Diabetes and Insulin

Question 1

Rapid acting insulin types

Answer 1

Lispro (Humalog) 
Aspart (NovoLog)
Onset: 5-15 minutes
Time of adverse reaction: midmorning
eat within 5-15 minutes

Question 2

Short acting insulin types

Answer 2

Regular (Humulin R, Novolin R, Iletin II Regular)
Onset: 30-60 minutes
time of adverse reaction: midmorning

Question 3

Intermediate acting insulin types

Answer 3

Isophane (NPH)
Onset: 2-4 hours
time of adverse reaction: early evening
can be given after meals

Question 4

Very long acting insulin types

Answer 4

Glargine (Lantus)
onset: 1 hr - no peak
Given at bedtime - cannot be given with other insulins

Question 5

Only insulin that can be given IV

Answer 5

Regular (Humulin R…)

Question 6

List of Oral Hypoglycemic Agents

Answer 6

Sulfonylureas:
-Glimepiride (Amaryl)
-Glipizide (Glucotrol)
-Glyburide (Micronase)
Biguanides:
-Metformin (Glucophage)
Alpha glucosidease inhibitors:
-Acarbose (Precose)
-Miglitol (Gluset)
Thiazolidinediones:
-Rosiglitazone (Avandia)
-Pioglitazone (Actos)
Meglitinides
-Repaglinide (Prandin)
Gliptins:
-Sitagliptin (Januvia)
Incretin mimetics 
-Exanatide (Byetta)

Question 7

Sulfonylureas:
-Glimepiride (Amaryl)
-Glipizide (Glucotrol)
-Glyburide (Micronase)
S/E and Nursing considerations

Answer 7

GI symptoms and dermatologic reactions
stimulates release of insulin from pancrease
Take with food if GI upset occurs

Question 8

Biguanides:
-Metformin (Glucophage)
SE and NC

Answer 8

N/D, abdominal discomfort
decreases glucose production by liver
Do not give if renal impairment exists
potential problem: lactic acidosis
Avoid alcohol (liver)
Do not give with alpha glucosidase inhibitors

Question 9

Alpha glucosidease inhibitors:

• Acarbose (Precose)
• Miglitol (Gluset)

Answer 9

Abdominal discomfort, diarrhea, flatulence
delays digestion of carbs
take immediately before meal

Question 10

Thiazolidinediones:

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

Answer 10

Infection, headache, rare liver failure
Decreases insulin resistance and inhibits gluconeogenesis
regular liver function tests

Question 11

Risk factors for type 2 diabetes

Answer 11

Parents or siblings with diabetes
Obesity (20% over ideal body weight)
African American, hispanic, native american, asian american
> 45 years
Previously impaired fasting glucose
HTN
HDL 250
Hx of gestational diabetes or delivery of baby > 9lbs

Question 12

Normal fasting blood glucose

Answer 12

60-110 mg/dL

Question 13

Significance of urine ketones

Answer 13

deteriorated diabetic control. body has started to use stored fat for energy

Question 14

Mixing insulins - which to draw up first

Answer 14

Draw up regular insulin first

Question 15

Hyperglycemia - blood sugar range

Answer 15

300-800 mg/dL

Question 16

Kussmaul’s respirations

Answer 16

Rapid and deep associated with hyperglycemia

Question 17

Hyperglycemia Hyperosmolar Nonketotic Syndrome

Answer 17

glucose levels > 800 mg/dL
Occurs in adults > 50 - type 2 diabetics
Ketosis and acidosis do not occur
Hypotension
Dry mucous membranes, poor skin turgor, tachycardia
alteration in sense of awareness, seizures, hemiparesis
Implementation:
NS or 0.45%
Regular insulin
Potassium when urine output is okay
Caused by acute illness, medications (thiazides) or dialysis