DM Pharm (NUR 325) Created by Diana Hallis Flashcards
Primary goal of diabetic pharmacology
prevent hyperglycemia and decrease chance of long-term complications
Must maintain a __ glycemic control and blood lipid levels
tight
Maintain a tight glycemic control by keeping a diabetic’s blood sugar between
80-140
For a diabetic you want to keep A1C
Less than 6.5
Keep close eye on a diabetic’s
fasting blood glucose levels, AIC, triglycerides, and cholesterol levels
Historically those with diabetes would
die within a few days of being diagnosed
Later, they discovered carbohydrates would cause they symptoms so they would starve the patient of
Carbs and they would die that way
Who discovered injecting the patient with insulin would help control diabetes?
Frederick Banting
First human protein to be chemically synthesized
1963
First insulin pen
1985
First insulin pump
1992
Future innovations…
artificial pancreas with insulin pump, bionic pancreas
All insulin is given
subcut only
Rapid acting insulin
Insulin lispro (Humalog/Novalog)
Short acting insulin
human regular (Humulin R/Novolin R)
Intermediate acting insulin
NPH (Humulin N)
Long acting insulin
glargine (Lantus)
Most people use the trade name for glargine
Lantus
Short acting insulin (regular insulin) is the only one that isn’t
given subcut
Where is insulin given?
Back of arms, stomach, or thighs
Rapid acting insulin (lispro) starts working in
15 minutes
Rapid acting (lispro) will peak in
1 hour
Rapid acting insulin (lispro) will continue to work for
2-4 hours
Rapid acting insulin (lispro) is given with meals to
control postprandial meal glucose rises
Insulin lispro make sure to give
WITH FOOD!
Insulin lispro must be used in conjunction with
intermediate or long acting insulin
Regular insulin (short acting) onset
30-60 minutes
Regular insulin (short acting) peak
2-6 hours
Regular insulin (short acting) duration
3-8 hours
Regular insulin (short acting) is given to
control postprandial hyperglycemia before meals
Regular insulin (short acting) can also be given for
longer acting glycemic control
Regular insulin (short acting) is often given to patients with
tube feeding because they receive tube feeding 24 hours per day
Only type of insulin give IV/through infusions
short acting regular insulin
NPH insulin (intermediate acting)
Neutral protamine hagedron (NPH)
The __ helps slow down the absorption in NPH so that it lasts longer throughout the day
protamine
“extended release insulin”
NPH
Onset of NPH insulin (intermediate acting)
2-4 hours
Peak of NPH insulin (intermediate acting)
4-10 hours
Duration of NPH insulin (intermediate acting)
10-20 hours
With NPH insulin you won’t experience
A big peak like you would with regular or lispro insulin
NPH is the __ looking insulin
Cloudy
Before administering NPH you need to
shake the bottle
NPH insulin (intermediate acting) is typically administered
twice daily to help with glycemic control with meals and throughout the night
NPH is the only insulin that is
combined in a shot with another type of insulin
NPH insulin (intermediate acting) can be combined with…
lispro (rapid acting) and regular insulin (short acting)
When mixing insulin, which one do draw up in the syringe first?
The rapid or short acting insulin/the lispro or regular insulin
How to remember which one to draw up first
Clear before cloudy
What do you not want to happen when drawing up two insulins in the same syringe?
You don’t want them to mix, so you need to draw it up and then give it to the patient right away. Don’t let it sit
Glargine is a __ acting insulin
long acting insulin
Glargine (long acting insulin) is indicated for
once per day dosing
Glargine (long acting insulin) onset is
70 minutes and it lasts all day
You do not have a __ with glargine like other types of insulin
peak
You should never do what with glargine (long acting) insulin?
Mix with other insulins. Must be given in its own shot
Glargine (long acting insulin) is typically given at __
at night
