Pharmacotherapy - Diabetes Cont...

Injecting in the abdomen is the preferred site for insulin injection because it offers less variability and faster absorption compared to other sites such as the butt, thigh, or arm. The abdomen has a larger surface area and a higher number of blood vessels, allowing for quicker absorption of insulin into the bloodstream. Additionally, injecting insulin in the abdomen provides more consistent results as the absorption rate is less affected by factors such as exercise or body temperature.

If your blood glucose levels are out of target post-lunch/presupper, it is recommended to check the pre-lunch rapid/short insulin and/or morning NPH. These are the types of insulin that are typically taken before meals to control blood sugar levels. Checking these insulin doses can help identify if there was an issue with the dosage or timing, which may have caused the high blood glucose levels after lunch or before supper.

The correct answer is to wait 48 hours after the completion of the procedure to start taking metformin again. This is because radiographic contrast dye can cause kidney damage in patients taking metformin. Stopping metformin before the procedure helps to prevent this potential harm. However, after the procedure, the dye is cleared from the body and it is safe to resume taking metformin after a waiting period of 48 hours.

Insulin is a medication that is usually available in the form of a liquid solution. It is typically stored in a vial or an insulin pen. However, shaking the insulin vigorously can cause air bubbles to form in the solution, which can affect the accuracy of the dosage. Therefore, it is generally recommended not to shake insulin before use.

Patients generally require 1 unit of rapid acting insulin for every 15 grams of carbohydrates. This ratio helps to regulate blood sugar levels after consuming meals or snacks. By calculating the amount of carbohydrates in a meal or snack, patients can determine the appropriate dose of insulin needed to properly metabolize the carbohydrates and prevent blood sugar spikes.

Injecting NPH (Neutral Protamine Hagedorn) insulin at bedtime (HS) rather than at dinner helps decrease the probability of the somogyi effect. The somogyi effect is a rebound phenomenon where low blood sugar levels during the night trigger the release of counter-regulatory hormones, leading to high blood sugar levels in the morning. By injecting NPH at bedtime, the insulin is at its peak action during the early morning hours, preventing the drop in blood sugar levels and subsequent rebound hyperglycemia. Injecting NPH at dinner would not provide adequate coverage during the critical overnight period.

If your blood glucose levels are out of target in the early morning, you should check your Evening NPH or long-acting insulin. This is because NPH or long-acting insulin is typically taken in the evening to provide a basal level of insulin throughout the night. If the blood glucose levels are not in target in the morning, it could mean that the evening dose of NPH or long-acting insulin needs adjustment. Checking and potentially adjusting the evening insulin dose can help to regulate blood glucose levels in the early morning.

Rotating sites prevents lipohypertrophy, which is the abnormal accumulation of fat in certain areas of the body. By regularly changing injection sites, the risk of developing lipohypertrophy is reduced. Lipohypertrophy can interfere with insulin absorption and lead to inconsistent blood sugar levels. Therefore, rotating sites is an important practice for individuals who require regular insulin injections to manage their diabetes.

Glipizide is the better sulfonylurea to use if a patient has renal impairment. This is because glipizide has a shorter half-life and is predominantly metabolized by the liver, rather than the kidneys. Therefore, it is less likely to accumulate in the body and cause hypoglycemia in patients with impaired renal function.

Basal insulin should equal 1/2 - 2/3 of your total daily dose. This means that approximately half to two-thirds of the total daily dose of insulin should be the basal insulin. Basal insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night, mimicking the body's natural insulin production. The remaining portion of the total daily dose is typically made up of bolus or mealtime insulin, which is taken before meals to cover the rise in blood sugar after eating.

Type 2 diabetics usually need more exogenous insulin because their bodies either do not produce enough insulin or do not use it effectively. Exogenous insulin is insulin that is taken externally, either through injections or an insulin pump, to help regulate blood sugar levels. Since type 2 diabetics have insulin resistance or insufficient insulin production, they often require additional insulin to effectively manage their blood sugar levels.

A glinide and Actos would be the safest drugs to use in renal dysfunction because they have a lower risk of causing further damage to the kidneys compared to other options.

Dividing dosing with meals and gradually increasing the dose can help reduce gastrointestinal (GI) upset with metformin by allowing the body to adjust to the medication slowly. Not exceeding 2000mg/day is also important as higher doses may increase the likelihood of GI side effects. Switching to Metformin XR (extended-release) can be beneficial as it releases the medication slowly over time, reducing the concentration of the drug in the stomach and potentially minimizing GI upset.

If your blood glucose levels are out of target at midafternoon, you should check your morning NPH and long-acting insulin. This is because morning NPH and long-acting insulin are typically taken in the morning and can have an effect on blood glucose levels throughout the day. By checking these insulin doses, you can assess if they were taken correctly or if any adjustments need to be made to better manage your blood glucose levels in the afternoon.

Meglitinides have a very rapid onset and should be taken immediately before a meal because they stimulate insulin release from the pancreas in response to glucose levels. They are glucose dependent, meaning they only work when there is glucose present in the blood. If a meal is skipped, it is not recommended to take the medication as it may cause hypoglycemia. Meglitinides possibly have less hypoglycemia than sulfonylureas, which are another class of medications that stimulate insulin release.

Alpha glucosidase inhibitors work by inhibiting the enzymes that break down carbohydrates in the gut, thereby reducing the absorption of glucose from the intestines. This blunting effect on carbohydrates in the gut helps to control blood sugar levels in individuals with diabetes. However, this mechanism can also lead to side effects such as flatulence and bloating. Unlike some other diabetes medications, alpha glucosidase inhibitors do not typically cause hypoglycemia (low blood sugar) when used as monotherapy. In the event of hypoglycemia, glucose or lactose should be used to treat it.

DPP-IV inhibitors are a class of medications used to treat type 2 diabetes by increasing insulin production and reducing glucose levels. Unlike other diabetes medications, DPP-IV inhibitors do not have any specific contraindications (CIs) listed. This means that they can generally be used in patients with various medical conditions, including renal or hepatic impairment. However, it is important to note that individual patient factors and medical history should still be taken into consideration before prescribing DPP-IV inhibitors.

Sulfonylureas are a class of medications used to treat diabetes. They increase beta cell insulin secretion, which helps to lower blood sugar levels. However, this can also lead to hypoglycemia, a condition characterized by low blood sugar levels. Chlorpropramide, a specific sulfonylurea, can cause syndrome of inappropriate antidiuretic hormone secretion (SIADH) and a disulfiram-like reaction. Sulfonylureas can be toxic to beta cells if blood glucose levels are over 300 mg/dL. They are believed to work better in patients who have had diabetes for less than 5 years. Sulfonylureas can accumulate in patients with renal impairment. Additionally, approximately 50% of patients continue to respond adequately to a sulfonylurea after 10 years of use.

Metformin is an oral medication commonly used to treat type 2 diabetes. It works by decreasing the production of glucose in the liver and increasing the uptake and utilization of glucose in peripheral tissues. Therefore, the statements "It decreases hepatic glucose production" and "It increases peripheral glucose uptake and utilization" are true. Metformin should be used with caution in patients with heart failure, so the statement "It should be avoided in patients with heart failure" is also true. Additionally, metformin can cause gastrointestinal (GI) side effects in some patients, with approximately one third of patients experiencing GI complaints. The statement "One third of patients have GI complaints" is true. Metformin XR (extended-release) tablets can sometimes appear as a "ghost tablet" in the stool, which means the outer shell of the tablet may be visible but the medication has been released. Therefore, the statement "Metformin XR can be a ghost tablet" is also true.

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