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79 Cards in this Set

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Rapid acting (Regular) (Humulin R, Novolin R)
ONSET, PEAK, DURATION?
.5-1HR ONSET
2-4 HR PEAK
5-7 HR DURATION
it has the quickest onset, peak, and duration of any of the available insulins. (onset is within 15 minutes, peaks 30-90 minutes, duration 300 minutes).
INSULIN LISPRO, HUMALOG
Patients should be instructed to eat within how many minutes of taking lispro (Humalog)?
15
What other drug must accompany Humalog if the diabetic patient is receiving these injections?
must use an intermediate or long acting insulin as well to achieve diabetic control
Intermediate Acting (NPH) (Humulin N, Novolin N)
Onset, Peak, Duration?
Onset- 1 to 2 hours
Peaks - 8 to 12 hours
Duration - 18 to 24 hours
(Humulin 70/30), ( Novolin 70/30) [this means 70 units of intermediate and 30 units of rapid], (Humulin 50/50) [50 units of intermediate and 50 units of rapid].
Onset, Peak, Duration?
generally have an onset of about 30 minutes
peak: 4-8 hours
duration 24 hours
Long Acting (Protamine zinc)
Onset, Peak, Duration?
Onset: 4 to 8 hours
Peaks: 10 to 30 hours
Duration: 36 or more hours
Insulin Glargine (Lantus) (Aventis)
Onset, Peak, Duration?
Onset of action: 1-2 hours
Peak: has none. It is a flat action
Duration: about 24 hours
What is different about Insulin Glargine (Aventis)?
It CANNOT BE MIXED WITH ANY OTHER INSULIN!!! IT HAS NO PEAK.
What does Insulin inhibit?
hepatic glucose production, and also inhibits the breakdown of glycogen, protein and fat.
Insulin decreases blood glucose by facilitating the uptake and metabolism of glucose by insulin dependent cells
What does insulin promote?
the storage of energy in the form of glycogen, protein and triglycerides. Also promotes the movement of potassium from the blood, into the cell.(risk of hypokalemia)
(Insulin is an anabolic hormone).
What can decrease absorption of an insulin injection?
Cigarette smoking decreases the absorption of s.c. insulin injections. (Don’t smoke within 30 min. after insulin injections).
What 3 things can increase blood sugar?
Steroids, marijuana, and diuretics all tend to increase blood sugar
What two things contribute to hypoglycemia?
alcohol and aspirin
Hypoglycemia usually results from...
too much insulin, too little food, too much exercise or a combo of all three
When do symptoms appear (what blood glucose level) and what are the symptoms of hypoglycemia?
symptoms typically appear when blood glucose level falls below 50 mg/dl.
Symptoms include: nervousness, diaphoresis(sweating), weakness, light-headedness, confusion, irritability.
What is lipodystrophy?
disturbance in fat metabolism caused by multiple s.c. insulin injections…..can be improved with rotating insulin injection sites. (Rotate within the same area since absorption may vary).
What insulin should be used within 28 days of opening?
insulin lispro (Humalog)
A person's insulin requirement who is stressed, pregnant, or has an infection will increase or decrease?
Increase.
Which diabetic patients can receive oral hypoglycemics?
Type II
What is on of the major causes of type II diabetes?
Obesity
Why are oral agents contraindicated in Type I diabetes patients?
Because beta cells are not functioning at a sufficient level.
the effects of oral hypoglycemic agents is contraindicated for which patients b/c the effects on them are unknown?
pregnant and lactating
3 disadvantages of oral antidiabetics
1)must have some endogenous insulin being secreted from the pancreas.
2)NPO problems.
3)Oral agents may not be enough to control blood sugar in type II diabetics who are under great stress, acute injury, stress, or infection.
newer prototype for sulfanylureas and older prototype
newer: glipizide (Glucotrol)
older: chlorpropamide (Diabenese)
prototype for biguanides
metformin (Glucophage)
prototype for Thiazolidinediones
rosiglitazone (Avandia)
Prototype for Meglitinides
repaglinide (Prandin)
older prototype of sulfanylurea which has a greater side effect of hypoglycemia in the elderly.
chlorpropamide (Diabenese)
if you are allergic to sulfa drugs, do not take...
The sulfanylurea called glipizide (Glucotrol)
alcohol and diabenese can cause what wretched side effects?
violent nausea, vomiting, headache, tachycardia.
what drug can displace sulfanylureas from their binding site and result in enhanced hypoglycemic reaction?
aspirin
besides hypoglycemia, what other side effects can sulfanylureas cause?
also have been known to cause skin rash, itching, and photosensitivity
sometimes causes massive diuresis or fluid retention.
what time should you take glucotrol or diabenese?
