DM part 2 Flashcards
what do all people with type 1 diabetes need
insulin to survive
which country is highest for type 1 diabetes
finland
what are the types of insulin
humalog (lispro), novalog (aspart)
regular insulin
NPH, Humulin N
lantus (glargine), levemir (detemir)
what are rapid acting insulin
lispro (humalog)
aspart (novalog)
what is the onset, peak and duration of rapid acting insulin
onset: 10-30 min
peak: 30 min to 3 hr
duration: 3-5 hours
what are short acting insulin
regular (humulin R or novolin R)
what is the onset, peak and duration of short acting insulin
onset: 30 min-1hr
peak: 2-5 hr
duration 5-8 hr
what are intermediating acting insulin
NPH (Humulin N or novolin N)
what is the onset, peakk and duration of intermediate acting insulin
onset 1.5-4 hr
peak 4-12 hr
duration 12-18 hour
what are long acting insulin
glargine (lantus)
Detemir (levemir)
degludec (tresiba)
what is the onset,peak and duration for long acting linsulin
onset 0.8 -4 hours
peak no pronounced peak
duration 18-24 hours
what is inhaled insulin
really fast ex: afrezza can't use if you have pulmonary problems onset 12-15 min peak 60 min duration 2.5-3 hr
can long acting be mixed
no, pH will inactive each other
you can take at the same time just in different syringes
how is insulin stored
can be kept room temp for a month once open
can mix leave in fridge for 1 week
if unopened leave in fridge
which insulin is the longest
degludec last up to 42 hours
can’t be mixed
what are premixed insulins
NPH/regular 70/30 MOST COMMON
aspart 0/30
lispro 50/50
lispro 75/25
how do type 1 base insulin dosage on
how many carbs
what BG is
how much physical activity
what are the new insulins
degludec (tresibu) 200 units/mL (the longest acting, long insulin that can be mixed with others, comes in a pen and twice as concentrated)
glargine (toujeo) 300 units/ ml
insulin R 500 untils/mL (type 2 b/c insulin resistance)
inhaled insulin- afrezza, technosphere
lispro U -200
what are insulin therapy for type 1
rapid before meals
long acting either morning or night for background
what are insulin therapy for type 2
basal at first, long acting
might need rapd
what is the most common mistake with insulin
not giving the right type
what do you do first with the pen
go to 2 to prime to get the air out
what are problems with insulin therapy
hypoglycemia - limiting facor for type 1
allergic reaction
lipodystrophy- using same spot, skin gets thicker, absorption slower, so move spots
smoggy effect- wake up with high BG from too much insulin
which insulin is used for PRN
rapid because we want BG down
what are oral agents
sulfonylureas (glipizide, glimepriide)
meglitinides (repaglinide)
a-glucosidase inhibitors (acarbose)
biguanides (metformin)
thiazolidinediones (pioglitazone)
dipeptidyl peptidase 4 inhibitor (sitagliptin)
sodium glucose co transporter 2 (canaglifozin)
what is sulfonylureas (glipizide, glimepiride)
this is the older oral agent lowers A1C about 1% effective medication only for 8-9 years cannot fix by increasing dosage causes pacers to secrete insulin can cause hypoglycemia an gain weight
what is meglitinides (repaglinide)
shorter acting, must be giver 30 mins before food, causes pancreas to secrete insulin, causes hypoglycemia
on liver
what is a-glucosidase inhibitors (acarbose)
on gut
slow down carbohydrate metabolism in gut
what is thiazolidinediones (pioglitazone)
work on insulin resistance cause people to hold onto fluid
what is biuanides (metformin)
approved for pre diabetes works on liver, slows down breakdown of glycogen does not causes hypoglycemia don’t gain or lose weight
if on for a long time can be vitamin b deficient
what is dipeptide peptidase 4 inhibitor (sitagliptin)
slows down gastric
extend normal incretins that are there
dont cause hypoglycemia
what is sodium glucose co transporter 2 (canaglifozin)
flow out of kidneys
work on kidney so we don’t hold on to glucose
UTI yeast infection decrease in weigh loss decrease in BP
what is uncertain based therapies
liraglutide (GLP 1 agonist) subcut
promotes weight loss
lowers BP
works on gut
extended life with people with cardiovascular disease
highly recommend for type 2, CV disease, high A1C on metaformin
nausea and vomitting
drugs associated with hyperglycemia
loop diuretics, thiazide diuretics (larger doses)
presdnisone (corticosteroids)
drugs associated with hypoglycemia
alcohol
beta blockers can prolong hypoglycemia and mask symptoms
what are causes of hypoglycemia (BS is less than 70 mg/dl
insulin excess oral hypglycemic meds inadequate nutrients physical activity alcohol intake in fasting state
what are adrenergic s/s of hypoglycemia
cold sweats weakness trembling irritabilty tachycardia pallor
what are neuroglycopenic s/s of hypoglycemia
heache mental dullness irrational behavior slurred pseech loss of consciousness seizure coma death
what are interventions when conscious with hypoglycemia
blood glucose 15 g of carbohydrate wait 15 min to recheck BS repeat carb if low include protein if meal is not soon
what are interventions when unconscious with hypoglycemia
check blood sugar SC or IM glucagon (1 mg) IV glucose (25-50 ml of 50%) recheck BS in 15 min treat as conscious
