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Phamacology Summer > ENDOCRINE: Diabetes Concepts and Insulin Therapy 1 > Flashcards

ENDOCRINE: Diabetes Concepts and Insulin Therapy 1 Flashcards

1
Q

◦ Rapid Acting
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

A

a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)

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2
Q

Regular Acting
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

A

b. Regular insulin (Humulin R®/Novolin R®)

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3
Q

Intermediate Acting
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

A

c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)

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4
Q

Long Acting
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

A 
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)
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5
Q
  • Excess glucose stored in liver and skeletal muscle tissue

* Glycogen or •Glycogenolysis

A

•Glycogen

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6
Q
  • Conversion of glycogen into glucose when needed

* Glycogen or •Glycogenolysis or Insulin

A

•Glycogenolysis

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7
Q

Direct effect on fat metabolism
•Stimulates lipogenesis and inhibits lipolysis
•Stimulates protein synthesis

•Glycogen or •Glycogenolysis or Insulin

A

Insulin

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8
Q

•Promotes intracellular shift of potassium and magnesium
into the cells

•Glycogen or •Glycogenolysis or Insulin

A

Insulin

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9
Q

Fasting blood glucose goal for diabetic patients

of ? to ? mg/dL

A

70 to 130

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10
Q

•Caused by insulin deficiency and insulin resistance

Type 1
Type 2

A

Type 2

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11
Q

HbA1C of less than ?%

A

7

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12
Q

◦ Insulin therapy

Type 1
Type 2

A

Type 1

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13
Q

Lifestyle changes
◦ Oral drug therapy
◦ Insulin when the above no longer provide
glycemic contro

Type 1
Type 2

A

Type 2

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14
Q 
USED TO TREAT:
◦ 1) Primarily for hyperglycemia
◦ type I and II diabetes
◦ 2) Can also use fast acting insulin for
hyperkalemia

•Glycogen or •Glycogenolysis or Insulin

A

Insulin

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15
Q

Rapid-acting: Lispro insulin
◦ ONSET: ? to ? min
◦ PEAK: ? to ? hr
◦ DURATION: ? to ? hr

A

Rapid-acting: Lispro insulin
◦ ONSET: 15 to 30 min
◦ PEAK: 0.5 to 2.5 hr
◦ DURATION: 3 to 6 hr

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16
Q

Short-acting: Regular insulin
◦ ONSET: ? to ? hr
◦ PEAK: ? to ? hr
◦ DURATION: ? to ? hr

A

Short-acting: Regular insulin
◦ ONSET: 0.5 to 1 hr
◦ PEAK: 1 to 5 hr
◦ DURATION: 6 to 10 hr

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17
Q

Intermediate-acting: NPH insulin
• ONSET: ? to ? hr
• PEAK: ? to ? hr
• DURATION: ? to ? hr

A

Intermediate-acting: NPH insulin
• ONSET: 1 to 2 hr
• PEAK: 6 to 14 hr
• DURATION: 16 to 24 hr

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18
Q

Long-acting: Insulin glargine
• ONSET: ? min
• PEAK: ?
• DURATION: ? to ? hr

A

Long-acting: Insulin glargine
• ONSET: 70 min
• PEAK: None
• DURATION: 18 to 24 hr

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19
Q

Primary/Required: Blood Glucose!
◦ Hypoglycemia is defined as mg/dL
◦ Consider holding if (provider preference)
◦ Consider holding dose if patient not ?

A

Primary/Required: Blood Glucose!
◦ Hypoglycemia is defined as <70 mg/dL
◦ Consider holding if <130 (provider preference)
◦ Consider holding dose if patient not eating

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20
Q 
Secondary:
◦ ?-We check this while patients are on IV DRIPS
◦ Hemoglobin A1C
◦ ? month average of glucose levels
◦ Goal %
A

Potassium-We check this while patients are on IV DRIPS
◦ Hemoglobin A1C
◦ 3 month average of glucose levels
◦ Goal <7%

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21
Q

◦ ? can be given as IV for emergency purposes

A

Insulin can be given as IV for emergency purposes

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22
Q

◦? insulin as IV push to treat hyperkalemia or critically high glucose

A

◦ Rapid insulin as IV push to treat hyperkalemia or critically high glucose

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23
Q

◦ ? insulin can be given as a continuous IV infusion for HHS/DKA
patients

A

◦ Rapid/Regular insulin can be given as a continuous IV infusion for HHS/DKA
patients

24
Q

Hypoglycemia
Lipo-hypertrophy
Hypokalemia
Weight gain
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

A

a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
b. Regular insulin (Humulin R®/Novolin R®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)

