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Diabetes Therapy Cheat Sheet (DRAFT) by

Drug therapy for Diabetes and more...

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Types of Insulin and Examples

Rapid-­acting analogue
Lispro, Aspart, Glulisine
Short-­acting (clear)
Regular (Humulin R)
Interm­edi­ate­-acting (cloudy)
NPH
Extended Long-a­cting analogue (clear)
Lantus
Premixed
Interm­ediate insulin is the only insulin that can be mixed with short or rapid insulin.
When preparing mixed insulin it is important to draw the short insulin first before the interm­ediate insulin to prevent contam­ination due to the cloudy nature.
Insulin is admini­stered subcut­ane­ously, insulin pen or IV with superv­ision.
Preferred site is the abdomen and should be rotated within that particular site.

Problems with Insulin Therapy

Hypogl­ycemia
Allergic reactions
Lipody­str­ophy: Hypert­rophy or atrophy of subcut­aneous tissue
Somogyi Effect: High blood glucose level in the morning which leads to an increased dose of insulin given and further decreases the blood glucose level due to too much insulin
Dawn Phenom­enon: Hyperg­lycemia present when an individual wakes up in the morning. Seems to be severe with growth hormone present.
 

Common Oral Antihy­per­gly­cemic Agents

 
Primary Function
Common examples
Insulin Secret­ago­gues/ Sulpho­nyl­ureas
Increase beta-cell insulin production from the pancreas
Gliclazide
Meglit­inides
Increase insulin production from the pancreas
Repagl­inide
Biguanides
Reduce glucose production by the liver. Increase the sensit­ivity at the tissue level and improves glucose transport.
Metformin (Only examples in this class)
Metformin does not lead to weight gain

Nutrit­ional Therapy

Type 1 DM food intake is based on increasing caloric intake to ensure desirable body weight and restore body tissues.
Type 2 DM is more of weight loss.
Major points are to eating three meals per day at regular times and no more than 6 hours apart.
Limiting sugar, sweets, high fat food and eating more high fibre foods.
Drinking water if thirsty and more physical activity.
Glycemic Index and percen­tages of food classi­fic­ation should be considered

Exercise

Exercise increases insulin sensit­ivity and has a direct impact on decreasing blood glucose.
A total of 150 minutes of moderate intensity aerobic activity over 3 days
However, with patients on insulin there is an increased risk of hypogl­ycemia with exercise.
It can last for 48 hours. Exercise should be scheduled I hour after a meal or snack should be taking before exercise.

Acute Compli­cations of DM

 
Hyperg­lycemia
Hypogl­ycemia
Manife­sta­tions
Abdominal cramps, blurred vision, glycos­uria, headache, increased appetite, polyuria, nausea, vomiting, progre­ssion to DKA or HHS, weakness and fatigue
Blood glucose less than 4.0, vision changes, cold and clammy skin, faintness, dizziness, headache, hunger, numbness of fingers, toes and mouth, rapid heart beat, seizures, coma, unsteady gait and slurred speech.
Manife­sta­tions
Abdominal cramps, blurred vision, glycos­uria, headache, increased appetite, polyuria, nausea, vomiting, progre­ssion to DKA or HHS, weakness and fatigue
Blood glucose less than 4.0, vision changes, cold and clammy skin, faintness, dizziness, headache, hunger, numbness of fingers, toes and mouth, rapid heart beat, seizures, coma, unsteady gait and slurred speech.
Causes
Cortic­ost­eroids, stress, illness, infection, poor absorption or lack of insulin, too much food, too little insulin.
Alcohol intake without food, diabetic medication taken at the wrong time, loss of weight, too little food, too much diabetic medica­tion, too much exercise, use of beta adrenegic blockers.
 

Diabetic Ketoac­idosis

Overview: This is an acute metabolic compli­cation of DM. This is because of lack of insulin the body breaks down fat.