Injectable and Inhaled Insulins Flashcards
What is the expected clinical effect of the GLP-1 agonists on blood glucose control
about 1%
Contraindications to GLP-1 agonists
- Type 1 DM
- Ketoacidosis
- Severe GI dz
- Hx of pancreatitis
MoA of GLP-1 Agonist
- Activate GLP receptors on the cell surface of beta cells → insulin release in the presence of elevated BG
- Decreases glucagon secretion in a glucose-dependent manner
- Lowers blood glucose by delaying gastric emptying
Additional contraindication to Byetta (GLP-1)
ESRD or severe renal impairment (CrCl <30 ml/min)
Additional contraindication to Victoza (GLP-1)
Hx or fam hx of medullary thyroid cancer (MTC) or hx of multiple endocrine neoplasia syndrome type 2 (MEN 2)
ADRs of GLP-1 Agonist
- MC: dose-dependent nausea
- nausea, HA, diarrhea
- hemorrhagic and necrotizing pancreatitis
- serious hypoglycemia (when used in combo w/ SU or meglitinide)
What are the rapid acting insulin preps?
- Novolog
- Humalog
- Apidra
What are the long acting insulin preps?
- Lantus
- Levamir
short acting insulin prep
Regular (Humalin R and Novalin R)
intermediate acting insulin prep
NPH (Humalin N and Novalin N)
Bolus insulin
- Novolog
- Humalog
- Apidra
- Regular
Basal insulin
- Lantus
- Levamir
- NPH
Given a regimen of bolus insulins, select the appropriate administration time.
- rapid acting: 15 min. before meal
- short acting: 30 min. before meal
Given a regimen of basal insulins, select the appropriate administration time.
- basal are injected once or twice daily (12 hrs apart) without regard to meals
- the injections should be at the same time daily
What is the purpose of rotating insulin injection sties?
to avoid or decrease the development of lipodystrophy (hypotrophy or atrophy)
Define U-100, U-200, U-300
- U = number of units of insulin per milliliter of fluid
- Ex: U-100 means there are 100 units of insulin per mL of fluid (same for 200 and 300)
- All vials are 10 mL (1,000 units of insulin per vial)
Insulin storage
- unopened vials should be kept in the fridge not freezer
- open vials can be kept at room temp (60-75 degrees) **except Lantus which has to be refrigerated
- discard after 28-30 days
- pens have expiration dates (10-14 days once used)
- keep out of sun and humidity
- avoid excess agitation (don’t shake)
which insulins should be clear vs. cloudy?
- clear: lantus, regular, humalog, nocolog
- cloudy: NPH
clinical indications for the use of insulin in T2D
- severe hyperglycemia (glucose toxicity) BG > 300 mg/dl
- temporary situations like pregnancy
- when co-morbid chronic conditions such as CHF, renal insufficiency or liver dz exists that makes it hard to use oral agents safely
- for tx of acute hyperglycemia complications such as hyperosmotic syndrome
Choose the appropriate starting dose and monitoring parameters for a patient with T2DM starting insulin
- start w/ bedtime basal insulin - 10U or 0.1-0.2 u/kg
- check fasting BG daily and increase dose 2U q 3 days until fasting levels are in target range
- if hypoglycemia occurs then decrease dose by 10%
titration options
- 2U every 3 days
- per the chart: 10-15% or 2-4U once-twice weekly
How to initiate a bolus insulin dose in a patient who is already using basal insulin
- Add a rapid acting insulin for post-prandial control
- Start with the time of day blood sugar is highest
- Start with 4 Units, 0.1 U/kg, or 10% of basal dose (Letassy says 5-10 units is fine)
- Adjust dose by 1-2 U or 10-15% once or twice weekly until reach target glucose levels
- Dosing is best based on CHO counting
given a pt. on a basal bolus insulin regimen, convert to a split mixed insulin product
- divide current basal dose into 2/3 AM 1/3 PM or 1/2 and 1/2
- increase dose 1-2U or 10-15% once-twice weekly until target is reached
