha-glucosidase inhibitors - Others
- Acarbose (Precose), Miglitol (Glyset)
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Where does Precose take effect?
Inhibits the enzyme alpha-glucosidease in the Small Intestine
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What are the four major classes of Insulin?
- Rapid acting - 5-15 min onset
- Short acting - 30-60 min onset
- Intermediate acting - 1-2 hours onset
- Long acting - slowly abosrbed given 1-2x's a day
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How is insulin manufactured?
- Derived from porcine or beef sources
- Most are human-derived, using recombinant DNA technologies
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Name each class then give Onset, peak, half life, and duration.
- Class Onset | Peak | 1/2Life | Duration
- Rapid acting - 5-15 min | 1-2Hr | 80min | 3-5Hr.
- Short acting - 30-60 min | 2-5Hr | ???? | 6-10 Hr
- Intermediate - 1-2 Hr. | 4-8Hr | ???? | 10-18Hr
- Long acting - 1 to 6-10 | 0 - 8-20 | ???? | 24+ to 20-24
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What is a sliding scale? How is it used?
- Sliding Scale short-acting (Lispro) or regular insulin doses adjusted according to blood glucose test results
- Typically used in hospitalized diabetic patients, or in patients on TPN or enteral tube feedings
- SC insulin is ordered in an amount that increases as the blood glucose increases
- Example:
- 2 units for glucose value:141-199mg/dl
- 4 units for glucose value 200-249 mg/dl
- 6 units for glucose value 250-299mg/dl
- 8 units for a glucose value of 300 mg/dl
- Greater than 300 call the physician
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Name five teaching education pointers you would instruct a newly diagnosed patient on prior to discharge?
- Disease process
- Diet and exercise recommendations
- Self-administration of insulin or oral drugs
- Potential complications
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