Lecture 11: Insulin (exam 3) Flashcards
Insulin therapy
biosynthesis: recombinant DNA origin
- genetic code for humin proinsulin is inserted into plasmid of ___ or ___ or yeast
- end product is indentical to human insulin after purification
E. coli
S. cerevisiae
Physical and CHemical Properties
T or F: NPH is a solution
F; suspension
not IV
Physical and CHemical Properties
Glargine is a ___ solution, but do not give ___
- ___ at physiological pH
clear
IV
precipitates
Physical and CHemical Properties
T or F: aspart, glulisine, lispro, and regular insulin are all approved for IV use
T; But there’s no advantage in using aspart, glulisine, or lispro in comparision in regular. Regular is cheaper, so use that one
Physical and CHemical Properties
Detemir and Degludec are ___ solutions but do not give ___
clear
IV
Insulin Uses
type I and II
- high fasting glucose levels: > ___ - ___ mg/dL
- pts with ___
- ___ diabetes
- hyper___
- type ___ diabetes in combination with various non-insulin agents
- 280-300
- ketoacidosis
- gestational
- hyperkalemia
- II
Difference between Toujeo and Toujeo Max
Max: single dose ___ units vs ___ units
- 80
- 160
factors altering insulin action
- route of administration: ___ > ___ > ___
- site of injection: ___ fastest, ___ and ___ slowest
- temperature: heat ___ absorption and action
- exercise/massage ____ absorption and action
IV > IM > SQ
- stomach, buttocks, thigh
- increases
- increases
factors altering insulin action
preparation/mixtures
- short acting effects of insulins may be ___ if mixed incorrectly
- U-500 regular insulin has a delayed ___ , peak, and longer ___ than U-100, but smaller volume allows for more ___
dont want to introduce cloudy NPH into clear, short acting insulin
- lost
- onset, duration, absorption
factors altering insulin action
Renal function
- renal failure ___ insulin clearance, thereby ____ insulin action
- 15-20% of insulin metabolism occurs in the ___
- decreases, increasing
- kidneys
Insulin Stability
- insulin vials are stable at room temp for ___ days
- ___ days with levemir
- insulin pens are variable ____ - ___ days
- open pens/vials should be discarded after ___ days
- insulin in prefilled syringes are stable for ___ days with refigeration as long as not ___
- insulin in prefilled syringes is stable for ___ - ___ days at room temp (highly variable)
- 28
- 42
- 7-56
- 28
- 28, mixed
- 10-28
Mixture stability
- regular/NPH: stable for ___ days in refrigerator; draw up ___ first
- aspart, glulisine, or lispro with NPH: must be given ___
- degludec, detemir, and glargine with any other insulin: ___
- 7, short acting
- immediately
- NEVER
complications of insulin therapy - hypoglycemia
Causes
- increased ___ doses
- decreased ___ intake
- increased ___ utilization
- excessive ___
- insulin
- caloric
- muscle
- alcohol
complications of insulin therapy - hypoglycemia classification
level 1) glucose < ___ mg/dL
level 2) glucose < ___ mg/dL
level 3) severe event with altered ___ and/or ___ functioning needing another person for recovery
- 70
- 54
- mental, physical
hypoglycemia signs and symptoms
- tremors
- diaphoresis
- anxiety
- dizziness
- hunger
- tachycardia
- blurred vision
- weakness/drowsiness
- headache
- irritability
- confusion
- slurred speech
hypoglycemia treatment - rule of 15s
- start with ___ gm of fast acting carbohydrate unless BS < ___ mg/dL (then they can use ___ gm)
- wait ___ min, check BS again. if BS is not > ___ mg/dL, repeat with another ___ gms
- eat your meal if it is in within the hour
- eat ___ gm snack if meal is over an hour away
- ___ for level 2 or 3 patients
- 15, 50, 30
- 15, 79, 15
- 30
- glucagon
hypoglycemia treatment - rule of 15s
examples of glucose sources:
- 4 oz ___
- 6 oz ___
- ___ lifesavers
- ___ tsp sugar
- ___ T honey
- ___ glucose tabs ( ___ gm CHO/tab) or gel
- OJ
- cola
- 5-6
- 2
- 1
- 4, (4-5)
changing between U-100 therapies
- pts switching from daily NPH to glargine/detemir/degludec, keep dose the same
- pts switching from BID NPH to glargine/detemir/degludec, decrease dose by ___ %
same
20%
T or F: you cannot mix other insulins with long acting insulin
T; available in premixtures
hypoglycemia treatment - rule of 15s
Glucagon for level ___ and ___ pts
- 3 mg intranasal ___
- 1 mg SQ, ___ , or IV glucagon
- 0.6 mg SQ ___
2, 3
- Baqsimi
- IM
- dasiglucagon
complications of insulin therapy
- weight ___
- lipo___ - repeated injections into the same site
- lipo___ - concavities caused by destruction of fat from antibodies or allergic reactions (rare with human insulin)
- gain
- lipohypertrophy
- lipoatrophy
review of agents
which analogs closely simulates physiologic insulin secretion relative to meals? (3)
glulisine, lispro, or aspart
Advantages of Short acting insulin
- decrease ____ hypoglycemia
- superior ___ lowering of BG
- fewer overall occurances of ___
- less ___ hypoglycemia
- greater flexibility
- post prandial
- post prandial
- hypoglycemia
- nocternal
made to take befor you eat, but you can also give after (good for kids)
Disadvantages to short acting insulin
- risk of hypoglycemia if no meal within ___ min of dose
- will need to combine with ___ acting insulin for optimal BS control
- if mixed with another insulin, give ___ after mixing
- hyperglycemia and ___ may occur more rapidly if insulin delivery in interupted
- 15 min
- long
- immediatley
- ketosis
