FNP III Diabetes Review

Sulfonylureas work by promoting insulin release.  

• First gen end in MIDE (MIDE = Mono, 1st gen)
• Tolbutimide (orinase); Tolazamide (Tolinase); Chlorpropamide (Diabanese)

• Second gen end in IDE
• Gylburide (DiaBeta)
• Glypizide (Glucotrol)
• Glimepiride (Amaryl)

Use with CAUTION in individuals with sulfonamide allergy

Metformin (Biguanide Class) works by decreasing production of glucose in the liver.  Increases peripheral uptake of glucose.

Monitor creatinine.

With radiocontrast use and surgery, omit day of and 48 post.  Re-initiate when baseline renal function has been re-established.

Thiazolindinediones work by decreasing insulin resistance.

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

Avoid in liver disease, monitor transaminases.

Alpha-glucosidase inhibitors work by delaying the absoption  of dietary carbohydrates.

• Drug Names:
• Acarbose (Precose)
• Miglitol(Glyset)

• Monitor transaminases
• Adverse reactions in Asthma, dizziness

Byetta works by mimicking incretin.  Stimulates insulin production in response to elevated serum glucose. 

Slows gastric emptying.

Starlix works like a sulfonylurea but has fewer side effects than biguanides or alpha-Glucosideas inhibitors.

• Onset >15min 
• Peak 30-60 min
• Duration 3-4 hours

• Onset: 30-60 min
• Peak: 2-6 hours
• Duration: 6-8 hours

• Humulin 50/50=
• NPH insulin 50% and Regular insulin 50%

• Onset: 30-60 min
• Peak: 3-5 hours
• Duration: 24 Hours

NPH insulins include: Humulin N, Iletin II NPH, Novalin N, Purified pork NPH

• Onset: 1-1.5 Hours
• Peak: 4-12 Hours
• Duration: 18-24 Hours

PEAKLESS, absorbed slowly with gradual onset and peak lasting  up to 24 hours.

The Somogy effect is when an insulin-induced hypoglycemia triggers excess secretion of glucagon and CORTISOL, this leads to hyperglycemia.

Result of reduced insulin sensitivity between 5 am and 8 am caused by earlier spikes of growth hormone.  

May split evening intermittent dose of insulin between dinner and bed time.