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PC707 Endocrine Exam Questions And Accurate Answers
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PC707 Endocrine Exam Questions And Accurate AnswersKnow types of Insulin onset, peak, and duration
What type of insulin is used in insulin pumps?
Lispro (Humalog) / aspart (Novolog)
The textbook says the below options. Canvas and the BBB says lispro/aspart.
Humulin R
Novolin R
What are the advantages and disadvantages of an insulin pump?
The advantages of the pump are that it more naturally replicates the body's release of
insulin, there is no longer the need for multiple injections, it delivers with greater
precision and improves HgA1c, levels, with fewer blood glucose swings up and down. It
also allows the patient to be able to exercise without having to eat a large amount of
carbohydrates beforehand?
The only disadvantages with the pump are since it contains insulin therefore it can
cause weight gain. Moreover, the catheter may come out and that can lead to DKA. It is
also very costly and requires insurance approval.
Inhaled Insulin
The inhalation insulin is a powdered form of insulin administered with an inhalation
device to the lungs, where it is absorbed. In general, inhaled insulins are more rapidly
absorbed than subcutaneously injected insulins, the peak serum concentration is
quicker, and metabolism is faster.
*****Black Box Warning*****
Some asthmatic and COPD patients have developed acute bronchospasm while using
inhaled insulin. It is contraindicated to use inhaled insulin in patients with chronic lung
,disease such as asthma or COPD. For all patients, perform a medical history, physical
examination, and spirometry before the initiation of inhaled insulin to identify any patient
who may have compromised lung function.
Meglitinides
Example:
Repaglinide (Prandin).
MOA:
The meglitinides stimulate the release of insulin from beta cells (they p romote insulin
secretion).
Side effects include bloating, abdominal cramps, diarrhea, and flatulence.
Special Considerations:
These medications are taken with meals, are useful for patients with unpredictable meal
schedules, and for those with normal FPG, but elevated postprandial blood glucose. The
meglitinides have a rapid onset and short half-life so the risk of hypoglycemia is less
than some of the other hypoglycemic agents. If used, they're the third line and used in
combination with metformin.
Non-Insulin Injectable Hypoglycemic Agents
There are two non-insulin injectable hypoglycemic classes of drugs for the management
of Type 2 DM: GLP-1 agonists (incretin mimetics) and the Amylin analogs.
,GLP-1 agonists (Incretin mimetics):
exenatide (Byetta)
exenatide ER (Bydureon)
semaglutide (Ozempic)
liraglutide (Victoza)
dulaglutide (Trulicity)
Amylin analogs:
Pramlintide (Symlin) is an amylin mimetic and is used to enhance effectiveness of insulin
in T1DM and T2DM. It is rarely used in primary care and has a BBW for severe
hypoglycemia when used with insulin. SEs include nausea, injection site irritation.
GDM and Medication
For instance, avoiding medication is also possible for diabetics on diet and with regular
physical activity. Diabetic medical nutrition therapy and exercise counseling, dietary
modification, appropriate exercise, and glucose monitoring, in that order, are the initial
steps in GDM management. Once the diet and exercise have inadequately controlled the
glucose, then medications are recommended.
This is a time you will be consulting, comanaging, or referring to. There are two
pharmacologic drug classes that are safe in pregnancy: Parenteral insulin and the oral
antidiabetic medication, metformin (Glucophage). Evidence of growing magnitude
suggests that metformin is probably safe and effective during pregnancy and is a
category B. Some data suggest that metformin may be the optimal oral
antihyperglycemic for overweight or obese women and is not associated with fetal
hyperinsulinemia and maternal hypoglycemia.
, Special Concerns The first-generation sulfonylureas are contraindicated in pregnancy
because of the associated fetal hyperinsulinemia; these drugs readily cross the
placenta. Severe hypoglycemia lasting 4 to 10 days has been observed in infants born to
mothers receiving a sulfonylurea at the time of delivery. Generally, sulfonylureas are
avoided in pregnancy. However, if they have been used, the sulfonylureas should be
stopped at least 2 weeks before the expected date of delivery.
Insulin is the gold standard due to its long history of safety and its inability to cross the
placenta. According to ACOG, oral antidiabetic agents should only be considered if the
pregnant client refuses insulin, or if the provider feels that safety concerns with insulin
administration outweigh the benefits. If an oral agent is required, metformin, a
biguanide, is the agent of choice.
See ACOG updates on the most current management of GDM in pregnancy for further
information.
https://drive.google.com/file/d/17u2SKF1Rl0-9SBeNIMRZTy16YTubMCxQ/view?usp=sha
ring
Insulin & Lactation:
NPH and regular human insulin are considered safe with breastfeeding. Exogenous
insulin is excreted into breast milk, including newer biosynthetic insulins (e.g., aspart,
glargine glulisine, lispro). Insulin is a normal component of breastmilk. Adverse effects
There are no reported adverse reactions and newborn exposure to insulin in breast milk
may help prevent type 1 diabetes in these infants. Aspart, detemir, glargine, glulisine,
lispro: Probably safe but caution is advised for the use of the newer biosynthetic insulins
with breastfeeding due to limited studies. Be sure to keep up to date as the information
becomes available.
Functions controlled by thyroid hormones
Signs & Symptoms of Thyroid Dysfunction
Causes of Thyroid Dysfunction
- Respiration, Heart rate, CNS and PNS, Body weight, Muscle strength, Menstrual
cycles, Body temperature, Cholesterol levels
- Symptoms of hyperthyroidism
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