Wk 3 Diabetes Pharm Flashcards
Goal
prevent hyperglycemia and decrease chance of long-term complications
- must maintain a tight glycemic control and blood lipid levels
Ways to observe effectiveness
fasting blood glucose levels
HgbA1C
triglycerides
cholesterol levels
Insulin injections
given subq only
- back of arm
- umbilicus
- anterior of thigh
ordered in units
4 types of insulin
rapid acting
regular/short acting
intermediate
long-acting
Rapid acting
insulin lispro (Humalog/Novolog)
- onset = 15 minutes
- peaks = 1 hr
- duration = 2-4 hrs
GIVE WITH FOOD
GIVE IN CONJUNCTION WITH INTERMEDIATE OR LONG ACTING
Regular (short acting)
human regular (Humulin R/Novolin R)
- onset = 30-60 minutes
- peaks = 2-6 hours
- duration = 3-8 hours
can be given in IV drip/insulin infusion
typically given before meals
given to pts receiving tube feedings
Intermediate
NPH (Humulin N)
- onset = 2-4 hours
- peak = 4-10 hours
- duration = 10-20 hours
CLOUDY
injected twice daily
NPH draw up
can be administered with rapid acting insulin and short acting insulin
CLEAR BEFORE CLOUDY
Long acting
glargine (Lantus)
- onset = 70 minutes
- peak = none
- duration = 24 hours
ONCE A DAY DOSING, normally at night
DO NOT MIX WITH OTHER INSULINS
Blood sugar monitoring
MUST KNOW FSBG before any insulin
CGM = continuous glucose monitoring
Insulin pumps
normally don’t have these in hospital
- used mostly in type 1, can be used in type 2
- computerized devices with a basal infusion of REGULAR insulin
- bolus doses calculated to match carb intake
Insulin Sliding Scale
regular insulin doses given throughout the day with meals according to blood glucose levels that are taken
- can also include a basal dose of long-acting insulin
- make sure to educate pt about this
Insulin complication of hypoglycemia
- insulin overdose
- decreased caloric intake
- pt v/d
- excessive alcohol
- unaccustomed exercise
- childbirth
Hypoglycemia s/s
tachycardia
sweating
nervousness
HA
drowsy
fatigued
decreased LOC
Hypoglycemia treatment
oral CHO intake (eat/drink)
parenteral glucagon
IV dextrose
Lipodystrophies
depression of skin at injection sites
feels hard, changes color
Somogyi effect
overdose of insulin -> causes hypoglycemia and counter-regulatory mechanisms cause hyperglycemia and ketosis
- related to poor diabetes management
Dawn phenomenon
hyperglycemia in the morning due to natural hormonal release
Teaching points for DM and insulin
- monitor glucose levels as directed
- carry a good source of carbs in case of hypoglycemia = unsalted nuts, popcorn, cheese, fresh fruit
- rotate insulin sites
- insulin vials are good for 30 days at room temp
Steroids + diabetes
make your BG RISE
Illness + DM
sickness causes the body stress, which may cause more glucose to be released
- check FSBG more when sick
- adjust insulin regimen
stomach virus = may not be eating or drinking
