Class 11 Deck 1 Flashcards
What are the rapid acting insulins?
- Lispro (humalog)
- Aspart (Novolog)
- Glulisine (apidra)
What are the Short acting insulins?
-Regular (Humulin R / Novolin R)
What are the Intermediate acting insulins?
-NPH (Humulin N / Novolin N)
What are the long acting insulins?
-Glargine (Lantus)
Detemer (Levimir)
Alpha stimulation does what to insulin secretion?
-Decrease secretion
Beta / Parasympathetic stimulation does what to insulin secretion?
-Increase secretion
Insulin response to glucose is_______ for oral ingestion than for I.V. infusion.
Greater
What is the onset, peak, DOA, and critical hypoglycemia time for Lispro (humalog)
- 15 minutes
- 30-90 minutes
- 3-5 hours
- 1/2 to 1 & 1/2 hours
How does Lispro compare to regular insulin in pump administration?
- Better glyccemic control
- Less hypoglycemia
Which insulin is clear, has a neutral PH and contains a small amount of zinc?
-Regular (Humulin R, Novolin R)
Regular insulin does what when SQ injected?
-It forms hexamers, that must dissociate into monomers before it can be absorbed
What is the onset, peak and DOA of regular insulin?
- Onset = 30-60 min
- Peak = 2-4 hours
- Duration 5-8 hours
How is regular insulin dosed perioperatively?
- 1-5 units IV
- 0.5-2 units /hr infusion (50 in 50)
Describe intermediate insulin.
- Humulin N and Novolin N
- Turbid solution w/ neutral PH
- Contain protamine which delays absorption
Can Humulin N or Novolin N be given IV?
No, SQ only
What is the onset, peak and duration of intermediate insulins?
- Onset = 1-3 hrs
- Peak = 8 hours
- Duration = 12-16 hours
What insulin is used as a basal insulin replacement?
-Long acting (Lantus, levemir)
Can long acting insulins be given IV, mixed with other insulins?
No and No
What is the PH of Long acting?
Acidic
What is the onset, peak and duration of long acting?
- Onset = 1hr
- no peak
- 20-26 hours
When is long acting administered and what might is cause?
- H.S
- nocturnal hypoglycemia
What drug is a useful baseline for diabetics, and what drugs are they usually used with?
- Long acting
- Short acting or orals
How are the all the insulins types dosed?
- Rapid/short = AC and HS
- Intermediate = BID
- Long = Daily
What is the most serious side effect of insulin? and what is it related to?
- Hypoglycemia
- Compensatory effects of increased epinepherine
What are the symptoms of hypoglycemia?
- Diaphoresis
- Tachy
- HTN
- Mental confusion → Seizures → Coma
What may mask the the correct diagnosis of hypoglycemia?
-Rebound hyperglycemia from SNS activity in response to hypoglycemia
What are the allergic reactions associated with insulin?
-Redness at site if injection
Chronic ______ administration may lead to the development of antibodies to protamine
NPH
What is lipodystrophy? and how do you avoid it?
- Atrophy of fat at injection site
- rotating injection sites
Define insulin resistance.
-Patients requiring more than 100 units per day
acute can be caused by trauma, surgery, infection
How are hypoglycemic effects of insulin countered?
- ACTH or Glucocorticoids
- Estrogen
- Glucagon
How does epinepherine effect insulin?
- Inhibits insulin secretion
- Stimulates glyconeogensis
What is the normal Hgb A1c? What is the ADA reccomendation?
- 4-6%
- 7-8.5%
What insulins can be given IV?
-Regular or Short acting
How should multiple SQ insulin be given?
- 70% of total dose as intermediate or long acting at bedtime
- Additional doses of rapid before meals/snacks
What are the goals of insulin therapy?
- Maintain BG levels as close to normal as possibe
- Delay long term complications of DM
What are the risks of periop hyperglycemia?
- Microangiopathy
- Impaired leukocyte
- Cerebral edema
- Impaired wound healing
- Post op sepsis
What is desired more periop, High or low BG? and whay?
-High, because GA can mask hypoglycemia signs
What is the optimal BG levels intraop?
- 80-180
- <80
How to dose patients preop with SQ insulin ( needing non-tight control)
-1/4 to 1/2 the AM dose of intermediate or long the morning of surgery (or decrease long acting PM)
What is Dr. Shulkosky’s insulin control dose?
- 1 unit regular for every 50-60 mg/dl of glucose
What is the goal for larger/longer procedures? and why?
- BG 80-120
- Improve healing, prevents infection, improves outcomes after CNS ischemia
how to treat hypoglycemia?
-15-25ml of D50 and stop infusion
Larger/longer procedures may require insulin drip, how much and when do you start?
- 0.05units/kg/hr (0.5-1unit/hr)
- Start at BG of 150
How to treat patients w/ insulin pumps?
- Maintain basal rate
- Turn off preprandial boluses
- Measure q1 hour
- Know typical bolus to decrease 50mg/dl
