Exam 3 "Diabetes" Flashcards
What insulin is used in IV formulation?
regular insulin
Can you use NPH in IV? Why or why not?
No, NPH is a suspension
Can you give glargine IV? Why or why not?
No, precipitates at physiologic pH
Can you give detemir IV? Why or why not?
No, binds to albumin
Can you give degludec IV? Why or why not?
No, can cause severe hypoglycemia if IV
What are the ultra-short acting insulins that we need to know?
aspart, lispro, glulisine (novolog, humalog, apidra)
What are the short acting insulins we need to know?
regular
What are the intermediate insulins that we need to know?
NPH
What are the long acting insulins that we need to know?
glargine, detemir
What are the ultra-long acting insulins that we need to know?
degludec
Give the routes of administration of insulin action from fastest to slowest.
(Intranasal) > IV > IM > SQ
Give the sites of injection of insulin action from the fastest to the slowest.
Stomach > buttock > thigh
Does heat cause insulin to act faster or slower?
FASTER
Does exercise/massage cause insulin to act faster or slower?
FASTER but may depend on injection site
Short-acting effect of insulins may be ___ if mixed incorrectly.
lost
Renal failure ___ insulin clearance, thereby ___ insulin action/
decrease, increase
Stress __ insulin clearance.
increases
How long do most insulin formulations stay stable for?
28 days
How long does levemir stay good for?
42 days
How long is Regular/NPH good for in what conditions?
stable for 7 days in the refrigerator ALWAYS DRAW UP SHORT-ACTING FIRST
How long is Aspart, Glulisine, or Lispro with NPH good for?
not long at all, give immediately
How long is Degludec, Detemir, and Glargine with any other insulin good for?
NOT GOOD AT ALL - NOT COMPATIBLE
What are the 4 causes of hypoglycemia?
- increased insulin dosage
- decreased caloric intake
- increased muscle utilization
- excessive alcohol
What are the 3 levels of hypoglycemia?
Level 1: Glucose < 70 mg/dL
Level 2: Glucose < 54 mg/dL
Level 3: Severe event with altered mental and/or physical functioning needing another person for recovery
What are the signs and symptoms are hypoglycemia?
Tremors, tachycardia, diaphoresis, irritability, confusion, hunger, slurred speech, drowsiness, weakness, headache and irritability
What class of blood pressure drugs decrease responsiveness to hypoglycemia due to blocking sympathetic warning symptoms?
Beta-blockers
How do you treat level 1 hypoglycemia?
15-30 gm carbohydrate
How do you treat hypoglycemia level 2 and level 3?
glucagon
What do insulin analogs more closely represent?
physiologic insulin secretion relative to meals
What are the advantages of insulin analogs?
- decreases in post-prandial hypoglycemia and superior postprandial lowering of BS
- fewer overall occurences of hypoglycemia, less nocturnal hypoglycemia
- greater flexibility
What are the disadvantages of insulin analogs?
- risk of hypoglycemia if no meal within 15 mins of dose
- will need to combine with longer acting insulin for optimal BS control
- if mixed with another insulin, give immediately after mixing
- hyperglycemia/ketosis may occur more rapidly if insulin delivery is interuppted