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What fasting and casual plasma glucose levels suggest diabetes mellitus?

Fasting: > 126 mg/mL
Casual: > 200 mg/mL


2. What are the preprandial and postprandial targets for patients with DM/ What is the target for A1c?

Preprandial: 70-130 mg/mL
Postprandial: < 180 mg/mL
A1c: < 7% (154 mg/dL)


3. What is an electrolyte indication for insulin?



4. How are insulin durations changed?

Change amino acid sequence or add a protein.


5. What are the mechanisms of action of insulin?

Transports glucose, amino acids, nucleotides, and potassium into cells. Promotes synthesis of glycogen, proteins, and triglycerides.


6. What are two contraindications for insulin?

Hypoglycemia and hypokalemia.


7. How long may opened insulin vials be stored at room temperature?

1 month.


8. When drawing up a short-acting insulin and NPH insulin in the same syringe, which is drawn first? Which short-acting insulins may be mixed with NPH insulin?

Short-acting insulin.
Regular insulin and the insulin analogs – insulin lispro, insulin aspart, & insulin glulisine


9. Are all clear insulins short-acting? Explain.

No. Insulin detemir (Levemir) and insulin glargine (Lantus) are intermediate- and long-acting insulins respectively and are clear.


10. How can you minimize lipohypertrophy with insulin injections?

Use the same site only one time per month and keep the sites one inch apart.


11. Which of the insulins may be given IV?

Insulin lispro (Humalog), insulin aspart (Novolog), insulin glulisine (Apidra), regular insulin (Humulin R or Novolin R).


12. When should short, rapid-acting insulins be given?

5-15 minutes before meals


13. When should regular insulin be given?

30 minutes before meals


14. When is NPH insulin given when given mixed with regular insulin?

30 minutes before breakfast and dinner


15. How often is insulin glargine (Lantus) given? When is the drug usually dosed?

Once per day. Same time each day.


16. Why are beta-blockers not recommended to be given to patients with diabetes?

Beta-blockers mask the signs of hypoglycemia and also prevent glycogenolysis, which allows glycogen to breakdown into glucose (necessary to prevent hypoglycemia).


17. What are the symptoms of hypoglycemia?

Tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue. Also convulsions, coma, death.


18. What is the treatment for hypoglycemia in alert patients? What about those taking alpha-glycosidase inhibitors?

Glucose tablet, orange juice, sugar cubes, honey, corn syrup, nondiet soda. Must use glucose tablets if take alpha-glycosidase inhibitors that prevent the breakdown of sugars into monosaccharides.


19. What drug is administered to unconscious patients with hypoglycemia? How does it work? What works faster?

Glucagon. Breaks down glycogen into glucose and accelerates hepatic gluconeogenesis. IV glucose.


20. What are the mechanisms of action of metformin (Glucophage), a biguanide?

Sensitizes cells to insulin and decreases liver glucose production. Also slightly inhibits intestinal absorption of glucose.


21. What procedure is used for patients who use metformin (Glucophage) who are undergoing tests with radiocontrast dye?

Stop drug 1-2 days before procedure, drink lots of fluids, restart drug if BUN, Cr have normalized 48 hours after the procedure.


22. What are the mechanisms of action of second-generation sulfonylureas? What occurs over time?

Stimulates the release of insulin from pancreatic beta cells. Lose effectiveness over time.


23. What allergic contraindication do sulfonylureas have?



24. What is adverse effect occurs with sulfonylureas and alcohol?

Dilsulfiram-like reaction


25. What is the difference in mechanisms of action between sulfonylureas and glinides?

Glinides must be given immediately before meals, because their action is much faster than sulfonylureas.


26. What is the mechanism of action of thiazolidinediones?

Sensitizes cells to insulin and decreases liver glucose production.


27. What is the black box warning for thiazolidinediones? Signs to look for?

Avoid with severe heart failure due to water retention. Shortness of breath with exertion, crackles, chest pain, restlessness, change in level of consciousness, increasing weight.


28. What is the mechanism of action of alpha-glycosidase inhibitors?

Prevents breakdown of carbohydrates into monosaccharides.


29. What adverse effect may occur with gliptins, incretin mimetics, and amylin mimetics?



30. What drug interactions may occur with gliptins, incretin mimetics, and amylin mimetics?

Hypoglycemia if taken with other antidiabetic drugs. Slows absorption of other drugs.