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Pharm- DM and Thyroid > Diabetes Lecture 2 > Flashcards

Diabetes Lecture 2 Flashcards

1
Q

Pharmacological Therapy

A

Insulin
Oral agents
Non-insulin injectables

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2
Q

Functions of Insulin (5)

A

Regulator of glucose metabolism
Released from pancreatic beta cells in response to elevated blood glucose
Inhibits hepatic glucose production
Facilitates glucose transport into cells (fat, muscles, hepatocytes)
Stimulates glucose storage

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3
Q

Types of Insulin

A

Rapid Acting Insulin
Short Acting Insulin
Intermediate Acting Insulin
Long Acting Insulin

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4
Q

3 Types of Rapid Acting Insulin

A 
Insulin lispro (humalog)
Insulin aspart (novolog)
Insulin glulisine (apidra)
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5
Q

Properties of Rapid Acting Insulin

A

Begins to Work in 5- 15min
Working hardest for 1-2 hours
Stops working effectively after 3-4 hours

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6
Q

1 type of Short Acting Insulin

A

Regular (Novolin, Humulin)

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7
Q

Properties of Short Acting Insulin

A

Begins to work in 35-45 min
Working hardest for 2-3 hours
Stops working effectively after 4-8 hours

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8
Q

1 Type of Intermediate Acting Insulin

A

NPH

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9
Q

Properties of Intermediate Acting Insulin

A

Begins to work in 120-240 min
Working hardest for 4-8 hours
Stops working effectively after 10-16 hours

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10
Q

2 Types of long acting insulin

A 
Insulin glargine (lantus)
Insulin dentimir (levamir)
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11
Q

Properties of Long Acting Insulin

A

Begins to work in 120 min
Working hardest- same all day
Stops working about 24 hours for Lantus
18-24 for levamir

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12
Q

Insulin Analogs

A

Targets the post-prandial glucoses

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13
Q

Basal Insulin

A

Provide peakless and prolonged insulin action

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14
Q

Pro’s of Rapid Acting Insulin

A

Provides better post-prandial glucose control
Lower frequency of hypoglycemia and severe hypoglycemia in type 1 diabetes
Convenience
Inject right before meal
Can inject after meal

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15
Q

Con’s of Rapid Acting Insulin

A

Expensive
Given prior to high-fat meal, potential increased risk of early post-meal hypoglycemia
Short duration may provide gaps in insulin supply between meals

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16
Q

Pro’s of Short Acting Insulin

A

No prescription is needed
Fairly inexpensive
Only insulin that can be used IV
Provides some basal activity which must be taken into account if switch to rapid-acting insulin

17
Q

Con’s of Short Acting Insulin

A 
Absorbed too slowly to match rate of glucose after meals
Postprandial hyperglycemia
Inject 30 to 45 minutes prior to meal
Relatively prolonged duration of action
Late post-meal hypoglycemia
18
Q

NPH

A

Dosed twice daily
Peaks, thus can cause hypoglycemia
Some patient variability
Can be mixed with other insulin’s

19
Q

Glargine

A

Normally dosed once daily
May not always provide 24 hour coverage (rising blood glucose levels in the evening)
Thus may need to dose twice day
No peak, less hypoglycemia compared to NPH
Equal or less patient variability compared to NPH
Can not be mixed with other insulin’s
No apparent overlap or accumulation

20
Q

Detemir

A

Duration of action similar/little longer than NPH but shorter than glargine
May require twice a day dosing
Possibly a smaller peak compared to NPH
Less patient variability compared to NPH

21
Q

Combination Insulins

A

75/25 (lispo protamine/lispro)
70/30 (aspart protamine/aspart)
70/30 or 50/50 (NPH/regular)

22
Q

Dosing Adjustments

A 
Dosing correctly (amount, technique)
Diet changes
Exercise, activity
Weight gain or losses, illness or stress
Symptoms of hypoglycemia or hyperglycemia
Changes in medication
23
Q

Carbohydrate based adjustments

A

500 Rule
500/total daily dose= XYZ grams carbohydrate covered by 1 unit of insulin (rapid acting)
In other words: 1 units of insulin will cover XYG grams of carbohydrates

24
Q

Post Meal Adjustments

A

1500 Rule or 1800 Rule
1500/total daily dose= XYZ mg/dL of glucose that will be lowered by 1 unit of insulin
In other words: 1 units of insulin will lower the glucose level by XYZ mg/dL
Add needed amount to prescribed amount when BG elevated before meals

25
Q

General Rule of Insulin

A

1 unit of insulin drops glucose by 30-60mg/dL

26
Q

Choosing Initial Insulin Regimen for Type 2 diabetics

A

Patient willingness
Patient adaptability
Lifestyle
Glycemic patterns

27
Q

Somogyi effect

A

Early morning low blood glucose followed by rebound hyperglycemia
Treat: Reduce dose of insulin

28
Q

Dawn Phenomenon

A

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

29
Q

Sick Days for Diabetics

A

Continue to take their normal diabetic medications/insulin and they may require more insulin than normal
Check glucose levels more often than normal
Stay hydrated

30
Q

Hypoglycemic Side Effect of Insulin

A

Daytime: Sweating, tachycardia, palpitations, tremor, headache, confusion, visual disturbances, irritability or other “personality changes”, seizures, unconsciousness
Nighttime: nightmares, night sweats, morning headache
Treatment
Rule of 15: Glucose tablets (take 4…they are grams each…15grams of sugar will raise your blood sugar by 15 points in 15 minutes
Glucose gel is a good option as well
Orange juice
If unconscious; use glucagon pen (family should be trained how to use this)

31
Q

Other Side Effects of Insulin

A

Weight gain
Injection site reactions
Fat deposits under skin surface which reduce insulin absorption
Prevent by rotating injection sites

32
Q

Storage of Insulin

A

Unopened vials:
Store in refrigerator

Opened vials:
Store at room temperature for up to 28 days

Pre-mixed syringes (NPH mixtures):
Refrigerator up to 21 days

Travel:
Keep it with you, not in luggage

33
Q

Mixing Insulin

A

Most insulin types can be mixed in one syringe and be injected together
Always draw up the clear insulin before the cloudy insulin (“clear before cloudy”)
NPH and Regular
NPH and Rapid acting
Insulin glargine can NOT be mixed with anything

34
Q

Formulations of Insulin

A

Vial and syringe
Premixed pens
Insulin pumps

Pharm- DM and Thyroid (4 decks)

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