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Chapter 41: Pancreatic Hormones, Antidiabetic Agents, & Glucagon

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A 13-year-old boy with type 1 diabetes is brought to the hospital complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15.

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Which of the following agents should be administered to achieve rapid control of the severe ketoacidosis in this diabetic boy?

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(A) Crystalline zinc insulin

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(B) Glyburide

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(C) Insulin glargine

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(D) NPH insulin

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(E) Tolbutamide

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Oral antidiabetic agents (listed in Table 41–1) are inappropriate in this patient because he has insulin-dependent diabetes. He needs a rapid-acting insulin preparation that can be given intravenously (see Figure 41–1). The answer is A.

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FIGURE 41–1 Extent and duration of action of various types of insulin as indicated by the glucose infusion rates (mg/kg/min) required to maintain a constant glucose concentration. The durations of action shown are typical of an average dose of 0.2–0.3 U/kg; the duration of regular and NPH insulin increases considerably when dosage is increased. (Reproduced, with permission, from Katzung BG, editor: Basic & Clinical Pharmacology, 12th ed. McGraw-Hill, 2012: Fig. 41–5.)

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TABLE 41–1: Duration of action of representative oral antidiabetic drugs.
Drug Duration of Action (hours)
Secretagogues
 Chlorpropamide Up to 60
 Tolbutamide 6–12
 Glimepiride 12–24
 Glipizide 10–24
 Glyburide 10–24
 Repaglinide 4–5
 Nateglinide 4
Biguanides
 Metformin 10–12
Thiazolidinediones
 Pioglitazone 15–24
 Rosiglitazone >24
Alpha-glucosidase inhibitors
 Acarbose 3–4
 Miglitol 3–4
Incretin modifiers
 Sitagliptin 8–14
SGLT2 inhibitors
 Canagliflozin 10–14

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A 13-year-old boy with type 1 diabetes is brought to the hospital complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15.

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Which of the following is the most likely complication of insulin therapy in this patient?

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(A) Dilutional hyponatremia

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(B) Hypoglycemia

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(C) Increased bleeding tendency

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(D) Pancreatitis

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(E) Severe hypertension

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Because of the risk of brain damage, the most important complication of insulin therapy is hypoglycemia. The other choices are not common effects of insulin. The answer is B.

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A 24-year-old woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following regimens is most appropriate?

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(A) Morning injections of mixed insulin lispro and insulin aspart

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