INSULINS Flashcards
RAPID acting insulin types (3)
- insulin aspart/NovoLOG
- insulin glulisine/Apidra/inhaled Afrezza
- insulin lispro/HumaLOG/Lyumjev
SHORT acting insulin types (2)
- regular insulin OTC/HumuLIN R, NovoLIN R, ReliOn R
- regular concentrated insulin Rx/Humulin R, Novolin R, HumuLIN R U-500.
INTERMEDIATE acting insulin names
isophane suspension insulin/ HumuLIN N, NovoLIN N, Novolin N Prefilled, ReliOn N.
LONG acting insulin types (3)
- insulin detemir/Levemir
- insulin degludec/Tresiba
- insulin glargine/Basaglar, Lantus, Semglee, Toujeo SoloStar
insulin MIXTURE types ((5)
- insulin degludec-insulin aspart / Ryzodeg 70/50
- insulin isophane suspension-regular insulin/ HumuLIN70/30, NovoLIN70/30
- NPH regular insulin mixture/ Humalin 7/30, Novolin7/30
- insulin lispro mixture/ HumaLOG Mix75/25, HumLOG mix 50/50
- insulin aspart mixture/ NovoLOG70/30, NovoLOG Mix Flexpen Prefilled 70/30.
insulin HOW IT WORKS
decreases blood glucose and allows cells to use glucose for energy
insulin MECHANISMS OF ACTION
- activates transport of glucose into cells
- facilitates conversion of glucose to glycogen
- indirectly increases blood pyruvate and lactate
- decreases phosphate and potassium
insulin INDICATIONS (3)
Type I DM (chronic/ pancreas produces no insulin)
Type 2 DM
Gestational diabetes
how to STORE insulins
- Keep away from heat/sunlight.
- Some can be stored at room temp for less than one month
- Regrigerate
- NPH and Premixed insulins should appear CLOUDY
- Regular, Rapid, and Long acting insulins should appear CLEAR
- do not freeze
For administration of insulins, which type of syringes should be used?
ONLY insulin syringes with markings matching units/mL.
Which types of insulins should appear as CLOUDY suspensions?
- Premixed and 2. NPH (neutral protamine Hagedorn) insulins
(trout semen)
which types of insulins should appear as CLEAR, colorless liquids? (3)
- regular human insulin
- rapid acting
- long acting
Is it OK to mix insulins when using a CSII pump?
NO
To prevent FATAL hypoglycemia & hypokalemia, which labs should be monitored often when regular insulin is being given IV?
BLOOD GLUCOSE
SERUM POTASSIUM
Common side effect of insulin use
hypoglycemia
What are the SOMOGYI and DAWN EFFECTS
post hypoglycemic HYPERglycemia or hyperglycemia upon waking… clinical research is mixed
insulin glulisine/Apidra/Afrezza ONSET, PEAK, DURATION
15-30 min onset
30min-90min peak
3-4hr duration
RAPID ACTING
insulin aspart/Novolog ONSET, PEAK, DURATION
onset 10-20min
peak 1-3hr
duration 3-5hr
RAPID ACTING
insulin lispro/Humalog ONSET, PEAK, DURATION
onset 15-20 min
peak 30 min- 90 min
duration 3-5hr
RAPID ACTING
insulin regular ONSET, PEAK, DURATION
onset 30 min
peak 2.5-5hr
duration up to 7hr
SHORT ACTING
insulin isophanse suspension NPH
ONSET, PEAK, DURATION
onset 1.5-4hr
peak 4-12hr
duration < 24hr
INTERMEDIATE acting
insulin degludec/Tresiba
ONSET, PEAK, DURATION
peak 9-12 h
duration 24hr after 8 doses?
this is a ONCE-DAILY insulin - but is considered INTERMEDIATE acting???
takes 3-4 days to achieve steady state
insulin detemir/ Levemir ONSET, PEAK, DURATION
onset 0.8-2hr
peak UNKNOWN??
duration _<_24h dependent upon concentration
LONG ACTING
insulin glargine/Basaglar, Lantus, SemGlee, Toujeo Solostar PEAK, ONSET, DURATION
onset 90 min
peak not identified
duration greater than >24h
LONG ACTING
which blood tests will be used to identify effectiveness of insulin therapy?
Fasting Blood Glucose
HbA1c q3m
Signs of HYPOglycemic reaction
- sweating
- weakness, dizziness
- chills
- confusion
- headache
- rapid pulse
- anxiety, tremors, slurred speech, hunger
“Cold and clammy, need some candy”
How are insulin requirements affected by STRESS, including illness or surgery?
Insulin requirements may INCREASE during times of stress
Signs of HYPERglycemia
- acetone breath
- polyuria
- flushing
- dry skin
- lethargy
“Hot and dry, sugar high.”
What should the nurse assess in patients receiving insulin therapy?
FBG/CBG
HbA1c
urine ketones during illness
look for decrease in polyuria, polydipsia, & polyphagia to indicate therapeutic response
What are three important points of patient teaching about insulin?
- Keep insulin equipment available at all times, with candy or oral glucose and glucagon kit
- Recognize HYPOglycemic reaction: headache, tremors, fatigue, tachycardia; and HYPERglycemic reaction: polyuria, thirst, flushing, dry skin, lethargy. (Cold and clammy, need some candy; hot and dry, sugar high)
- How to use blood glucose testing equipment
Insulin times of onset from fastest to slowest
TIMES OF ONSET
- insulin ASPART 15min
- insulin GLULISINE 15min
- insulin LISPRO 15min
- regular insulin 30-60 min
- insulin DEGLUDEC 1h (ultra long acting)
- insulin DETEMIR 1-2hr (long acting)
- insulin GLARGINE 1-2h (long acting)
- insulin ISOPHANE suspension/NPH onset 2-4h (intermediate acting)
Who are the three fast gals?
glulisine
aspart
lispro
which insulin is ULTRA LONG ACTING (up to 42 hours)?
insulin degludec
which long acting insulin has a typical duration of 24 hours
insulin glargine/Lantus
which long acting insulin has a duration ranging from 6-24h?
insulin detemir/Levemir
