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53 Cards in this Set
- Front
- Back
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glucose before and after meals
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70 - 130 mg/dl before meals
<180mg/dl (ADA) 2 hrs after meals Some doctors may suggest <150 mg/dl |
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Hemogobin A1c
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less than 7% (ADA)
less than 6.5% (AACE) |
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glucose at bedtime
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110 - 150 mg/dl (plasma)
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Aspart (Novolog) Onset, Peak, and Duration
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Onset- 5-15 min
Peak- 0.5-2.5hr Duration: 3-4 h |
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lispro (Humalog)
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O- 5-15 min
P- 60-90 min D- 3-4 hrs |
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glulisine (Aprida) O, P, D
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O- 5-15 min
P- 60-90 min D- 3-4 hrs |
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Humulin R and Novolin R O, P, D
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O- 30-60 min
P- 2-3 h D- 3-6 h |
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Humulin N and Novolin N O, P, D
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O- 2-4 h
P- 4-10 h D- 10-16 h |
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Glargine (Lantus) O, P, D
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O- gradual
P- NO peak D- 24 h |
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Detemir (Levemir) O, P, D
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O- 1-2 h
P- 2-12 h (dose dependent) D- varies by dose |
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Humulin 70/30 O, P, D
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70% NPH
O- 2-4 h P- 4-10 h D- 10-16 h 30% (humulin)regular O- 30-60 min P- 2-3 h D- 3-6h |
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Humalog 75/25 O, P, D
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75% NPH
O- 2-4 h P- 4-10 h D- 10-16 h 25% Humalog O- 5-15 min P- 60-90 min D- 3-4 h |
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Novolog 70/30 O, P, D
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70% NPH
O- 2-4h P- 4-10h D- 10-16 hr 30% Novolog (aspart) O- 5-15 min P- 0.5-2.5h D- 3-4 h |
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Meal bolus
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Given when pt looks at food (usually carbs) and determines how much insulin is needed from that (insulin to carb ratio)
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Correction bolus
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correction of high blood sugar (scale usually given by MD)
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What insulins have flex pen
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Novolog, Novolog 70/30, and levemir insulins
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Food and blood glucose
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Timing, Type, and Amount all affect it
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Gliptins names and action
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Januvia - gliptins
Janumet (mixed with metformin) - prevents breakdown of pts own hormone |
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Januvia adverse effects
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- by its self does not cause hypoglycemia
- SJ syndrome - anaphylaxis *Use lower dose for renal insufficiency or failure |
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Bile acid sequestrant
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Cholesterol lowering agent
- for type 2 diabetes - Im or subcu |
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Glucagon dosage
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Adult 1 mg
Child under 44 pounds 0.5mg Repeat 15 minutes if no response and call EMS *Position pt on side, high risk of vomiting in unconscious pt |
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Glucagon use
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hypoglycemia (unconscious or uncooperative)
administered by friend or family |
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Glucagon shelf life
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short shelf life, keep current
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Sulfonylureas names
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-GLYBuride
-GLIPizide (glucotrol) - GLIMiprimide |
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Sulfonylureas adverse effects
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Weight gain
hypoglycemia (MUST EAT REGULAR MEALS!) |
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Sulfonylureas and alcohol
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disulfiram reaction
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Meglitinides names
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--glidine or - glindine
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Meglitinides use
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RAPID ACTING
- pancreas - like a PO Novolog |
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Meglitinides adverse
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- severe hypoglycemia (DO NOT SKIP MEALS AND DON"T TAKE IF MISSED THE MEAL!!)
- hepatic insufficiency will elevate drug levels and decrease hepaic gluconeogensis |
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Biguanides name
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Metformin, Glucophage
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Buguanides use
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Controls Hepatic glucose production
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Adverse effects of Biguanides
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- Diarrhea, GI upset (slowly titrate)
- DOES NOT CAUSE HYPOGLYCEMIA OR WEIGHT GAIN |
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Contraindications for Biguanides
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-Impaired renal, CHF, impaired hepatic
Creatinine >1.5 in males and 1.4 in females - don't use if pt having dye contrast testing |
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Alpha glucosidase inhibitors action
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delays card digestion
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Action sof sulfonylureas
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stimulates insulin releae from beta cells in pancreas
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Side effects of alpha glucosidase inhibitors
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GAS
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names of alpha glucosidase inhibitors
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Acarbose (precise)
Miglitol (Glyset) |
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Alpha glucosidase inhibitor being taken and pt has hypoglycemia...
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Sucrose (foods) will not work, must give glucose tablets
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Titration of alpha glucosidase inhibitors
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titrate slowly starting with 25 mg with the first bite of each meal
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Thiazolinediones action
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peripheral tissues (makes muscle, etc more sens to insulin)
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Thiazolinediones names
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--glitazone
rosiglitazone (avandia) only given to high risk pts (LDL cardio issues) |
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Cautions with Thiazolinediones
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* may induce ovulation and birth control pill scan be ineffective!
-impaired hepatic (eval ALT prior and every 3-6 months) *Caution if ALT> 2.5x than upper limit of normal * IN CHF may promote significant edema and fluid retention - osteoporosis |
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Incretin mimetics action
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- helps insulin secretion
- suppress liver glucose production - promote satiety - slow gastric emptying *Type 2 only |
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Incretin mimetic name
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Byetta (exanatide)- injectable pen
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When to take Byetta (Incretin mimetic)
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NEVER AFTER A MEAL (take with a meal)
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Adverse effects of Byetta
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-low blood sugar (worse with alcohol)
- nausea - injection site redness - if miss dose, wait till next is due - don't adjust dose! |
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Amylin analog name
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Symlin (pramlintide)
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DO NOT TAKE PRAMLINTIDINE IF
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- a meal is skipped or missed or less than 250 calories or less than 30mg carbs
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Byetta and Symlin pens
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only prime on first use
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Lantus/Levemir
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- Basal insulin
- No bolus coverage - Dosed at bedtime (hs) - NEVER adjusted for blood sugar - NO MIXING - injection may sting- pH of 4 - NOT appropriate for type 1 (no meal coverage) |
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Rapid acting
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--log and glulisine
- most like natural insulin |
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Regular (short acting)
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- only insulin can give IV
- comes in 100 and 500 units |
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Combination insulins
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Increase the chance of having hypoglycemia
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