Insulin therapy Flashcards
Major adverse effects of insulin?
- hypoglycemia
- hypokalemia
- lipodystrophy
- local or systemic allergic reaction
- somogyi effect
What is the somogyi effect?
- if blood sugar drops too low in early morning hours (3-4 am): hormones 9GH, cortisol, and catecholamines) are released -> blood sugar rebounds
- these help reverse low blood sugar level but may lead to elevated blood sugar levels in the morning
- this may occur if pt who takes insulin doesn’t eat a regular bedtime snack resulting in decreased blood sugar in early AM
What is the Dawm phenomenon?
- normal rise in blood sugar as person’s body prepares to wake up
- in early morning hours, GH, cortisol, and catecholamines cause liver to release large amounts of glucose into bloodstream
- if there isn’t enough insulin to cover this than AM glucose will be high
Smogyi vs. Dawn?
- check blood sugar levels at bedtime, around 2-3 am, and at normal wake up time for several nights. A continuous glucose monitor could also be used throughout the night (happens in type 1)
- if blood sugar level low at 2 am to 3 - suspect somogyi effect
- if blood sugar level normal or high at 2-3 am than likely it is the dawn phenomenon
Main problem and solution in smogyi effect?
- taking too much insulin and not eating enough before bed
- eat bedtime snack or cut back on insulin
Main problem and solution in dawn phenomenon?
- going to have that normal rise of blood sugar in the morning so need enough insulin to cover rise
What are the rapid acting analogs of insulin?
- just used to cover meals
- Lispro (humalog)
- Aspart (Novolog)
- Glulisine (Apidra)
What are the short acting insulins?
- human insulin
- human Regular (Humulin R and Novolin R)
What are the intermediate acting (basal) insulins?
- human NPH
- Lente (Humulin L and Novolin L)
What are the basal insulin analogs?
- Glargine (Lantus)
- Detemir (Levemir)
- Degludec (Tresiba): not out yet
What has better effect, human insulin or non-human insulin?
- human insulin doesn’t stick around in the body as long, so you want to prescribe analogs for better effect
What is the difference between human insulin and insulin analogs?
- human insulin (NPH and Regular) don’t replicate the time to peak concentration or duration of action of endogenous insulin secretion
- rapid acting insulin analog preps have: faster onset and shorter DOA than regular insulin
- long acting insulin analog preps have: longer onset of action and a flatter serum concentration than NPH for basal coverage
- analogs resemble endogenous insulin
Human insulin action profile?
- give NPH human: get rapid rise and peak but then drops (this is basal - intermediate acting)
- give glargine and its more even of an effect, doesn’t really peak, just stays constant
What is conventional insulin therapy?
- either single daily injections, or 2 injections per day of regular and NPH insulin, mixed together in the same syringe and given in fixed amounts before breakfast and dinner
What is intensive insulin therapy?
more complex regimens that:
- basal insulin delviery ( given as 1 to 2 daily injections of intermediate or long acting insulin)
- with superimposed doses of short-acting or rapid-acting insulins 3 or more times daily (bolus every time they eat)