Diabetes Insulin Flashcards
what is the ONLY hormone known to have a direct effect in lowering blood glucose levels?
Insulin
Is insulin anabolic or catabolic? why do i care?
• Anabolic hormone –> conservative, constructive, builds up energy stores like gylcogen, promotes cell growth/division
what are the 3 actions of insulin?
- Glucose uptake by cells and glucose storage as glycogen in liver
- Prevent fat and glycogen breakdown and inhibits gluconeogenesis
- Increase protein synthesis
Route for insulin admin?
SubQ, IV, IV infusion, inhaled
Types of insulin are classified but what characteristics?
Onset, peak, and DURATION** –>
• Short duration ◦ Rapid or slower onset • Intermediate duration • Long duration ◦ Long and ultra-long
prototype for short duration RAPID acting insulin?
Aspart (novolog)
I want to get through the ass part very quickly
Onset, peak and duration for Aspart (Novolog)
Onset : 10-20 minutes
Peak: 1-3 hours
Duration: 3-5 hours
Which of our insulins acts most like for the pancreas acts in repsonse to a rise in blood glucose?
Aspart (Novolog)
Which insulin is out highest risk of hypoglycemia?
Aspart (novolog)
onset for inhaled insulin?
12 minutes!
inhaled insulin is contraindicated in…..
respiratory disorder like COPD
what is the route for aspart?
SQ or infusion pump/drip
When do we want to give Aspart in relation to food?
◦ Don’t give until food tray arrives! (5-10 min AC)
◦ “Give the shot while the tray is hot”
prototype for SLOWER acting insulin?
RegulAR (Humulin R, Novolin R)
slowAR regulAR R R R R
onset peak and duration for regular insulin
slowAR acting
Onset: 30-60 minutes
Peak: 1-5 hours
Duration: up to 10 hours
(longer peak and duration than rapid acting)
-does not mimic what the body naturally does as well
drug of choice for insulin drips?
regular (Humulin R, Novolin R)
When do we give regular insulin in relation to food?
◦ 30 to 60 min AC
◦ give before meal even arrives!
What is U500 insulin ? how do we admin it?
5x more concentrated than normal
• Special syringe that says U500 on it OR have conversion sheet to use regular insulin or tuberculin syringe
who is taking U500 insulin?
• Reserved for patients takes more than 200 units on insulin/day
All insulin is _____ ____ but U 500 is ____ ____ ___ (think safety)
high alert, very high alert
prototype for intermediate acting insulin?
Intermediate acting NPH (Humulin N, Novolin N)
iNtermediate Nph humulin N N N N N
How do they make NPH last longer?
regular insulin mixed with a special protein that slows down absorption
onset peak and duration for NPH
Onset: 1-2 hours
Peak: 6-14
Duration: 16-24
when do we want to give NPH in relation to food?
30 minutes before meal
NPH- once per day? BID? TID?
BID or TID
NPH + Regular insulin- how ya gonna give it?
clear (reg) then cloudy (NPH)
prototype for long acting insulin?
glargine (Lantus) (U-100)
Long Acting - LAntus, gLArgine
onset peak and duration of glargine (Lantus) (U-100)
Onset: 70 min
Peak: none
Duration: 18-24
indication for using glargine (Lantus) (U-100)
used for basal control?
is there a risk of hypoglycemia with glargine (Lantus) (U-100)?
No peak, so low risk for hypogly
frequency and admin of glargine (Lantus) (U-100)?
1-2x day
Give it at same time
Cant be mixed or given IV
prototype for Ultra-long duration Insulin
Insulin glargine (U-300) (Toujeo)
Duration, peak and onset for Insulin glargine (U-300) (Toujeo)?
Onset: ? same as u100? my notes dont say and the book is too heavy
Peak: None
Duration: >24 hours
frequency f admin for Insulin glargine (U-300) (Toujeo)?
Q 24 hours
prototype for combination insulin
NPH/regular 70/30 (Humulin 70/30)
onset peak duration for NPH/regular 70/30 (Humulin 70/30)
Onset: 30-60 min
Peak: 1.5-16 hours
Duration: 10-16
what kind of patients use NPH/regular 70/30 (Humulin 70/30)
*unpredictable b/c of wide range
• Good for patients with routine lives (diet, exercise) and set doses will work for them
indication for using sliding scale dose insulin?
when patients are hospitalized
what is a sliding dose scale insulin?
• will give certain amount of insulin based on patients current blood sugar
◦ backward thinking! give units based on elevation that has already occurred
what are correction dose insulins?
• Based on patient’s weight and current blood sugar
• Calculator in computer
◦ backward thinking! based on what has already occurred in body and what current reading is
what is meal dose insulin?
• Adjust insulin based on % amount eaten
◦ forward thinking!
-Can have sliding scale + meal dose or correction dose + meal dose
what is standing dose insulin?
• Doesn’t matter what CBG is, how much they ate –> give set amount every meal
4 doses scales for insulin?
sliding scale
correction
meal %
standing
insulin drips have ______ mortality
improved
considerations for patient on insulin drip (what is the nurse having to do?)
- More frequent blood sugar monitoring : the more stable the patient gets the wider we can make those time frames
- Titrate frequently
what kind of insulin goes in a drip?
Usually use regular or rapid acting insulins insulin
◦ All rapid acting insulins could be used
how do we discontinue an insulin drip?
give patient a longer acting insulin before stop drip, frequent CBG, rapid acting + long acting to normal routine
–> cant stop the drip cold turkey
Insulin pumps provide ____ dose with rapid acting analogs
basal
—• Set for bolus dose based on Carbohydrate count
consideration for insulin pumps: D/C them before…..
mri/procedures/ when admitted
when is hypoglycemia likely to occur for a diabetic?
◦ Especially at peak times
◦ During increased exercise
◦ Too much insulin
◦ Skipped meal
2 main side effects from insulin
hypoglycemia
lipodystrophy -hard formation of tissue @ injection site over time
◦ Rotate injection sites
where is insulin absorbed the quickest?
abdomen
storage of insulin: room temp vs fridge - how long is it good for
- RoomTemp: 30 days
- Fridge: 3 month –> give @ room temp**
how long is insulin good for in a syringe pre mixed? how do we want to store it?
1-2 weeks in syringe already mixed. Store upright to avoid clogging of needle