25
Biggest hypoglycemia risk is during PEAK a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
26
-Rotate injection sites weekly a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
27
ADMINISTRATION- SUBCUTENAEOUS or IV , SHOULD LOOK CLEAR! a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®)
28
ADMINISTRATION- SUBCUTENAEOUS, CAN ALSO USE IN CONTINUOUS IV DRIPS FOR DKA/HHS a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
b. Regular insulin (Humulin R®/Novolin R®)
29
Administer 30 minutes before a meal - This insulin is CLEAR a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
b. Regular insulin (Humulin R®/Novolin R®)
30
ADMINISTRATION- SUBCUTENAEOUS a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
31
CLOUDY INSULIN!!!! Administer 30 minutes before a meal a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
32
CLOUDY INSULIN!!!! Administer 30 minutes before a meal a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®)
33
- SUBCUTENAEOUS, CLEAR INSULIN This insulin does NOT Peak, therefore does not matter with or without food. a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
``` d. insulin glargine (Lantus®) nsulin detemir (Levemir®) ```
34
-45 to 90°angle Small needle (28 to 31 gauge), shorter length Sites: Arms, Thighs, Abdomen a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) nsulin detemir (Levemir®)
a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) Insulin detemir (Levemir®)
35
Hypoglycemia- | • ? is the most dangerous time
Hypoglycemia- | • Peak is the most dangerous time
36
``` •Lipo-hypertrophy- • rotate sites ? • Each day, rotate around? -?inch from previous site, then after ?week, go to new site ```
``` •Lipo-hypertrophy- • rotate sites weekly • Each day, rotate around ½-1 inch from previous site, then after 1 week, go to new site ```
37
* Hypokalemia- * Seen with ? doses * We check potassium if on insulin ?
* Hypokalemia- * Seen with high doses * We check potassium if on insulin drips
38
A patient gains or lose weight with insulin
gain
39
◦ Confusion, irritability, tremor, sweating, SNS activation Early Signs or late
Early
40
Hypothermia, seizures ◦ Coma and death will occur if not treated Early Signs or late
Late
41
▪Hypoglycemia is mg/dL
▪Hypoglycemia is <70 mg/dL
42
Give 15 grams of carbohydrates ▪If patient is alert or ▪If patient has altered mental status
▪If patient is alert
43
Hospitals will always have glucose tablets ▪If patient is alert or ▪If patient has altered mental status
▪If patient is alert
44
▪ If at home, can do 4 ounces of orange juice, 2 oz of grape juice ▪If patient is alert or ▪If patient has altered mental status
▪If patient is alert
45
▪ Give IV glucose (DEXTROSE) ▪If patient is alert or ▪ If patient has altered mental status
▪ If patient has altered mental status
46
▪ Or IM Glucagon ▪If patient is alert or ▪If patient has altered mental status
▪ If patient has altered mental status
47
Which to cautioun with diabetes Oral diabetes med + insulin = higher risk for HYPO event ◦ Beta blockers ◦ can mask S/S of hypoglycemia + suppress the liver ◦ Diuretics + Steroids known to cause HYPERglycemia ◦ HCTZ- HyperGLUC (Hyperglycemia as well)
all
48
◦NPH Cloudy or Clear
Cloudy
49
NEVER MIX Long acting insulins (?) with any other insulins a. insulin lispro (Humalog®), aspart (Novolog®), glulisine (Apidra®) b. Regular insulin (Humulin R®/Novolin R®) c. Neutral Protamine Hagedorn (NPH) insulin (Humulin N®) d. insulin glargine (Lantus®) Insulin detemir (Levemir®)
NEVER MIX Long acting insulins (glargine or detemir) with any other insulins ``` d. insulin glargine (Lantus®) Insulin detemir (Levemir®) ```
50
When mixing insulin its's always Clear to cloudy or Cloudy to clear
Clear to cloudy
51
NPH + Regular process air in air out
1. NPH- Air in 2. R.I. Air In 3. R. I. Air out 4. NPH Air out
52
* Premade combinations * Humulin 70/30 * Novolin 70/30 * Humalog 75/25 * NovoLog 70/30 Rapid or Regular
Regular Regular Rapid Rapid
53
``` • NEVER SHAKE INSULIN! or SHAKE INSULIN or Roll insulin ```
• NEVER SHAKE INSULIN! | Roll insulin
54
◦ In general, keep UNOPENED insulin in ?
refrigerator
55
◦ Once opened, can keep at ? temperature
Room
56
? insulin (insulin lispro or insulin aspart) Bolus or Basal
Bolus insulin (insulin lispro or insulin aspart)
57
? insulin is a long-acting insulin (insulin glargine) Bolus or Basal
Basal insulin is a long-acting insulin (insulin glargine)

Phamacology Summer (48 decks)

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