Diabetes/Endocrine (Insulin)

Question 1

Regular Insulin (action profile)

Answer 1

• Type: Short Acting
• Onset of Action: 30-60 min
• Peak: 1-5 hours
• Duration: 6-10 hours
• Bolus insulin (give it before a meal)
• Regular is cheap!

Question 2

Lispro/Humalog (action profile)

Answer 2

• Type: Rapid acting
• Onset of action: 15-30 minutes
• Peak: 0.5-2.5 hours
• Duration: 3-6 hours

Question 3

Aspart/Novolog (action profile)

Answer 3

• Type: Rapid acting
• Onset of action: 10-20 minutes
• Peak: 1-3 hours
• Duration: 3-5 hours

Question 4

NPH (action profile)

Answer 4

• Type: Intermediate Acting
• Onset: 1-2 hour
• Peak: 6-14 hours
• Duration: 16-24 hours
• Before breakfast and before supper
• 2nd cheapest

Question 5

70% NPH/30% Reg (novolog) (action profile)

Answer 5

• Type: Pre-mixed combo
• Onset: 10-20 minutes
• Peak (2 peaks): 1.5-16 hours & 1-4 hours
• Duration: 10-16 hours
• % vary
• 2 peaks
• Morning and afternoon peaks

Question 6

Levimir (Determir) (action profile)

Answer 6

• Type: Long-acting
• Onset: 2 hours (Clear)
• Peak: Peakless
• Duration: 24
• keep blood sugar in a nice and steady state
• Basal insulins (long acting)
• Usually have to only take 1 injection in the evening

Question 7

Lantus (Glargine) (action profile)

Answer 7

• Type: Long Acting
• Onset: 2-4 hours (clear)
• Peak: Peakless
• Duration: 20-24 hours

Question 8

Humalog (Lispro)

Answer 8

• Give subQ only 5-15 minutes before a meal
• Very quick acting but action lasts for only 5 hours
• Good for those who eat IRREGULARLY
• Does not provide basal insulin needs (use NPH, Lantus, or other long-acting insulin
• Can be mixed with NPH
• DO NOT MIX WITH LANTUS
• Monitor BG levels, hypoglycemia, allergic reaction

Question 9

Apidra (glulisine)

*not too important: go over briefly

Answer 9

Rapid Acting Insulin Analog

Can be used in insulin pump, syringes, pens

Mix only with NPH, drawing Apidra up 1st

Must be used with a basal insulin

Give premeal or within about 20 minutes postmeal

Question 10

Human Insulin Glargine (Lantus)

Answer 10

• Produced by recombinant DNA using E coli
• Differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-Chain
• Give SC only, NEVER IV.
• Peakless insulin, lasting 24 hours
• DO NOT MIX WITH OTHER INSULINS OR DILUTE WITH OTHER SOLUTIONS
• Keep Refrigerated

Question 11

Lantus Cont.

Answer 11

• Given at bedtime once per day; can be given twice per day**
• Monitor for hypoglycemia, allergic reactions, injection site reactions, lipodystrophy
• When switching from bid NPH, reduce dose by 20%
• Lantus is a CLEAR solution unlike other long-acting insulins
• Pregnancy studies in humans not done
• Not known if excreted in breast milk

Question 12

Detemir (Levemir)

Answer 12

• Approved by FDA June 17, 2005; Similar to Lantus;
• Has less hypoglycemia and weight gain than Lantus
• Long Acting insulin given -once or twice a day, Peakless
• Clear Insulin; do not mix with other insulins; do not put in insulin pumps

Question 13

Humalog mix 75/25

Answer 13

• 75% lispro protamine
• 25% lispro (rapid)
• Peak effect at two hours
• Duration: 12 hours
• Manufactured by altering E-coli
• Give SC only
• Give 15 minutes before meal
• Do not mix with any other insulin
• Side effects: hypoglycemia, hypokalemia, lipodystrophy and sensitivity

Question 14

Intermediate Acting FIXED Mixed Insulin

Answer 14

• nonanalogs
• 70/30: 70% NPH, 30% Regular

*Analogs
75/25
50/50

Question 15

Client education:

Answer 15

• Make sure you are using the correct U100 syringe that matches the type of insulin
• Disposal of needles: State law requires that syringes and lancets be disposed of as a single unit in a hard container without recapping or breaking the needle
• Store syringes at room temperature
• Reuse of syringes and needles should be discouraged

Question 16

Insulin Infusion Pumps

Answer 16

• Delivers continuous 24 hour regular insulin SQ
• The basal dose is meant to cover blood glucose levels between meals and overnight
• Bolus doses are programmable
• Bolus doses are based on 4-12x/day measurement of glucose

Question 17

Addition of sliding scale _ per day allows for maximum control of BG

Answer 17

4x

Question 18

Many type 2’s are on both _____ and ____ hypoglycemic agents

Answer 18

Insulin and oral

Question 19

HYPOGLYCEMIA

LESS THAN 52 mg/dl

Answer 19

s/s vary: hunger, nervousness, anxiety, sweating, confusion, drowsiness, coma

• more common in Type 1
• Always carry a quick-acting glucose source such as hard candy or glucose tablets
• Unconscious at home: Teach a family member to give glucagon SQ or IM; call 911

Question 20

__g glucose source should be given to those experiencing hypoglycemia

Answer 20

15 g glucose source

Question 21

Hypoglycemia Cont.

Answer 21

• Usual causes: Eating too little for the amount of insulin received; too much exercise and too little food; medications, sulfonylureas
• Quick onset; if food doesn’t relieve symptoms then unconsciousness will follow
• BS<18 and brain damage is likely
• Hospitalized pt., get capillary BS and then give 10-15 grams of glucose e.g. orange juice

Question 22

Hypoglycemia Cont…

Answer 22

• If person unconscious, treat as if hypoglycemic and not hyperglycemic, if unknown
• Unconscious: Give 50 cc. 50% IV Dextrose (Glucose) per push, give slowly *
• Symptoms are usually the same each time
• Behavioral changes will occur in children
• Hypoglycemia unawareness (loss of autonomic nerve activity)- caused by diabetes complications or beta blockers

Question 23

Insulin Sensitivity: How much of a blood glucose drop is achieved with one unit of insulin?

Answer 23

• usually 10-50 points
• TDD (total daily dose):
• Type 1 (new onset): 0.6-0.7 Units/kg/day
• TDD Type 2 new onset (FBS 140-220): 0.3-0.4 units/kg/day
• (FBS>220): 0.5-1.2 units/kg/day

Question 24

Changing Insulin Dosage

Answer 24

• Correct lows first
• Second, get FBG normal (about 90-100); adjusting basal dosing q4 days in 1-4 unit increments
• Third, use bolus dosing (humalog, novolog, or regular) premeal to obtain normal post prandials (<140)
• Make adjustments in rapid acting in 1-2 unit increments, every 2-4 day

Question 25

Therapeutic goals

Answer 25

Look at chart on slide 71** ADA GOALS

Question 26

Rotation sites include:

Answer 26

Abdomen, upper arm, anterior and medial thighs, upper hips Absorbed fastest in abdomen* In hospitals, it is best to use arms due to lack of use at home*

Question 27

Use about _ sites in each area then move to next area to prevent __________

Answer 27

8 sites prevent lipohypertrophy *cool insulin may cause lipohypertrophy; recommend room temperature