WEEK 3+4 PHARMA Flashcards
Insulin is always required for type 2 diabetes. True or false?
False, Always required for type 1 diabetes
What is done for people with type 1 diabetes when body does not produce endogenous insulin?
replacement therapy
goal of insulin therapy
prevent long term complications of diabetes by keeping BG levels within targeet ranges
Are insulin requirements the same throughout for everybody?
No, it varies in response to fluctations of BG that occur with daily activities - excersise, sleeping, eating
Insulin: indication, moa, desired effects and adverse effects
Indication: required for those with type 1 diabetes and for those whose BG is uncontrolled in type 2 diabetes
Mechanism of action: replacement for endogenous insulin - literally works like endogenous insulin
Desired effects - restores ability to metabolize carbohydrates, fats and proteins, glucose uptake by cells
Adverse effects: Hypoglycemia (taking too much insulin, not timing insulin right with food intake, skipping a meal)
TCSD - Totally Care Seeing you Die
Signs of hypoglycemia
T- Tachycardia
C - confusion
S - sweating
D - drowsiness
If severe - convulsions, coma, death
How is hypoglycemia treated
glucagon, D50W or glucose source
Are insulin dosages/routes the same for everyone? if so, what does it depend on?
No, doses and route are higly individualized for each client
depends on - how many doses daily, type of insulin (long vs short)
Common route for insulin
subcutaneous
why is insulin given subcu and not orally or any other way?
if intramuscular - uptake is super fast and can be inconsistent
if oral - goes through digestive enzymes and may not produce action
what is an insulin pump?
- to deliver small doses of insulin at predetermined intervals, with large boluses programmed manually at mealtimes
- pump delivers insulin through small pliable catheter that is anchored in SC tissue of abdomen
Types of insulin
Rapid - Lispro
Short acting (regular) - Humulin-R
Intermdiate acting - Humulin - N
Long acting - glargine
Diabetes checklist
- USE - basal-bolus injection therapy or continuous subcutaneous insulin injection
- TAILOR - insulin regimen to treat individual treatment goals lifestyle, diet, age, general health, motivation, hypoglycemia motivation, self management
- COUNSEL- about the risk, prevention and treatment of insulin-induced hypoglycemia
Difference between basal - bolus injection therapy and continuous subcutaneous insulin infusion
- Basal-bolus injection therapy - bolus insulin at mealtime+basal insulin once or twice a day
- continuous subcu insulin infusion - insulin pump therapy with a continuous subcutaneous infusion of insulin via a catheter
Rapid:Lispro
- bolus injection
- prandial - 15 minutes before or after a meal
- onset of action - 10-15 minutes
- peak - 30-60 minutes
- duration of action - 5 hours or less
- used in combination with intermediate or long acting insulin - basal
short acting - Humulin R
-AKA regular
- bolus injection
- given 30 minutes before meal with one or more meals
- hypoglycemic reactions can occur if regular insulin is not supported by suffiecient food or is given to hypoglycmeic patients
- onset - 30-60 minutes
- peak effect- 2-3 hours
- duration of action - 5-7 hours
Intermediate - Humulin N
- basal insulin
- often started once daily at bedtime
- can be given once or twice a day , not specific to meals
- onset - 1-3 hours
- peak effect - 5-8 hours
- duration of action - longer acting source of insulin - upto 18 hours
Long acting - Glargine
- basal insulin
- once daily at bedtime
- no specific peak (provides consistent BG levels)
- onset - 90 minutes
- duration - upto 24 hours
Role of nurse: insulin therapy
- familiar with onset, peak, duration
- convey info to client
- explain hypoglycemia and DKA and what actions to take
- not all insulin are compatible and may not be mixed together in a single syringe
- provide education bout insulin, potential adverse effects, technique for self administering insulin, diet and lifestyle
- monitor - BG levels, increase frequency of testing if client has fever, vomiting, diarrhea, weight on regular basis, serum K levels, urine for ketones if BG above 14mmol/L, signs of long term complication
- rotate injection sites and monitor for signs of irritation/infection
- have client report adverse effects related to insulin therapy
When is hypoglycemia most likely to occur?
- when insulin reaches its peak effect
- during excersise - depletion of glycogen stores needd to compensate for you working out
- acute illness
why is insulin used in caution for pregnant clients or those with severe stress/infection
- increased insulin requirements and must be monitored more carefully
Client education - insulin therapy
- closely monitor BG before each meal and before insulin adminsitration
- always carry source of simple sugar in case of hypoglycemic reactions
what do you do If BG less than 4 mmol/L
take a fast acting carbohydrate (15g glucose tablets, 3tsp sugar or 1/2 cup orange juice)
- repeat in 15 minutes if blood glucose is still less than 4mmol/L
- is there is more than 1 hour until next meal, eat a snack of starch and protein
remember hypoglycemia - too much insulin is given
Signs of hypoglycemia
- nervousness
- confusion
- excessive sweating
- rapid pulse
- tremors
- signs of overdose
remember hyperglycemia (too much glucose - insulin is not right)
Signs of hyperglycemia
- increased thirst or urine output
- decreased appetite
- excessive fatigue
what to do when youre not sure about whether they are hypo/hyperglycmeic?
treat for hypoglycemia - hypoglycemia progresses rapidly and hyperglycemia progresses slowly
why do we need to rotate insulin sites?
to prevent lipodystrophy - person lose fat from parts of body and gains it in organs
do I keep insulin vials in the fridge?
No, store at room temp but refrigerate to keep it stable when not needed
Pharmacotherapy in type 2 diabetes
- choose intial therapy based on glycemia
- start with metformin
- individualize your therapy choice based on characterists of the person with diabetes and the agent
- reach target within 3-6 months of diagnosis
if glycemic targerts are not achieved in 3 months, what do you do (type 2)
antihyperglycmeic therapy should be added to reduce the risk of microvascular complications
why is metformin chosen over other agents
due to its low risk of hypoglycemia and weight gain
Choice of therapy? (type 2)
A1C<1.5% over target - initate healthy behavior intervention and start metformin if not at target in 3 months or start metformin with healthy behavior interventions
A1C> 1.5% over target - start metformin with healthy behavior interventions or consider second concurrent agent
How is type 2 diabetes controlled?
- some clients can achieve target BG levels with nutrition guidance and physical activity alone
- but most also need oral antihyperglycemic drugs
- insulin only prescribes when BG not controllable by other means
So when is insulin used for type 2 diabetes?
- symptomatic hyperglycemia and/or metabolic decompensation
- polyuria
- polydipsia
- weight loss
- volume depletio
- start insulin with/without metformin
Three core mechaninsms contributing to type 2 diabetes?
- decreased insulin stimulated glucose uptake - insulin resistance
- impaired insulin secretion - beta cell dysfunction
- excessive glucagon secretion and increased hepatic glucose production
