diabetes - insulin Flashcards
s+s of hyperglycemia
“warm + dry…. sugar’s high!”
polyphagia, polyuria, polydipsia, weight loss, fatigue
s+s of hypoglycemia
“cold + clammy…. need some candy!”
tremors, diaphoresis, tachycardia, hunger, HA, difficulty concentrating (not enough glucose to brain)
actions of insulin (5) + what is main goal ?
- helps glucose get into cells
- prevent breakdown of fat (for other energy source)
- prevent breakdown of glycogen (to make more glucose)
- inhibits gluconeogenesis
- increases protein synthesis
main goal = lower blood sugar + help body use energy sources properly
what is most common route of insulin?
subQ
short duration insulin can be broken down into which 2 categories?
rapid-acting + slow acting
what is our prototype for short-duration rapid-acting insulin?
aspart (Novolog)
others: lispro (Humalog)
inhaled insulin
inhaled insulin is contraindicated in which patient population?
COPD or other respiratory disorders
what is onset of aspart?
10-20 mins (rapid acting)
what is peak of aspart?
1-3 hrs
what is the duration of aspart?
3-5 hours (short duration)
this insulin is used frequently b/c it’s a very “natural” response and closely mimics pancreas action r/t blood sugar rise
aspart ◡̈
when should aspart be given? what’s a mnemonic to remember this?
5-10 mins before meals (rapid acting!)
“give the shot while the tray is hot!!”
what is the prototype of the short-duration slow-acting insulin?
regular insulin (Humulin R, Novolin R)
what is our drug of choice for insulin drips?
regular insulin (Humulin R, Novolin R)
what is onset of regular insulin?
30-60 mins
what is peak of regular insulin?
1-5 hrs
what is duration of regular insulin?
up to 10 hrs (“short” duration - 2x longer duration than aspart)
when should regular insulin be given in regards to meals?
30-60 mins before
MOST regular insulin is which concentration?
U-100
insulin is a high alert med. what should you be doing before administration?
- check current CBG
- draw up insulin
- take vial and syringe to another RN - show what you drew up, give CBG value, and have them check independently!!
what is our prototype for intermediate-acting insulin?
NPH (Humulin N, Novolin N)
what is the NPH combo?
regular insulin + protamine (protein) to slow down absorption
what is onset of NPH?
1-2 hrs (intermediate acting)
a step up from regular insulin b/c of that protamine added
what is peak of NPH?
6-14 hrs
what is duration of NPH?
16-24 hrs
NPH is commonly given (dosing interval)?
BID (b/c peak is around 12 hours)
when should NPH be given?
30 mins before meals
I’m asking Knowlton about this b/c why give 30 mins before meals when onset is 1-2 hours??? don’t we risk hypoglycemia???
if mixing NPH with regular insulin, what are your steps?
roll cloudy
air in cloudy then air in clear
draw up clear (regular) then draw up cloudy (NPH)
“you have to see things CLEARLY before you can draw up the insulin”
what is our prototype for our long-acting insulin?
glargine (Lantus)
what is our GoLd StAr insulin? why?
glargine (Lantus)
b/c it mimics the body’s basal control of insulin + there is no peak, which means low risk of hypoglycemia….therefore SAFER!
what is onset of glargine?
70 mins
what is peak of glargine?
trick question! there is NO PEAK
what is duration of glargine?
18-24 hours
glargine is used for _______ ________ of blood glucose
basal control
what is important factor of glargine administration?
given @ same time each day - doesn’t matter when, just as long as it’s consistent
what is our prototype for ultra-long duration insulin?
glargine U-300
what is duration of glargine U-300?
over 24 hrs (U-300 is 3x the concentration of glargine, so it has a longer duration by 3x)
how often is glargine U-300 dosed?
q 24 (B/c of ultra-long duration)
what is our prototype for combination insulin?
NPH + regular 70/30 (an example)
what is an insulin that’s “good for patients with routine lives (diet and exercise) with not much variability”?
NPH + regular
(b/c it’s a set dose and no titration is needed(
KNOWLTON SAYS WE DON’T NEED TO WORRY ABOUT THIS OR KNOW THIS
correction doses of insulin are based on what?
patient’s weight + current blood sugar
used much more often
if discontinuing an insulin drip, what is the protocol?
have a longer-acting insulin on board, then titrate off; DON’T stop all at once!
what type of insulin device can be used for home management of DM? what do they deliver?
insulin pump
basal dose w/ rapid-acting doses for meal coverage
what should be checked EVERY TIME before insulin administration?
CBG !!!
insulin is good for how long @ room temp? how should it be stored?
30 days; upright
also, 1-2 weeks in syringe if mixed
when are patients at highest risk of hypoglycemia with insulin administration?
when insulin is PEAKING
always know onset, peak + duration of insulin
what is a SE of insulin? (r/t injection site) + what should we do?
- lipodystrophy –> can cause hard spots @ injection sites
rotate sites, and assess - palpate - sites before admin
