Rapid Insulin Flashcards
Rapid acting insulins include:
Aspart, lispro, glulisine
The onset, peak and duration of action for rapid acting insulin
Onset: 5-15 min.
Peak: 45-75 min.
Duration: 2-4 hours
Regular is considered
Short acting insulin and it has an onset of 30 minutes, a peak of 2-4 hours, and a duration of 6-8 hours
Intermediate acting insulin includes
NPH
The onset, peak, and duration of intermediate acting insulin is
Onset: 2 hours
Peak: 4-12 hours
Duration: 18-28 hours
Long acting insulin includes
Detemir
Glargine
Onset, peak and duration for long acting insulin is
Onset: 2 hours
Peak: 3-9
Duration up to 24
The most commonly used commercial preparation is
Insulin U-100
Type 1 DM patients
Require at least two daily SQ injections of intermediate or long acting insulin and rapid acting insulin following meals
The benefit of lispro is
Decrease in postprandial hyperglycemia and less risk of hypoglycemia
Lispro has a lysine switch that prevents
Hexamer formation and the monomer is rapidly absorbed
Regular insulin is the only
Preparation that can be given IV and subcutaneous
What are the five main side effects of insulin?
Hypoglycemia (most serious side effect) and the first symptoms are compensatory effects of increased epinephrine secretion (diaphoresis, tachycardia, HTN) Allergic reactions Lipodystrophy Insulin resistance Drug interactions
The four classes of oral anti diabetics include:
Secretagogues, biguanides, thiazolidinediones, and alpha glucosidase inhibitors
Contraindications for metformin include
Lactic acidosis, AKI, GI intolerance, and acute hepatic disease
Metformin does not
Undergo metabolism!
The mechanism of action of metformin is
It activates adenosine monophosphate activated protein kinases
Metformin should be
Discontinued 48 hours prior to surgery and should not be administered in patients with hepatic dysfunction, renal insufficiency, IV contrast dye, acute MI, CHF arterial hypoxemia and sepsis
Sulfonylureas should not
Be administered to patients with sulfa allergy
Secretagogues
Include sulfonylureas and meglitinides increase insulin availability
Biguanides
Include metformin and it suppresses excessive hepatic glucose release
Thiazolidinediones or glitazones
Include rosiglitazone and pioglitazone and they improve insulin sensitivity
Alpha glucosidase inhibitors include
Acarbose and Miglio ok and they delay GI glucose absorption (used to maintain glucose control)
With sulfonylurea oral hypoglycemics
Hypoglycemia while infrequent is more often prolonged and more dangerous than hypoglycemia from insulin
Sulfonylureas close
K-ATPase channels and inhibit ischemic preconditioning (CV mortality has been associated with sulfonylureas)
Accumulation of active metabolites
May cause hypoglycemia with nateglinide
Acarbose and Miglitol work by
Decreasing carbohydrate digestion and absorption of dissachardies by interfering with intestinal glucosidase activity
Thiazolidinediones work by
Decreasing insulin resistance and hepatic glucose production and increase use of glucose by the liver
Glucagon like peptide 1 receptor agonists
Increase insulin secretion from beta cells (glucose dependent)
Amylon agonists
Do not alter insulin levels and instead readied HBA1 C
The goal of combination therapy is:
Decrease hba1c, decrease in daily insulin dose
Diabetic autonomic neuropathy is
Decreased ability to compensate/risk of CV stability/ sudden cardiac death
Diabetic patients should be
Assessed for temporomandibular joint and cervical spine mobility to assess difficult intubation
Glucose levels should be kept less than
180 mg/dL Intraop
AM dose of regular insulin
Should be held on the day of the surgery
Plasma glucose should be monitored
Q30 minutes or hourly
What drugs should be discontinued 24-48 hours before surgery?
Sulfonylureas and metformin due to long half lives