Diabetes & Insulin Flashcards
What are the categories of insulin in order of shortest acting to longest acting?
Rapid —> Short —> Intermediate —> Long —> Very Long
What Insulins fall into the category of Rapid Acting Insulin?
Lispro + Aspart + Glulisine
What Insulin falls into the category of Short Acting Insulin?
Regular
What Insulin falls into the category of Intermediate Acting Insulin?
NPH
What Insulins fall into the category of Long Acting Insulin?
Glargine + Detemir
What Insulins fall into the category of Ultra Long Acting Insulin?
Degludec
What is the onset of Rapid Acting Insulin
15-30 min
What is the onset of Short Acting Insulin?
30-60 min
What is the onset of Intermediate Acting Insulin?
2-4 hr
What is the onset of Long Acting Insulin?
1-2 hr
What is the onset of Very Long Acting Insulin?
1 hr
How long is the peak of Rapid Acting Insulin?
1-3 hr
How long is the peak of Short Acting Insulin?
2-4 hr
How long is the peak of Intermediate Acting Insulin?
8-12 hr
How long is the peak of Long Acting Insulin?
None
How long is the peak of Ultra Long Acting Insulin?
None
How long is the duration of Rapid Acting Insulin?
4-6 hr
How long is the duration of Short Acting Insulin?
5-8 hr
How long is the duration of Intermediate Acting Insulin?
10-18 hr
How long is the duration of Long Acting Insulin?
~1 Day
How long is the duration of Ultra Long Acting Insulin?
48 hr+
What is important to keep in mind about Rapid Acting Insulin?
Use just before meals + This insulin has the highest risk of Hypoglycemia
What is important to keep in mind about Short Acting Insulin?
Take 30-60 min before meal + Useful for managing DKA
What is important to keep in mind about Intermediate Acting Insulin?
These act as Basal Insulin + Cover the need of insulin for about 1/2 of the day
What is important to keep in mind about Long Acting Insulin?
These act as Basal Insulin + Cover the need for insulin for ~1 day
What is important to keep in mind about Ultra Long Acting Insulin?
Useful for extra long glucose control
Insulin is always clear except for-
NPH + Lispro + Aspart
What order should insulin be mixed?
Put air into NPH, then R.
Draw R, then NPH.
How do you mix NPH without causing bubbles to form?
Rub the insulin together with the palm of your hands, do not shake
What angle do you administer Insulin?
90 if the pt is big, 45 if normal or smaller sized
When administering Insulin, what should be done with the needle and plunger?
Push the plunger down all the way, leave the needle in place for 5 seconds
What are some problems that can result from Insulin Therapy?
Hypoglycemia + Allergic Reactions + Lipodystrophy + Atrophy + Hypertrophy + Overuse of Site that alters the absorption of Insulin
What allergic reactions can occur from Insulin administration?
Local or Systemic (Rare) + Preservative / Latex / Rubber Stopper
What is Atrophy?
Wasting of SUBQ Tissue; Indentations
What is Hypertrophy?
Thickening of SUBQ Tissue
What is the Somogyi Effect?
High doses of insulin = Hyperglycemia at night
The release of counterregulatory hormones causes rebound hyperglycemia at night. What is this called?
Somogyi Effect
When should the Somogyi Effect be assessed for?
Between 2-4 AM
What are the manifestations of the Somogyi Effect?
Headache + Night Sweats + Nightmares
How is the Somogyi Effect treated?
Bedtime Snack + Reducing the Dose of Insulin
What is the Dawn Phenomenon?
Morning Hyperglycemia present on awakening due to counterregulatory hormones in Predawn Hours
What counterregulatory hormones cause the Dawn Phenomenon?
Growth Hormone + Cortisol
What age group does the Dawn Phenomenon affect the most?
Adolescents + Young Adults (Because this is the peak time for growth hormone)
What is the treatment for Insulin?
Increase Insulin or Adjust Administration Time
What is Afrezza?
Rapid Acting Inhaled Insulin
When is Afrezza administered?
Administer at the beginning of every meal or within 20 min after starting a meal
What is Afrezza used in combination with for T1DM?
Long-Acting Insulin
What are the common adverse reactions of Afrezza?
Hypoglycemia + Cough + Throat Pain + Irritation
Afrezza is not recommended for the treatment of-
DKA + Smokers + Pt’s with Asthma or COPD (Bronchospasm Risk)
How do Oral and Noninsulin Injectable Agents treat DM?
Work to improve the mechanism by which the body makes and uses Insulin
What T2DM defects do Oral and Noninsulin Injectable Agents treat?
Insulin Resistance + Decreased Insulin Production + Increased Hepatic Glucose Production
Can Oral and Noninsulin Injectable Agents be used in combination?
Yes
What is the most effective 1st line treatment for T2DM?
Metformin
What forms can Metformin be given?
Immediate Release + ER + Liquid Forms
What is the pharmacological action of Metformin?
Lowers Hepatic Glucose Production + Enhances Insulin Sensitivity + Improves Glucose Transport
Can Metformin be given to prevent T2DM in Prediabetic pt’s?
Yes
What is a potential side effect of Metformin?
Weight Loss
When should Metformin be withheld?
Pt’s undergoing surgery or radiologic procedures with Contrast Medium
24-48 hrs before and at least 48 hrs after when serum creatinine is within normal limits
What are the CI’s of Metformin?
Renal + Liver + Cardiac Disease + Lactic Acidosis
Iodine Based Contrast Medium (May cause Acute Kidney Injury)
Excessive Alcohol Intake
Is a person with DM allowed to eat the same foods as someone without?
Yes, but moderating certain foods is important
What do you always give Rapid Acting Insulin with?
Food
