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Chapter 41: Pancreatic Hormones, Antidiabetic Agents, & Glucagon

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.

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

(A) Crystalline zinc insulin

(B) Glyburide

(C) Insulin glargine

(D) NPH insulin

(E) Tolbutamide

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

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.

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

(A) Dilutional hyponatremia

(B) Hypoglycemia

(C) Increased bleeding tendency

(D) Pancreatitis

(E) Severe hypertension

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.

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?

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

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