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Therapeutics II > Lecture 25: Insulin Therapy > Flashcards

Lecture 25: Insulin Therapy Flashcards

1
Q

Insulin biosynthesis

A

-rDNA
-genetic code for human proinsulin inserted into plasmid of E. coli or bacteria/yeast to produce human proinsulin
-connecting peptide cleaved
-end product identical to human insulin

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2
Q

Physical and chemical properties fo insulin

A

-Lispro, Aspart, Glulisine, Regular insulin approved IV
-regular insulin used as IV formulation bc other ones are expensive and not even better
-NPH is suspension
-glargine and degludac are solutions

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3
Q

IV insulin

A

-REGULAR
-can use LAG but more expensive not worth it

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4
Q

insulin suspension

A

NPH

-cloudy solutions
-DO NOT give as IV

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5
Q

insulin solutions

A

-glargine
-degludec

-clear solutions
-do NOT give as IV

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6
Q

Insulin uses

A

-type 1 and 2 diabetes
-hyperkalemia
-type 2 diabetes in combo w noninsulin agents

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7
Q

insulin use in type 1 and 2 diabetes

A

-high fasting glucose levels > 280-300
-pt w ketoacidosis
-gestational diabetes
-whatever clinician says

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8
Q

Ultra short acting insulins

A

-Lispro (Humalog)
-Aspart (Novolog)
-Glulisine (Apidra)

-10-20 min onset
-dose after eating
-last 3-5 hours
-compatible when mixed w NPH

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9
Q

Short acting insulin

A

-Regular (Humulin R)

-take 30 min before meals

-30-60 min onset
-5-8h duration
-compatible w NPH

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10
Q

-intermediate acting insulin

A

-NPH (humulin N)
-2-4h onset
-8-12h duration
-peak 4-10 hours dont have to give lunch dose
-can combo w lispro, aspart, gluilisince, regular

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11
Q

Long acting insulin

A

-Glargine (Lantus)
-2-4h onset
-20-24h duration
-no peak
-no combo

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12
Q

Ultra long acting insulin

A

-Degludec (Tresiba)
-onset 1h
-24-48h duration
-no peak
-no combo

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13
Q

Insulin pre mixtures (short+long)

A

-NPH/regular mix 70/30 (Humulin 70/30 or Novolin 70/30)
-75% NPH (lispro instead of H) / 25% lispro (humalog 75/25) (or 50/50)
-70% aspart suspension / 30% aspart (Novolog 70/30)
-Degludec/aspart (Ryzodeg 70/30)

-add protamine to short acting to make last longer

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14
Q

Concentrated insulins

A

-Regular U500 (weight gain)
-Degludec U200
-Toujeo U300
-Lispro U200

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15
Q

Factors altering insulin action

A

-route of admin
-site of inj
-temp
-exercise/massage
-mixtures
-dose
-compliance
-pt errors
-irregular diet/exercise
-renal function
-stress
-drugs

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16
Q

Site of injection

A

-stomach fastest
-butt and thighs slowest

-dont change the site for same meals

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17
Q

Temp effect

A

-heat increases absortpion and action

-outside heat
-heat from exercise

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18
Q

Exercise effect

A

-inc absorption and action
-less insulin on exercise days
-impacts injection site

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19
Q

Prep/mixture effect

A

-short-acting effect may be LOST is mixed incorrectly or left too long

-U-500 vs U 100 regular

20
Q

Dose effect

A

-smaller dose are absorbed more RAPIDLY

21
Q

Renal function effect

A

-dec insulin clearance
=inc insulin action
-15-20% of insulin metabolized by kidneys

22
Q

Stress effect

A

-inc insulin clearance

23
Q

INsulin stability

A

-vials at room temp: 28 days
-refrigerate vials/pens not in use (NO FREEZE)
-opened: discard after 28 days max
-prefilled syringes (non-mixes): 28 days cold, 10-28 days room temp

24
Q

Mixture stability: Regular/NPH

A

-stable 7 days in fridge
-always draw up short-acting fast

25
Q

Mix stability: L/A/G + NPH

A

-give immediately

26
Q

Mix stability: Degludec or Glargine with any other insulin

A

-NEVER
-NOT COMPATIBLE

27
Q

Complications of insulin therapy

A

-HYPOglycemia
-weight gain
-lipohypertrophy
-lipoatrophy
-allergic reactions

28
Q

Hypoglycemia causes

A

-inc insulin dosage
-dec caloric intake
-inc muscle utilization
-excess alcohol

29
Q

Classification hypoglcemia

A

-Level 1: glucose <70
-2: <54
3: severe event w mental/physical impairment needing another peson for recovery

30
Q

Low blood sugar symptoms

A

-shaking
-sweating
-anxious
-dizziness
-hunger
-inc HR
-vision
-fatigue
-HA
-irritable

-lots of sx gonna be masked by beta blockers

31
Q

Hypoglycemia tx

A

-Rule of 15s
-15g carb (30g if BG<50)
-wait 15 min and check BG
-if not >70 mg/dL, repeat

-follow w complex carb (30g) if a meal is not planned within one hour

-glucagon for sever

32
Q

15g fact acting sugars

A

-4-5oz OJ
-4-6oz cola (half can)
-5-6 lifesavers
-4 tsp sugar
-1 T honey
-glucose tabs/gel

33
Q

Glucagon

A

-use for pt w severe hypoglycemia
-IN, SQ, IM, IV
-Baqsimi inhalation 3mg
-Glucagen injection 1mg
-Zegalogue injection 0.6mg

34
Q

Lipohypertrophy

A

-repeated inj into same site
-tumerous-like fat pads

35
Q

Lipoatrophy

A

-concavities caused by destruction of fat from immune response

36
Q

Advantages of ultra short

A

-dec postprandial hypoglycemia
-better lowering of BG
-less risk of hypoglycemia
-better flexibility

37
Q

Disadvantages of ultra-shorts

A

-risk of hypoglycemia if no meal right after dose
-need to use w long acting insulin
-must use immediately after mixing
-hyperglycemia may occur faster is insulin delivery interuppted

38
Q

Advantages of long acting

A

-24+ hour coverage w constant absorption
-good for pt w nocturnal hyperglycemia

39
Q

Disadvantages of long acting

A

-risk of cancer?
-can NOT be mixed w other insulin

40
Q

Glargine vs degludec

A

-degludec less hypoglycemia risk
-more expensive maybe

41
Q

Coverting U-100 insulins

A

-if pt changes from qd NPH to long acting, keep same dose
-if from BID NPH, dec dose by 20%

42
Q

Coverting U-100 to concentrated insulins

A

-if pt change from BID NPH to U-300 glargine, dec dose by 20%
-1:1 conversion between daily glargine or detemir to daily glargine (Toujeo) may need an inc dose over time
-1:1 conversion between basal insulin and U-200 insulin degludec (Tresiba)
-1:1 between lispro U-100 to U-200
-U-100 to U-500 maybe 20% dec depending on A1c (replaces basal and bolus insulin types)

43
Q

Conversion to U-500

A

A1c < 8%: dec daily dose 10-20%
A1c = 8-10%: same
A1c >10: inc dose 10-20%

-more at breakfast bc it hangs out longer

44
Q

If daily dose 150-300 units conversion to U500

A

-BID 60% before breakfast, 40% dinner
-TID: 40/30/30

45
Q

If TDD 300-600 units conversion to U500

A

-change to TID
-consider 10% dose at bedtime for 4th injection

46
Q

If TDD>600 conversion to U500

A

30/30/30/10

Therapeutics II (55 decks)

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