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Pharmacology Test #3 > Diabetes Day 2: Insulin > Flashcards

Diabetes Day 2: Insulin Flashcards

1
Q

What does insulin do?

A

Regulator of glucose metabolism

Inhibits hepatic glucose produciton

Facilitates glucose transport into cells (fat, muscles, liver)

Stimulates glucose storage

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2
Q

Where/When is insulin secreted?

A

Released from beta cells in response to elevated blood glucose

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3
Q

Describe the pattern that insulin normally has throughout the day?

A

Has baseline amount and will spike during meals

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4
Q

What are the types of insulin available?

A

Rapid Acting

Short Acting

Intermediate Acting

Long Acting

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5
Q

What are the 3 common rapid acting insulins?

A

Lispro = humalog

Aspart = novolog

Glulisine = apidra

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6
Q

How long before the rapid acting insulins begin to work?

A

5 - 15 minutes

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7
Q

What is the peak (when it is working the hardest) of the rapid acting insulins?

A

1 - 2 hours

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8
Q

When does the rapid acting insulins stop working?

A

3 – 4 hours

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9
Q

What are the common short acting insulins?

A

“Regular”

Novolin aka NovolinR

Humulin aka HumulinR

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10
Q

How long until the shorting acting insulins begin to work?

A

30 - 45 minutes

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11
Q

When do short acting insulins peak (work the hardest)?

A

2 - 3 hours

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12
Q

When do short acting insulins stop working?

A

4 - 8 hours

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13
Q

What is another name for intermediate acting insulin?

A

NPH

HumulinN, NovolinN

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14
Q

When do intermediate acting insulin (NPH) begin to work?

A

120 - 240 minutes

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15
Q

When do intermediate acting insulin (NPH) peak (work the hardest)?

A

4 - 8 hours

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16
Q

When do intermediate acting insulin (NPH) stop working?

A

10 - 16 hours

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17
Q

What are the names of the long acting insulin?

A

Glargine aka lantus (most common)

Dentimir aka levamir

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18
Q

When do the long acting insulins start to work?

A

120 minutes

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19
Q

When do long acting insulins peak (work the hardest)?

A

Same all day

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20
Q

When do long acting insulins stop working?

A

Lantus = 24 hours

Levamir = 18 - 24 hours

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21
Q

What are they talking about when they are talking about bolus insulin?

A

Rapid/fast acting

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22
Q

What are they talking about when they are talking about basal insulin?

A

Intermediate or long acting insulin

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23
Q

What are the goals for insulin analogs?

A

Targets post-prandial glucoses

**after pt eats; brings down glucose

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24
Q

What are the goals for basal insulin?

A

Provide peak less and prolonged insulin action

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25
Q

Which pt populations would rapid acting insulin be good for?

A

Elderly

Kids

**dosing is a little more flexible

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26
Q

What are the pros for rapid acting insulin?

A

Better post-prandial glucose control

Lower frequency of hypoglycemia and severe hypoglycemia in type 1 diabetes

Convenient:
inject right before meal
inject after meal

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27
Q

What are the cons of rapid acting insulin?

A

Expensive

If given before high-fat meal will have increased risk of early post-meal hypoglycemia

Short duration may provide gaps in insulin supply between meals

28
Q

What are the pros of short acting insulin?

A

No Rx needed

Fairly inexpensive

Only insulin that can be used IV

Provides some basal activity (need to be taken into account if switch to rapid-acting insulin)

29
Q

What are the cons of short acting insulin?

A

Absorbed to slowly to match rate of glucose after meals –> postprandial hyperglycemia; want to inject 30 - 45 minutes prior to meal;

Relatively prolonged duration of action –> late post-meal hypoglycemia

30
Q

What should we know about NPH?

A

Dose twice daily

Peaks –> hypoglycemia

Some pt variability

Can be mixed w/ other insulins (decrease # injections they have to give themselves)

31
Q

What should we know about glargine (lantis)?

A

Normally dosed once daily

May not always provide 24 hr coverage –> rising blood glucose in the evening (may have to dose twice/day)

No peak –> less hypoglycemia compared to NPH

Equal or less pt variability compared to NPH

Can’t be mixed w/ other insulins

No apparent overlap or accumulation

32
Q

What should we know about detemir?

A

Duration of action similar/little longer than NPH but shorter than glargine –> may require 2/day dosing

Possibly smaller peak compared to NPH

Less pt variability compared to NPH

33
Q

What are combination insulins?

A

Short/long acting insulins that come together in same vial

**decrease # of injections

34
Q

When would you want a pt to use a combination insulin?

A

Reserved for noncompliants

BUT they still need to dose themselves regularly

35
Q

What are the combination insulins?

