Exam 3: Diabetes pt 2: Insulin Tx Flashcards
Solutions approved for IV use
Aspart, glulisine, lispro, and regular insulin
Regular insulin is the insulin used as the IV formulation
NPH as a suspension
Cloudy
-Top is clear - bottom is a white section
Shake it and it looks like milk
NOT AN IV SOLUTION
Clear solutions that you cannot give as IV
Glargine
Precipitates at high physiological pH
Makes a snowflake under the skin
Degludec
Can cause severe hypoglycemia
Ultra Short acting insulin
Aspart (Novolog, Novolog Flexpen, Fiasp)
Lispro (humalog, Humalog KwikPen U-100 and U-200)
Glulisine (Apidra, Apidra solostar)
Short acting Insulin
Regular (Humulin R, Humulin N - both U-100)
Intermediate acting Insulin
NPH (Humulin N, Novolin N)
Long-acting insulns
Glargine (Lantus, Lantus Solostar, Basaglar, Rezvoglar, Semglee®)
[all U-100]
Ultra long acting insulin
Degludec (Tresiba®U-100)
Important to remember with NPH
Delayed peak
-Take dose at breakfast - kicks in around lunch
-Helpful if someone cannot take a dose at lunch
Insulins compatibility
Shorts and intermediate - compatible
Long are not compatible with anything
Long acting/ultra long acting - no peak effect, cannot respond to meal time
Insulin premixes
NPH/Regular mixture 70/30 (Humulin 70/30, Humulin 70/30 Pen,
Novolin 70/30)
75% neutral protamine lispro (intermediate activity like NPH) / 25% lispro (Humalog Mix 75/25, Humalog Mix 75/25 KwikPen)
50% neutral protamine lispro / 50% lispro (Humalog Mix 50/50, Humalog Mix 50/50 KwikPen)
70% aspart protamine suspension / 30% aspart (Novolog Mix 70/30 Novolog Mix 70/30 FlexPen)
Degludec U-100 / aspart U-100 (Ryzodeg 70/30)
Route of admin
IV > IM > SubQ
Intranasal might be fastest - we do not usually use it
Site of injection for insulins
Stomach is the fastest
Butt and Thigh are the slowest
-Keep sites of injection consistent
-Might need to rotate injection sites
Preparation/mixtures
Short-acting effect of insulins may be lost if mixed incorrectly
U-500 regular insulin has a delayed onset, peak, and a long duration of action when compared to U-100 insulin, but its smaller volume often allows for overall increased absorption
If mixing insulins, always use short acting first
Insulin dosing property
Lower dose absorbed more rapidly
-When patient is using 100, then switch to 5000, 500 is going to be absorbed better (500 is more of a dose but in a smaller volume)
Patient compliance and insulin
Correct dose, timing, relation to meals, etc.
TIMING - purpose of insulin is to cover your meal glucose surge - smack sugar down and keeps it level
Patient errors and insulin
Dialing/drawing up insulin
Irregular diet and exercise
Will affect absorption and patient response
If they fast, can mess up insulin
Renal function
Renal failure decreases insulin clearance, thereby increasing insulin action
Greater risk of hypoglycemia
15-20% of insulin metabolism occurs in the kidneys
Stress
Increased insulin clearance
Stress - blood sugars increased; making more hormones: Also have less insulin
Drug interactions
Does not necessarily mean we will remove the medications - important to be aware
Insulin vials stable at room temp for
28 days (no exposure to extreme temps) - **90 day supply - keep in fridge
Insulin pens are variable
Refrigerate vials/pens nor in use and DO NOT FREEZE
discard opened insulin vials/pens after 28 days
Prefill insulin stability
Insulin your prefill in syringes is stable for 28 days with refrigeration as long as not mixed
Insulin you prefill in syringes is stable for 10-28 days at room temperature - highly variable