Diabetes Flashcards
From where is insulin secreted and stored?
B islet cells of pancreas
What are the 2 ways to make insulin?
- enzymatic modification to porcine insulin
- recombinant technology with E. Coli
Less allergic reactions with which type of insulin?
Recombinant
Insulin activates ____ and ___, converts glucose to ____, and enhances ___ and ____ entry into cells
glucokinase and glucose phosphatase
glycogen
AA and potassium
When insulin is administered, what happens to serum K levels?
decrease
how much insulin per day?
1 unit / kg / day
Name 6 drugs that cause hyperglycemia
- Glucagon
- Oral contraceptives
- Epinephrine
- Steroids
- Thyroid hormones
- Diuretics
What time of molecule is insulin? Why is this significant?
peptide (protein) so denatures upon PO administration
human insulin is ____ rapidly absorbed compared to animal sources
more
Human insulin is ____ immunogenic compared to animal sources
less
What is the immediate insulin? 3 types, significance, onset, best usage, benefit?
Lispro, aspart, glulisine
immediately decreases blood sugar
closely resembles normal insulin
replaced “regular” insulin
15 minute onset, lasts 4 hours
Good for pump (not injection, you’d be injecting all the time!)
Flexibility in eating, can give right before meal
What is the short insulin?
Regular insulin
Takes ~2 hours to work, last 8
What is the intermediate insulin?
NPH insuin
lasts 12 hours
inject at 7am, covers lunch and dinner
does not cover breakfast, slow on slow off
What is the long insulin?
Glargina, Detemir
Injected once, lasts 24 hours.
Hard to get dose right, patient must be very stable
What is standard insulin amount in a mL?
100 units (VERY CONCENTRATED)
Describe the intensive prescribing approach
multiple daily injections of SHORT (lisper, apart, glulisine) acting agents with a long acting at bedtime
Describe the conventional prescribing approach
two injections of biphasic (70/30 ) with short acting agents PRN.
Usually give 75% of the units in AM, 25% of the units in PM.
If patient requires 40 units of insulin per day, and want to give 75% am 25% pm, calculate units for each dose
75% in AM = 30 units
25% in PM = 10 units
.7(30) = 21u NPH or detemir .3(10) = 3u regular or lispro
Describe the all day prescribing approach
single long acting (glargine or determir) injection covered by lispro
DM 30 require __
insulin (almost always)
1/3 diet, 1/3 insulin, 1/3 PO agents
T OR F
Two long acting insulins should be mixed
FALSE
T OR F
Shorter acting agents may be mixed in one syringe and used immediately
True
T OR F
Only non-suspended insulin products should be administered by IV gtt
WHY?
TRUE
long acting agents are suspensions, which will separate and precipitate
How many days can you keep insulin out of the refrigerator?
30 days
