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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
Q

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

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
Q

-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

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
Q

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

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

28
Q

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®)

A

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

29
Q

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®)

A

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

30
Q

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®)

A

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

31
Q

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®)

A

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

32
Q

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®)

A

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

33
Q
  • 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®)
A 
d. insulin glargine (Lantus®)
nsulin detemir (Levemir®)
34
Q

-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

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
Q

Hypoglycemia-

• ? is the most dangerous time

A

Hypoglycemia-

• Peak is the most dangerous time

36
Q 
•Lipo-hypertrophy-
• rotate sites ?
• Each day, rotate around? -?inch from
previous site, then after ?week, go to
new site
A 
•Lipo-hypertrophy-
• rotate sites weekly
• Each day, rotate around ½-1 inch from
previous site, then after 1 week, go to
new site
37
Q
  • Hypokalemia-
  • Seen with ? doses
  • We check potassium if on insulin ?
A
  • Hypokalemia-
  • Seen with high doses
  • We check potassium if on insulin drips
38
Q

A patient gains or lose weight with insulin

A

gain

39
Q

◦ Confusion, irritability, tremor, sweating, SNS activation

Early Signs or late

A

Early

40
Q

Hypothermia, seizures
◦ Coma and death will occur if not treated

Early Signs or late

A

Late

41
Q

▪Hypoglycemia is mg/dL

A

▪Hypoglycemia is <70 mg/dL

42
Q

Give 15 grams of carbohydrates

▪If patient is alert or ▪If patient has altered mental status

A

▪If patient is alert

43
Q

Hospitals will always have glucose tablets

▪If patient is alert or ▪If patient has altered mental status

A

▪If patient is alert

44
Q

▪ 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

A

▪If patient is alert

45
Q

▪ Give IV glucose (DEXTROSE)

▪If patient is alert or ▪ If patient has altered mental status

A

▪ If patient has altered mental status

46
Q

▪ Or IM Glucagon

▪If patient is alert or ▪If patient has altered mental status

A

▪ If patient has altered mental status

47
Q

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)

A

all

48
Q

◦NPH

Cloudy or Clear

A

Cloudy

49
Q

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®)

A

NEVER MIX Long acting insulins (glargine or detemir) with any other
insulins

d. insulin glargine (Lantus®)
Insulin detemir (Levemir®)
50
Q

When mixing insulin its’s always
Clear to cloudy
or
Cloudy to clear

A

Clear to cloudy

51
Q

NPH + Regular process
air in
air out

A
  1. NPH- Air in
  2. R.I. Air In
  3. R. I. Air out
  4. NPH Air out
52
Q
  • Premade combinations
  • Humulin 70/30
  • Novolin 70/30
  • Humalog 75/25
  • NovoLog 70/30

Rapid or Regular

A

Regular
Regular
Rapid
Rapid

53
Q 
• NEVER SHAKE INSULIN!
or 
SHAKE INSULIN 
or
 Roll insulin
A

• NEVER SHAKE INSULIN!

Roll insulin

54
Q

◦ In general, keep UNOPENED insulin in ?

A

refrigerator

55
Q

◦ Once opened, can keep at ? temperature

A

Room

56
Q

? insulin (insulin lispro or insulin aspart)

Bolus or Basal

A

Bolus insulin (insulin lispro or insulin aspart)

57
Q

? insulin is a long-acting insulin (insulin glargine)

Bolus or Basal

A

Basal insulin is a long-acting insulin (insulin glargine)

phamacology summer (48 decks)

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