Insulin

Question 1

Rapid acting

Answer 1

-onset: <15min
-peak: 0.5-2.5 hr
-duration: 3-6hr
-generic: lispro (Humalog), aspart (Novalog), glulisine (Apidra)

Question 2

Short acting

Answer 2

-onset: 0.5-1hr
-peak: 2-3hr
-duration: 5-7hr
-generic: Regular insulin (Humulin R)

Question 3

Intermediate acting

Answer 3

-onset: 1-2hr
-peak: 6-12hr
-duration: 16-24hr
-generic: NPH (Humulin N)

Question 4

Long acting

Answer 4

-onset: 1hr
-peak: none
-duration: 10-24hr
-glargine (Lantus), Detemir (Levemir)

Question 5

Insulin preparation

Answer 5

-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

Question 6

Storage of insulin

Answer 6

-don’t heat or freeze
-room temp up to 4 weeks
-avoid exposure to direct sunlight

Question 7

Insulin administration

Answer 7

-2ND CHECK WITH NURSE**
-KNOW S/S OF HYPOGLYCEMIA AND TEACH
-IV only regular

Question 8

Insulin pump

Answer 8

-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

Question 9

Sliding scale

Answer 9

-MD order for dose
-given according to glucose check ACHS or q 4 hrs
-regular insulin

Question 10

Diet change and insulin

Answer 10

-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

Question 11

Problems with therapy

Answer 11

-hypoglycemia
-allergic
-lipodystrophy: dissolve fat @ site
-somogyi effect: decline glucose bc too much insulin
-dawn phenomenon: hyperglycemia when waking

Question 12

Sulfonylureas

Answer 12

-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

Question 13

Glucosidase inhibitor

Answer 13

-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）

Question 14

Biguianide

Answer 14

-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)

Question 15

Thiazolidinediones

Answer 15

-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

Question 16

Meglitinides

Answer 16

-increase insulin from pancreas
-take 15-30min ac; NOT IF MEAL SKIP
-no if with gemfibrozil—hypoglycemia
-AE: hypoglycemia
-repaglinide (prandin)
-nateglinide (starlix)

Question 17

Gliptins

Answer 17

-slow inactivation of incretin to allow increased activity
-AE: URI, headache, HF
-contraindicated: ESRD, hypoglycemic drugs
-sitalgliptin (januvia)
-saxagliptin (onglyza)
-linagliptin (tradjenta)

Question 18

Amylin mimetics

Answer 18

-adjunct to insulin for better BS control
-subq BID ac
-slows gastric emptying
-AE: N/V, hypoglycemia in type 1
-pramlintide (symlin)

Question 19

Incretin mimetics (more for type 2)

Answer 19

-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

Question 20

Sodium glucose contransporter 2

Answer 20

-provide renal protection
-monitor GFR!!!!
-AE: urination, electrolytes imbalance, yeast infections, AKI, bone demineralization
-canagliflozin (invokana)
-dapaglifozin (farxiga)
-empagliflozin (jardiance)

Question 21

Other agents

Answer 21

-adrenergic blocker: mask hypoglycemia
-thiazide: potentiate hyperglycemia
-corticosteroids: glucose raising

Question 22

Hyperglycemics

Answer 22

-treat hypoglycemia
-buccal rapid absorb
-glucagon: best option for unconscious with no IV, roll on side N/V
-D50W if patent IV present