Insulin Tx Flashcards
Pancreas secretes … (how much/when/phases)
30 units of insulin per day, in response to glucose, but also to maintain a basal level at all times
First phase: initial release over 5min
Second phase: occurs with sustained hyperglycemia (35-40 mins)
Mech of release
Glucose –> ATP/ADP up –> Ca into cell –> release of insulin (CHECK THIS)
Who gets insulin tx?
ALL with type 1
some with type 2 (ALWAYS if HbA1c >10%, if cannot control dz with lifestyle and non-insulin tx - or contraindications to other tx eg. renal or heaptic dysfxn, CHF)
Insulin for Type 1
1) Basal bolus (long acting on once per day and then rapid insulin before meal - calculate carbs)
2) continuous subC rapid acting-insulin (more costly, more difficult)
Insulin Tx Lab Goals
Fasting Glu: 70-130
2-h PP:
Early morning HYPERglycemia (due to?)
1) inadequate basal insulin
2) waning effect of basal insulin
3) somogyi effects (nocturnal HYPOglycemia causes surge of counter-regulatory hormones in morning)
Inpatient insulin
In hospitalized pts hyperglycemia can come from stress, meds etc.
STOP oral agents and ADMINISTER INSULIN (targets
Barriers to insulin Tx
Fear of injection Hypoglycemia Weight gain Stigma Inconvenience
Adjusting insulin
eliminate lows first, then highs, by adjusting dose 10-20%
When/how to monitor blood sugar?
Use glucometer, at least 2x per day (fasting, pre-lunch, pre-dinner, bedtime)
Rapid acting (-log) Lispro/Aspart etc.
Right before meal Used in SC inj, or pump Can be mixed with NPH Onset 5-15 min Peak 1-1.5 hr Lasts 3-5 hrs (2)
Short Acting (-lin R) (Novolin R/Humulin R)
Recombinant human insulin (Zn improves stabliity/shelf life) Inject 30 min before meal Used IV for DKA in hospital (also SC) Onset 30-60 min Peak 2 hrs Lasts 6-8 hrs (4-6)
Intermediate Acting (NPH) (-lin N) (Novolin N/Humulin N)
Usually for basal coverage Cloudy (so mix before admin, others are clear) Onset 2-4 hrs Peak 6-7 hrs Lasts 10-20 hrs (~12) SC inj only (2x per day)
Long-acting (Glargine, Detemir etc.)
CANNOT BE MIXED IN SAME SYRINGE WITH ANY OTHER INSULINS (because of acidic pH)
Onset 1-3 hr
NO PEAK
Lasts 24 hr (glargine) or 17 hr (or 18-22) (determir)
SC inj only
Biphasic/Mixed (NPH/Regular intermediate/-log)
Reduces # of injections, basal and prandial at same time
SC inj, rapid onsen right before meal then NPH/regular before breakfast and dinner for basal
