Class 6 Antidiabetics-1 - Diabetes Mellitus Type 1 Formerly...

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Diabetes Mellitus Type 1 Formerly called: Type I IDDM (Insulin Dependent Diabetes Mellitus) Type 2 Formerly called: Type II NIDDM (Non insulin Dependent Diabetes Mellitus)
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Type 1 DM Autoimmune pathophysiology Usually onset before age 20 Sudden onset Diabetic Ketoacidosis (DKA) common Accounts for 10% of diabetics
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Type 2 DM Characterized by hyperglycemia and Insulin resistance Usually later onset, after age 40 Recent rise in children Obesity major risk factor Higher risk among African Americans, Native Americans, and Hispanics
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Complications MI (#1 cause of death) Stroke Blindness Amputations Renal Failure (Retinopathy, nephropathy, neuropathy)
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INSULIN--characteristics Protein Secreted by BETA CELLS OF THE PANCREAS 1-2 units/hour basal rate 4-6 units/hour as needed
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Insulin--a little history First used 1922 by Frederick Banting and Charles Best Cannot be given PO as it is metabolized Until recently, most insulin came from cow and pig pancreases. Beef and now pig insulin (as of 1/06) are no longer available for us in USA. Insulin today made from recombinent DNA technology
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Insulin History First person to receive insulin was Leonard Thompson, a Toronto teenager Insulin was very dilute, and the first insulin injection was 7.5 mL IN EACH BUTTOCK!!
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Insulin History
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Endogenous Insulin Production After a meal normal insulin peaks in 30 minutes, returns to baseline in 3 hrs
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Insulin-Effects on metabolism Carbohydrate Metabolism Fat Metabolism Protein Metabolism
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Comparing Different Insulins http://www.fda.gov/fdac/features/2002/chrt_in
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Lispro insulin--Humalog and Insulin aspart (Novolog) Synthetic insulin VERY rapid acting Onset 5-15 minutes Peak 1/2 to 1 hour Duration 2-4 hours Taken just as person eats a meal
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Insulin glulisine Apidra Brand name: Apidra® Class : insulin analog For : insulin-treated diabetes adults, and for use in insulin pumps Route of Administration : subcutaneous Action : short-acting insulin Other drugs with approximately the same duration of action : Insulin lispro (Humalog®), Insulin aspart (Novolog®).
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Discontinued Insulin http://www.medicalnewstoday.com/medi calnews.php?newsid=27213
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Regular Insulin-Humulin, Ilentin II, Novolin R Short Acting Only insulin that can be given IV: Humalog, Novolog and LANTUS (insulin glargine) are clear, but not indicated for IV Onset 1/2 to 1 hour Wait 1/2-1 hr before eating Peak 2-4 hours Duration 6-8 hours
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NPH Insulin-Humulin N, Novolin N, NPH Ilentin II Intermediate acting insulin Onset 2-4 hours Peak 8-12 hours (more like 6+hrs) Duration 18-24 hours Cloudy appearance DO NOT SHAKE bottle
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Lente Insulin-Humulin L, Novolin L, Lente L Intermediate acting Similar to NPH Onset 2-4 Peak 8-12 Duration 18-24
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Long acting Insulin-Ultralente or Humulin U Ultralente VERY long acting Onset 4-8 Peak 12-24 Duration 36+ Not commonly used
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Lantus (insulin glargine) Onset in 2 hours Long acting (24 hours) Non-peaking Lantus home page
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Insulin detemir ( Levemir ) Long acting, non peaking insulin http:// www.multum.com/insulin_detemir.htm
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