Insulins

Question 1

what insulin acts more rapidly than regular insulin but have a shorter duration of action?

Answer 1

• insulin lispro

Question 2

insulin lispro: class

Answer 2

• short duration: rapid acting insulin

Question 3

insulin lispro: MOA

Answer 3

• effects w/in 15- 30 min and last 3-6 hours
• faster than regular insulin but has a shorter duration
• administered immediately before eating
• given via subQ

Question 4

insulin: indications

Answer 4

• diabetes mellitus
  
  • required for all pts with type 1
  • many pts with type 2
• iv: diabetic keoacidosis
• diagnosis of growth hormone deficiency

Question 5

insulin: SEs

Answer 5

• hypokalemia
• swelling
• erythema
• lipohypertrophy: accumulation of subQ fat under injection site

Question 6

insulin: ADRs

Answer 6

• hypoglycemia
  
  • need to treat immediately b/c can cause brain damage or death
  • give fast acting sugar, IV glucose
  • can result in coma
• diabetic ketoacidosis
  
  • can result in coma
  • requires giving insulin
• anaphylaxis

Question 7

insulin: nursing implications

Answer 7

• teach pt to prepare subQ injections
  
  • roll vial of insulin suspension in hands
  • swab cap
  • eliminate air bubbles
  • cleanse skin
• sites of injection:
  
  • abdomen, upper arm, thigh
    
    • make all injections in just one of these areas
  • leave 1 in b/w sites
• store unopened vials in fridge
  
  • can keep vial in current use at room temp for 1 month
• teach pt to use glucometer
• teach pt to recognize the S/S of hypoglycemia: tachycardia, palpitations, sweating, headache, drowsiness

Question 8

regular insulin: class

Answer 8

• short duration, slow acting insulin

Question 9

regular insulin: MOA

Answer 9

• route: subQ injection/infusion, IM injection, oral inhalation
• can be injected before meals to control post prandial hyperglycemia
• effects in 30-60 min, peak in 1-5 hours, last 10 hours

Question 10

insulin isophane suspension: class

Answer 10

• intermediate duration
• NPH

Question 11

insulin isophane suspension: MOA

Answer 11

• prepared by conjugating regular insulin with protamine which dec the solubility of the insulin and delays absorption
• onset of action is delayed and duration of action extended
• DO NOT administer at meal time
  
  • inject 2-3 times daily to control glycemic control b/w meals and during the night

Question 12

insulin glargine: class

Answer 12

• long duration insulin

Question 13

insulin glargine: MOA

Answer 13

• prolonged duration up to 24 hours
• indicated for once daily subQ dose
• give dose at same time every day
• b/c it has a low solubility at physiologic pH, it forms microprecipitates that slowly dissolve and release insulin over a long period of time
  
  • achieves blood levels that are relatively steady

Question 14

insulin detemir: class

Answer 14

• long duration

Question 15

insulin detemir: MOA

Answer 15

• slow onset and dose dependent duration of action
  
  • low dose: lasts 12 hours
  • high dose: 20-24 hours
• used to provide basal glycemic control
  
  • not given before meals
• absorption is delayed b/c fatty chains on the insulin adhere to each other and b/c the detemir binds strongly to albumin

Question 16

insulin zinc suspension: class

Answer 16

• short acting insulin

Question 17

glucagon: class

Answer 17

• polypeptide hormone produced by alpha of the pancreas

Question 18

glucagon: MOA

Answer 18

• has effects on carb metabolism that are opposite those of insulin
  
  • acts on liver and muscles
• promotes breakdown of glycogen to glucose, reduces conversion of glucose to glycogen, and stimulates synthesis of glucose
  
  • causes plasma glucose to rise
• promotes relaxation of GI smooth muscle

Question 19

glucagon: indications

Answer 19

• severe hypoglycemia
• antidote to beta blockers, CCBs

Question 20

glucagon: SEs

Answer 20

• nausea
• vomiting
• hypotension

Question 21

glucagon: ADRs

Answer 21

• anaphylaxis

Question 22

glucagon: nursing implications

Answer 22

• monitor blood glucose
• if available, use IV glucose instead of glucagon to raise blood sugar b/c it works faster than glucagon
  
  • glucagon takes 20 min or so
• cannot correct hypoglycemia caused by starvation b/c it acts by breakdown of glycogen