Insulin Flashcards
Rapid acting
-onset: <15min
-peak: 0.5-2.5 hr
-duration: 3-6hr
-generic: lispro (Humalog), aspart (Novalog), glulisine (Apidra)
Short acting
-onset: 0.5-1hr
-peak: 2-3hr
-duration: 5-7hr
-generic: Regular insulin (Humulin R)
Intermediate acting
-onset: 1-2hr
-peak: 6-12hr
-duration: 16-24hr
-generic: NPH (Humulin N)
Long acting
-onset: 1hr
-peak: none
-duration: 10-24hr
-glargine (Lantus), Detemir (Levemir)
Insulin preparation
-rapid: 0-15 mins ac
-onset 15 mins
-short acting: 30-45 mins ac
-onset 30-60 mins
-Long acting: inject once a day achs
-no peak
-cannot be mixed with any other insulin or solution
Storage of insulin
-don’t heat or freeze
-room temp up to 4 weeks
-avoid exposure to direct sunlight
Insulin administration
-2ND CHECK WITH NURSE**
-KNOW S/S OF HYPOGLYCEMIA AND TEACH
-IV only regular
Insulin pump
-continuous subcutaneous infusion of RAPID/SHORT 24hrs a day
-basal can be temporarily increase or decrease
-change site q 2-3 days
-advantage: potential for tight glucose control
Sliding scale
-MD order for dose
-given according to glucose check ACHS or q 4 hrs
-regular insulin
Diet change and insulin
-NPO: need MD input,hold or given according to orders
-Clear liquid diet: simple carb (diet drink, jello)
-tube: ATC 4-6hrs, stopped call MD
Problems with therapy
-hypoglycemia
-allergic
-lipodystrophy: dissolve fat @ site
-somogyi effect: decline glucose bc too much insulin
-dawn phenomenon: hyperglycemia when waking
Sulfonylureas
-increase insulin from pancreas
-Antabuse effects with ETOH
-admin with first meal or 30 min before
-assess hypoglycemia
-renal and liver impairment
-glipzide, glimepiride, glyburide
Glucosidase inhibitor
-preventing spike
-debate and reduces absorption
-no serious AE (GI upset, thrombocytopenia, leukopenia, anemia)
-TAKE WITH FIRST BITE OF EACH MEAL 3 TIMES A DAY IF MISSED AND MEAL DONE SKIP AND TAKE AT NEXT MEAL
-acarbose (precose）
Biguianide
-reduce glucose by liver, enhance sensitivity, improve transport
-AE: lactic acidosis, CHF, liver failure
-HOLD 48 HRS PRIOR AND AFTER SURGERY OR WITH CONTRAST
-metformin (glucophage)
Thiazolidinediones
-makes insulin work better
-SE/AE: fluid retention (CHF), elevated LDL, hepatoxicity, sinusitis
-contraindication: liver dx, HF
-rosiglitazone (avandia) with meals
-pioglitazone (actos) take whenever
Meglitinides
-increase insulin from pancreas
-take 15-30min ac; NOT IF MEAL SKIP
-no if with gemfibrozil—hypoglycemia
-AE: hypoglycemia
-repaglinide (prandin)
-nateglinide (starlix)
Gliptins
-slow inactivation of incretin to allow increased activity
-AE: URI, headache, HF
-contraindicated: ESRD, hypoglycemic drugs
-sitalgliptin (januvia)
-saxagliptin (onglyza)
-linagliptin (tradjenta)
Amylin mimetics
-adjunct to insulin for better BS control
-subq BID ac
-slows gastric emptying
-AE: N/V, hypoglycemia in type 1
-pramlintide (symlin)
Incretin mimetics (more for type 2)
-increase satiety, decrease gastric empty
-take 1hr ac, not after
-NOT ACHIEVED OPTIMAL CONTROL WHILE ON ORAL
-SE/AE: hypoglycemia, nausea, pancreatitis, thyroid CA
-exenatide (byetta) BID
-liraglutide (victoza) QD
-exenatide ER (bydureon) 1/wk
Sodium glucose contransporter 2
-provide renal protection
-monitor GFR!!!!
-AE: urination, electrolytes imbalance, yeast infections, AKI, bone demineralization
-canagliflozin (invokana)
-dapaglifozin (farxiga)
-empagliflozin (jardiance)
Other agents
-adrenergic blocker: mask hypoglycemia
-thiazide: potentiate hyperglycemia
-corticosteroids: glucose raising
Hyperglycemics
-treat hypoglycemia
-buccal rapid absorb
-glucagon: best option for unconscious with no IV, roll on side N/V
-D50W if patent IV present
