INSULIN

Question 1

what is diabetes mellitus, what are the results of it?

Answer 1

chronic disease of deficient glucose metabolism
- results in hyperglycemia

Question 2

what are the major symptoms of diabetes mellitus?

Answer 2

polyuria, polydipsia, polyphagia

Question 3

what are the types of diabetes?

Answer 3

type 1: insulin dependent
type 2: non insulin dependent
secondary (due to meds)
gestational (hormone changes)

Question 4

where is insulin released from? what is the function?

Answer 4

released from beta cells of islets of langerhans in pancreas
functions:
promotes uptake of glucose, amino acids and fatty acids
converts glucose to glycogen

Question 5

what is the normal fasting blood glucose range

Answer 5

70-99

Question 6

what are the diagnostic HgA1C values

Answer 6

non diabetic: 5% or less
pre-diabetic: 5.7-6.4%
diabetic: 6.5% or more
**optimal for diabetics is 7% or less

Question 7

how to store insulin?

Answer 7

refrigerated if opened
room temp for 1 month
avoid sunlight and high temps

Question 8

what are the rapid acting insulins?

Answer 8

insulin lispro (humalog)
insulin aspart (novalog)
insulin glulisine
oral inhalation insulin

Question 9

what is the onset, peak and duration of rapid acting insulin?

Answer 9

onset: 15-30 min
peak: 30-90 min
duration: 3-5hr

Question 10

what are the short acting insulins?

Answer 10

regular: humulin R, Novolin R, regular insulin

Question 11

what are the onset, peak and duration of short acting

Answer 11

onset: 30 min SQ, 15 min IV
peak: 2.5-5 hrs SQ, 15-30 min IV
duration: 4-12hrs SQ, 30-60 min IV

Question 12

what are the intermediate acting insulins? what are the onset, duration and peak of them?

Answer 12

insulin isophane NPH (humulin N, Novolin N)
onset: 1-2 hrs
peak: 4-12 hrs
duration: 14-24hrs

Question 13

what are the long acting insulins? what are the onset, peak and duration?

Answer 13

insulin glargine (lantus, tovjeo)
onset: 1 hr
peak: none
duration: 24 hrs
**administered at bedtime

Question 14

what are the combos of insulins?

Answer 14

composed of short and intermediated acting OR rapid and intermediate acting
NPH 70/regular 30
NPH 50/ regular 50

Question 15

what are insulin interaction?

Answer 15

decreased hypoglycemic effect with thiazides, glucocorticoids and estrogen and oral contraceptives, thyroid drugs, furosemide and green tea and smoking
increased hyperglycemic effect with TCAs and MOIs, tetracyclines, aspirin, oral anticoagulants, alcohol, beta blockers, ace inhibitors and ARBs(?)

Question 16

what are the general side effects of insulin

Answer 16

hypoglycemia: tachy, slurred speech, lack of coordination, confusion, trembling, cold/clammy skin
somogyi effect: response to excess insulin, occurs in pre-dawn hours, rapid decrease in BS during night
lipodystrophy: when you continuously use same site for insulin
dawn phenomenon: hyperglycemia when waking up
diabetic ketoacidosis: hyperglycemic reaction leads to fat catabolism
- extreme thirst, polyuria, fruity breath
kussmaul respirations: deep, rapid, distressed breathing

Question 17

what is insulin resistance ?

Answer 17

body tissues do not respond to action of insulin (insulin receptors or either unresponsive, or deficit in numbers)
antibodies cause insulin resistance and allergy

Question 18

what are the methods of the insulin administration

Answer 18

injection: SQ or IV (short acting)
insulin pen injectors
insulin jet injectors
insulin pumps

Question 19

what does sliding scale insulin involve?

Answer 19

short or rapid acting