Diabetes 2 Flashcards
What function does insulin serve
inhibit hepatic glucose production
stimulates glucose storage
facilitates glucose transport into cells
what are the 3 rapid acting insulins
Lispro (humalog)
aspart (novalog)
glulisine (apadria)
what are the short acting insulins
novolin
humulin
what is an intermediate acting insulin
NPH
what are the long acting insulins
glargine (lantus)
dentimir (levamir)
what is so special about glargine compared to other insulin
last for 24 hours
what is the function of insulin analogs
targets post prandial glucoses
what is the purpose of basal insulin
provide peakless and prolonged insulin coverage
what are the PRO’s of rapid acting insulin
better post prandial glucose control
lower freq of hypoglycemia in type 1
convient can inject before or after meal
what are the CON’s of rapid insulin
Expensive
can not be give PRIOR TO HIGH FAT MEAN BECAUSE OF RISK OF HYPOGLYCEMIA
what are the PRO’s of short acting insulin
no prescription needed
Fairly inexpensive
only insulin that can be used IV
provides some basal coverage
what are the CONs of short acting insulin
absorbed TOO SLOWLY to match rate of glucose after meal
Post prandial hyperglycemia
Needs to be used 30-45 min prior to mean
relatively long duration late post meal hypoglycemia
What are important things to know about NPH
dosed twice daily
peak thus can cause hypoglycemia
can be mixed
what is important to know about glargine
dosed once
may not always provide 24 hour glucose coverage
no peaks less hypoglycemia
CAN NOT BE MIXED
what is important to know about detemir?
duration is a little longer than NPH
May require 2x day dosing
smaller peak than NPH
less variability compared to NPH
What are the considerations to using insulin with diabetics
patients with A1C>8%
Type II may require higher doses of insulin that Type 1
Who do you have to be more careful with increasing 1 unit of insulin with
Type 1 because it may have more drastic result and cause hypoglycemia
how is dosing determined for insulin
50% of daily dose is provided as basal (glargine)
50% daily as bolus insulin which gets divided into 3 for Bfast,lunch,dinner
can be given before or after meals
NO MEAL NO BOLUS
when would you consider dosing adjustments
correct dosing diet changes exercise and activity wight loss/gain hypoglycemia or hyperglycemia med changes
how much does 1 unit of insulin drop the blood glucose by
30-60mg/dl
what is the carbohydrate rule
500 rule
500/total daily dose=xgrams of carbs covered by 1unit of insulin
what is the rule for post meal adjustment
1500
1500/total daily dose=Xgrams of glucose that will be lowered by 1 unit of insulin
how do we choose insulin regimen
patient willingness
patient adaptability
lifestyle
glycemic patterns
what is the somogyi effect
early moring glucose followed by rebound hyperglycemia
treat by reducing insulin