A

Background/mealtime:

75/25 (lispo protamine/lispro)

70/30 (aspart protamine/aspart)

70/30 or 50/50 (NPH/regular)

36
Q

When treating pts w/ insulin, who should be considered to use insulin?

A

Consider in pts w/ Type I DM A1c > 8%

Consider in pts w/ Type II DM if A1c of > 9 % (will have to give higher dose b/c of insulin resistance)

37
Q

For a start up dose of insulin, how much should pts be taking?

A

.1 units/kg/day - .5 units/kg/day

**she said to use .5 units/kg/day for tests

38
Q

After you figure out their daily dose of insulin, how is that divided?

A

50% as basal insulin (i.e. glargine) (if brand new to insulin, decrease daily dose by 20%)

50% as bolus insulin (i.e. lispro, aspart, glulisine) (divided among meals)

39
Q

If a insulin dependent diabetic misses a meal, should they still give their bolus insulin dose?

A

No!

40
Q

What are the questions you should be asking when figuring out if the insulin dose should be adjusted?

A

Dosing correctly (amount, technique)

Diet changes

Exercise, activity

Weight gain/loss

Illness/stress

Symptoms of hypoglycemia or hyperglycemia

Changes in meds

41
Q

How much does 1 unit of insulin drop glucose by?

A

30 - 60 mg/dL

42
Q

What is the 500 rule (carbohydrate based adjustment)?

A

500/total daily dose= XYZ grams carbohydrate covered by 1 unit of insulin (rapid acting)

**1 unit of insulin will cover XYG grams of carbs

43
Q

What is the 1500 or 1800 rule (post-meal adjustment)?

A

1500/total daily dose= XYZ mg/dL of glucose that will be lowered by 1 unit of insulin

**1 unit of insulin will lower the glucose level XYZ mg/dL

44
Q

After you calculate the 1500 or 1800 rule, what should you do?

A

Add needed amount of insulin to the prescribed amount when BG elevated before meals

45
Q

Do all type II diabetics need insulin?

A

Yes @ some point all type II diabetics will need insulin

46
Q

What factors need to be considered when choosing an initial insulin regimen for type II diabetics?

A

Patient willingness

Patient adaptability

Lifestyle (what do they do for work, when do they work, etc)

Glycemic patterns

47
Q

What is the somogyi effect?

A

Early morning low blood glucose followed by rebound hyperglycemia

**may not have eaten dinner or snack before bed and still gave themselves insulin

48
Q

How do you treat somogyi effect?

A

Reduce dose of insulin

Eat snack/don’t skip meals

49
Q

What is the dawn phenomenon?

A

Relative resistance to insulin in early morning (d/t excessive action of counter-regulatory hormones)

50
Q

What is the treatment of the dawn phenomenon?

A

Insulin dose adjustment

51
Q

What do patients have to do to figure out if they’re suffering from the somogyi effect or the dawn phenomenon?

A

Have patient check blood glucose in early morning (2 or 3 am)

52
Q

What should insulin dependent diabetics do on sick days?

A

Continue to take normal daily meds/insulin (may have to take more than normal)

Check glucose levels more often than normal

Stay hydrated

53
Q

What is the #1 side effect of insulin use?

A

Hypoglycemia

54
Q

What are the daytime signs/symptoms of hypoglycemia?

A

Sweating

Tachycardia

Palpitations

Tremors

Headache

Confusion

Visual disturbances

Irritability

Personality changes

Seizures

Unconsciousness

55
Q

What are the nighttime signs/symptoms of hypoglycemia?

A

Nightmares

Night Sweats

Morning Headaches

56
Q

What is the treatment of hypoglycemia?

A

Rule of 15

Glucose gel

Orange juice

Glucagon pen (if unconscious)

57
Q

What is the rule of 15?

A

Glucose tablets (they’re 4 g each) want to take 15 g (so take 4 tablets) –> raise blood glucose 15 points in 15 minutes

58
Q

What are the side effects of insulin?

A

Weight gain

Injection site reactions –> fat deposits under skin surface (reduce insulin absorption; prevent by rotating injection sites)

59
Q

How do you store unopened vials?

A

Refrigerator

60
Q

How do you store opened vials?

A

Room temp for up to 28 days

61
Q

How do you store pre-mixed syringes (NPH mixtures)?

A

Refrigerator for up to 21 days

62
Q

What should you do with your insulin while you travel?

A

Keep it with you!

63
Q

Can you mix insulin?

A

Yes except glargine

mix in 1 syringe and inject together

64
Q

Which insulin should be drawn up first?

A

Clear before cloudy

regular BEFORE NPH

rapid acting BEFORE NPH

65
Q

What are the formulations of insulin?

A

Vial and syringe

Premixed pens

Insulin pumps

Pharmacology Test #3 (6 decks)

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