Insulin in DM Flashcards
T/F Insulin therapy has CHF risk
True
What is two major ADE of insulin therapy
- Hypoglycemia
2. Weight gain
MOA of NPH?
NPH – insulin bound with protamine and zinc –less soluble with longer duration of action
MOA of Detemir?
Detemir - fatty acid side change added - binds to albumin – slows absorption
MOA of glargine?
Glargine – low solubility at neutral pH forming a precipitate in SQ tissue - slows absorption
MOA of degludec?
Degludec – long chains of hexamer in SQ tissue depot - leads to slow release for absorption
MOA of Lispro, Asport, and Glulisine?
rapid acting
Altered DNA sequence of amino acids decreases formation of hexamer and will increase absorption and onset of action
What are the raid acting drugs?
Lispro, Aspart, Glulisine
All are analogs
28 day room temp expiration
Which short acting insulin has a 42 day expiration?
Novolin R
What are 2 premixed insulin/GLP-1R antagonist
degludec/liraglutide: prefilled pen
Glargine/Lixisenatide
If inuslin therapy is needed what do you start?
consider GLP-1R antagonist sub Q
or
basal insulin or bedtime NPH
What can you add if A1C is still elevated and NPH and basal insulin is already started?
add prandial insulin
What is starting point for insulin therapy in Type I DM?
- Must begin basal-bolus insulin
- Basal-bolus therapy includes a basal insulin for fasting and post absorptive control
- -Rapid acting bolus insulin for mealtime
What is starting point for insulin therapy in Type II DM?
May begin with background/basal insulin with usually metformin +/- GLP-1
-If all things else are accounted for and yet A1c and blood sugars are increasing Consider dosing insulin for both basal first and add bolus (mealtime) as needed
-If economics is a factor
Use of the traditional insulins NPH and R can be prescribed
What is starting point for insulin therapy in Type II DM?
May begin with background/basal insulin with usually metformin +/- GLP-1
-If all things else are accounted for and yet A1c and blood sugars are increasing Consider dosing insulin for both basal first and add bolus (mealtime) as needed
-If economics is a factor
Use of the traditional insulin NPH and R can be prescribed
which injection site has best insulin absorption
abdomen
-give injection in same site of body and at the same time each day
What is basal insulin replacement?
- Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals.
- The basal or background insulin dose usually is constant from day to day
What is bolus insulin?
The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction.
What are the use of traditional insulin?
improved adherence (less intense)
can achieve desired goal
financial concerns
requires patient eat consistent meals
What can be some causes of not acheiving glucose control
too much insulin
injection technique
outdated product
T/F The answer to all high glucose readings includes more insulin
False
What is the site that is best for insulin injection
abdominal wall
should always give the insulin injection in the same region of the body and at the same time of the day each day
How much carbs should men and women take per meal
women: 45-60
snack: 15
men: 60-75
snack: 15-30
Which drugs cause weight gain? (6)
steroids insulin, SU, TZD Antiepileptic: gabapentin, VA Antipsychotic: Clozapine Anti-depressants: TCA, mirtazapine HIV HAART
