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39 Cards in this Set

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Insulin used for?

1
Treatment of Type 1 diabetes, gestational diabetes and for patients on TPN (total parenteral nutrition)
Reason for TPN to get insulin

2
Sugar goes into blood and not liver to be metablolizm, not stimulated
Insulin goal

3
A steady state of the blood glucose is the goal of therapy in order to minimize long term complications of hyperglycemia and to prevent hypoglycemic events.

3
What glucose levels should be

4
HgbA1c<7% Indication of glucose control every 4 months.
Glucose levels 80-140 mg/dl
Bedtime Glucose levels >/or= to, 140mg/dl
Rapid acting insulins

5
lispro works 30 min or less given with meals.
o=minutes
p=30-60min
d=3-4hrs.
Other rapid acting

6
Aspart
Glulisrine
onset 15min good till 5 hrs.
Short Acting regular insulin subcue

7
o=30-60min
p=2-4hrs
d=5-7hrs
Humilin R- only one available
Numbulin R- becauase of reaction.
Given for sliding scale. If bs level to high.
Regular insulin IV

8
IV insulin always regular
o=10-30min
p=15-30min
d=30-60min
Intermediate acting Insulins
isophane suspension, NPH insulin sc:

9
o=1-4hrs
p=6-12hrs
d=18-28hrs
Intermediate acting insulin
zinc suspension, lente insulin

10
0=1-3hrs
p=8-12hrs
d=18-28hrs
Long acting insulins
extend zinc suspension, ultralente insulin

11
o=4-6hrs
p=18-24hrs
d=36hrs
Insulin mixtures

12
NPH insulin plus regular insulin
70/30 & 50/50
o=30min
p=4-8hrs
d=up to 24hrs
Nursing Implications related to insulin administration
Patient Education

13
regarding
disease medical alert band
signs and symptoms and treatment of hypoglycemia
exercise
insulin administration
blood glucose monitoring
sick day management
patients activities
Signs and symptoms of treatment of hypoglycemia

14
a patient shuold carry a quick acting form sugar at all times
Family members should be instructed in the administration of glucagon
Excercise related to Insulin

15
Helps glucose get into the cells and can decrease daily requirements of insulin, lowers blood glucose levels
avoid exercising when at peak times of insulin absorption
do not exercise if glucose level is over 300 mg/dl, will increase rather then decrease
Insulin administration

16
abdomen>arms>thighs>buttocks
Clear before cloudy, within 20 minutes after drawing up.
Storage and Stability for insulin

17
Room temperature for 18-24 months, will lose potency if stored at temperatures over 100 degrees F; used vitals at room temperature, refrigerate unused vials, do not freeze, do not store in direct sunlight.
Sick day management for insulin

18
More frequent monitoring of blood glucose levels, test urine for ketones, 200 and or your ketone levels are elevated on 2 or more consecutive testings.
Sliding scale insulin

19
with regular insuline coverage, doctor order how many units
10% rule

20
with regular insulin coverage, baseline 200-300.
Activity level with insuline

21
consider the patients activities for the day before dosing with insulin, status patient is nauseated or has been vomiting.
Human type is the most widely used today.
Use only syringes calibrated for U-100 insulin,
Lispro rapid acting
Adverse Effects of insulin

22
Hypoglycemia, (lipodystrophy, lipoatrophy)-sute if ubhectuib wgerem cab gave fat deposits, weight gain.
Drug interactions related to insulin administration

23
Beta blockers may mask the signs and symptoms of hypoglycemia
Thiazide diuretics, glucocorticoids, calcium channel blockers, thyroid drugs, estrogen and nicotine may increase insulin requirements (ie. increase blood glucose levels)
Testosterone, ETOH, coumadin, oral hypoglycemic agents may decrease insulin requirements (ie. decrease blood glucose) levels)
Sulfonylureas

24
May have allergies.
Stimulates the release of insulin from the pancreas.
Increases insulin receptor binding (helps imrove insulin resistance)
First generation sulfonylureas

25
3 times a day more of a chance of reaction.
Diabinese

26
o=60min
p=3-6hrs
d=24-72hrs
Tolinase

27
o=60min
p=1-6hrs
d=12-24hrs
Orinase

28
o=60min
p=4-6hrs
d=6-12hrs
Second Generation Sulfonylureas

29
Give once a day
Amaryl

30
o=??
p=2-3hrs
d=24hrs
Glucotrol

31
o=15-30min
p=1-2hrs
d=24hrs
Miconase, DiaBeta

32
o=45-60min
p=1.5-3hrs
d=24hrs
Glynase- 100% bioavilability
Nursing Implications related to Sulfonylureas

33
Patients may need insulin
If sick the patient should not take thier Sulfonylurea
Patient should carry a quick acting sugar with them at all times for potential hypglycemic reactions
Patients should be taught to avoid ETOH
Patients should not be taught to use sunscreen and protective clothing when outside
Should not take oral hypoglycemic
Adverse Effects related to Sulfonylureas

34
Hypoglycemia
Photosensitivity
GI upset
Headache
Rash
Weight Gain
Drug Interactions related to Sulfonylureas

35
Similar to insulin, when sulfonylureas are combined with ETOH they can cause a disulfiram like reaction (anabuse-like reaction)
Biguanides

36
Lactic acidosis- rare but fatal
decrease insulin resistance
Helps decrease insuline resistance
Decrease glucose absorption in the intestine
Decrease hepatic glucose production
Metaformin
Alpha-glucosidase Inhibitors

37
Acarbose (precose)
Miglitol (glyset)
Thiazolidinediones

38
Troglitazone (Rezulin)-took off market, liver toxicity.
Rosiglitazone (Avandia)
Repaglinide (prandin)

39
Can give to Allergic to sulfa