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What is the MOA of insulin?
- Stimulates entry of glucose into cells
- Promotes storage of glucose as glycogen in muscle and liver cells
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What is the method of action of GLP-1 receptor agonists?
- Stimulates glucose-dependent insulin secretion
- Inhibits glucagon secretion after meals
- Slows rate of gastric emptying
- Increases satiety
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What is the MOA of Pramlintide?
- Amylin agonist
- Reduces PPG levels
- Supresses glucagon secretion
- Enhances satiety
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What is the onset of action of the various insulin products?
- Rapid acting: 5-15 min
- Short acting: 30-60 min
- Intermediate acting: 2-4h
- Long acting: 2-4h (Levemir) or 3-8h (Lantus)
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What is the time to peak of the various insulin products?
- Rapid acting: 30-90 min
- Short acting: 2-3h
- Intermediate acting: 4-10h
- Long acting: no peak
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What is the duration of action of the various insulin products?
- Rapid acting: <5h
- Short acting: 5-8h
- Intermediate acting: 10-16h
- Long acting: 12-24h (Levemir) or 20-24h (Lantus)
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What type of injectable therapy is used for Type I diabetes?
- Basal bolus insulin (but need less than Type II d/t no/less insulin resistance)
- Pramlintide can be dosed with bolus doses
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What is the place in therapy for basal insulin in Type II diabetes?
- When A1c is > 10%
- When Orals are not enough
- Use NPH, Lantus, or Levemir
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What is the place in therapy for intensive insulin therapy in Type II diabetes?
- When oral and basal insulin are not enough
- Lantus or Levemir + Aspart, Lispro, or Glulisine (NOT regular)
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What is the place in therapy for GLP-1 agonists?
Can be added to Metformin in Type II DM
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What is the place in therapy for Pramlintide?
Dosed with bolus doses in Type I and Type II DM
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How is insulin therapy monitored?
- Basal-bolus:
- Fasting, pre-prandial, 2h post-prandial (6x/d)
- Fasting, pre-prandial, hs (4x/d)
- Fasting, 2h post-prandial (4x/d)
- Premixed:
- Fasting, pre-dinner
- Basal:
- Fasting (minimum)
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How is basal-bolus insulin therapy adjusted?
- High fasting: increase basal dose
- Meal time: base on either 2h post-prandial or next meals pre-prandial (ie, if pre-dinner is high, dose more at lunch)
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How is premixed insulin therapy adjusted?
- High Fasting: increase pre-dinner dose
- High pre-dinner: increase fasting dose
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How is basal insulin therapy adjusted?
High Fasting: increase HS basal dose
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What are the SE of insulin?
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What are the SE of GLP-1 agonists?
- NV (start low and never start above 5mg with Byetta)
- Hypoglycemia when combined with orals
- BBW (Liraglutide may cause Thyroid C-cell tumors)
- Take Byetta (Exenatide) 60 min before meals BID
- Take Liraglutide without regard to meals
- Wt loss
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What are the SE of Pramlintide?
- NV
- Hypoglycemia (decrease insulin dose by 50% when starting Pramlintide)
- Dosed along with bolus dose immediately before major meals
- Wt loss
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