Have other clinical conditions associated with insulin resistance PCOS or

Have other clinical conditions associated with

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Have other clinical conditions associated with insulin resistance (PCOS or acanthosis nigricans, History of CVD Insulin Pharmaco- dynamics Promotes protein synthesis by increasing amino acid transport into cells Stimulates glucose entry into cells as energy source Increases storage of glucose as glycogen (glycogenesis) in muscle and liver cells Inhibits glucose production in liver and muscle cells (glycogenolysis) Enhances fat storage (lipogenosis) and prevents mobilization of fat for energy (lipolysis and ketogenesis) Inhibits glucose formation from noncarbohydrate sources, such as amino acids (gluconeogenesis) Dosing: 50% bolus, 50% basal needs Depends on (BG) levels, diet, exercise, weight; Based on type of DM, type of insulin, calories, exercise Average insulin doses: 0.3 to 0.8 U/kg/24 hours Example: 60 kg adult type 1 DM (using 0.5 U/kg/24 hours) o Requires 30 units o Insulin glargine (Lantus): 15 units at bedtime o Insulin Lispro: 15 units total divided over meals Before breakfast: 5 units Before lunch: 5 units Before dinner: 5 units Type 2 DM: Basal insulin with either IAI or LAI once or twice daily to achieve desired BG levels Glargine & detemir: less nocturnal hypoglycemia than NPH; detemir: less wt gain Oral agents Insufficient production of endogenous insulin Sulfonylureas cause an increase in insulin production. Meglitinides, insulin secretagogues, increase secretion of insulin from beta cell. Dipeptidyl peptidase-4 (DPP4) inhibitors act on the incretin hormone system to indirectly increase insulin production. Tissue insensitivity to insulin : Thiazolidinediones improve insulin sensitivity (insulin sensitizer). Impaired response of beta cells : Meglitinides increase secretion of insulin. Excessive production of glucose by the liver Metformin improves hepatic response to elevated BG and decreases glucose production, decreases gastrointestinal (GI) absorption, & increase peripheral glucose uptake & utilization Alpha-glucosidase inhibitors inhibit absorption of cholesterol (CHO) in GI system. Metformi n Approved in children 10+; indicated for type 2 w/ dyslipidemia, obesity, insulin resistance, elevated FPG; can reduce by 1.5-2% of Hb A1c
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Sulfonylure as Increase insulin secretion, improve binding btw insulin & insulin receptors, increase # of receptors; Hypoglycemia may occur (second line therapy); indicated for no overweight and no dyslipidemia; skin rash, wt gain, & GI disturbance are common ADRs Alpha- glucosidas e inhibitors inhibit and delay the absorption of complex CHO from the small bowel and lower BG levels after meals; diminish wt increasing effect of sulfonylureas; Thiazolidin e-diones Pioglitazone (Actos) and rosiglitazone (Avandia) only approved. Increase utilization of available insulin, reduce hepatic glucose production (glycogenesis); ADRs: CV problems Meglitinide s
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  • Spring '14
  • Henrikson,J
  • c Criteria

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