Take 30 minutes before breakfast
prototype for biguanides?
metformin (Glucophage)
how does metformin (glucophage) work?
increases sensitivity of insulin receptors on cells (causing cells to receive glucose therefore lowering blood sugar)
when should patient call physician and why when taking the biguanide metformin(glucophage)?
Patient should call physician if unusual fatigue, muscle pain, difficulty breathing, stomach discomfort, dizziness, light-headedness, or irregular heartbeat occurs...symptoms of lactic acidosis are often subtle
which patients is it a contraindication to take metformin and why?
patients with renal or hepatic dysfunction. Lactic acidosis may occur, resulting from the buildup of metformin in the blood.
metformin should be held if they are scheduled to receive a procedure using?...
contrast dye
Alpha-Glucosidase Inhibitors prototype
acarbose(Precose)
acarbose(Precose) method of action?
delays absorption of CHO in intestines.
acarbose (precose) contraindicated in which patients?
inflammatory bowel disease, colonic irritation, partial intestinal obstruction , or any chronic intestinal disorders of absorption......acarbose (Precose) may worsen all of these conditions.
what two oral antidiabetics can be used along with sulfanylureas or insulin?
glucophage and precose
Thiazolidinediones prototype
rosiglitazone (Avandia)
what type of oral antidiabetic cannot be given along with insulin and why?
rosiglitazone (Avandia)
subsequent onset of CHF
How does avandia work?
works by increasing insulin receptor sensitivity (specifically works on receptors in adipose tissue, skeletal muscle and liver)
Meglitinides prototype
repaglinide (Prandin)
Both of these choices have shown good results when combined with Metformin.
Avandia and Prandin
Inhaled Insulin
Exubera
what forms/doses does exubera come in?
1-3 mg-
available for adults as powder aerosol
In what patients is exubera contraindicated?
any patients with a lung disease
onset, peak and duration of exubera?
Onset 15 minutes
Peak 30-90 minutes
Duration 4-6 hours
what time should you administer exubera?
10 minutes before a meal
Amylin mimetics prototype
Pramlintide (Symlin)
what is symlin used for?
Used to complement the effects of insulin in patients with Type I or Type 2 diabetes
why is symlin given before meals?
Given subcutaneous before meals to enhance the effects of mealtime insulin for patients who failed to achieve glucose control with insulin therapy
Name some of the adverse effects of Symlin.
Hypoglycemia
nausea
possible injection site redness, swelling and itching
usually resolves w/in days-weeks
What is the mechanism of action for Symlin?
delays gastric emptying and suppresses glucagon release-helps reduce post prandial hyperglycemia.
Name the prototype for incretin mimetics
exenatide (Byetta)
adverse effects of Byetta
nausea, hypoglycemia (long term effects unknown)
what is Byetta used for? (patients taking what drugs?)
used to improve glucose control in patients taking metformin or a sulfonylurea such as Glucotrol
Byetta's mechanism of action?
slows gastric emptying...stimulates insulin release, inhibits post prandial release of glucagon, suppresses appetite.
Byetta's indications for use?
Type 2 diabetic patients taking metformin or sulfynlureas, or both
Which patients are contraindicated for use of Byetta?
End stage renal disease and pregnant women.
What dose of Byetta is given to decrease blood sugar? When is blood sugar decreased a modest amount and when is it decreased a large amount?
5-10mcg sc before meals=modest decrease in Blood sugar and a
large decrease in post prandial blood sugar.
When should you give oral drugs when patient is taking byetta?
an hour before byetta is given b/c it delays gastric emtying and decreases the absorption of oral drugs.
Where is glucagon produced?
in the alpha cells-islets of langerhans in the pancreas
What does glucagon do to the blood glucose?
increases blood glucose.
Can glucagon be taken orally and why/why not?
NO-b/c it is a protein which would be destroyed by GI tract.
How is glucagon usually administered?
SC, IV or IM
Where does glucagon's effects occur? What 2 processes does it start?
In the liver, it increases glycogenolysis and gluconeogensis.
Is glucagon a catabolic or anabolic hormone?
It is catabolic, meaning it increases the breakdown of protein and fat which provides additoinal fuel for cellular metabolism.
When is glucagon used? what emergency?
emergency treatment of hypoglycemia
How long after first injection of glucagon can another injection be given if patient has not awakened?
5 minutes after first injection
What drug interaction can occur with glucagon?
increases anticoagulant effects of oral anticoagulants
In what patients is glucagon virually ineffective? Why?
starving or poorly nourishedc patients...b/c they have no glycogen stored in the liver, and glycogenolysis cannot occur.
glucagon cannot be added to IV solutions with what substances and why?
b/c if you add glucagon to a solution that has Ca, K, or NaCl precipitation can occur (solution turns to chalk)
Why should you give the patient a complex carb after administration of Glucagon?
to replinish the stores of glycogen in the liver and prevent secondary hypoglycemia.
What is the national magazine designed for patients and families of diabetes?
Diabetes Forecast