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32 Cards in this Set

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Name the rapid acting insulins
Lispro (Humalog)
Glulisine (Apridra)
Aspart (Novolog)
Name the short-acting insulins
Regular (Novolin, Humulin)
Name the intermediate-acting insulins
NPH (Novolin N)
Name the long-acting insulins
Glargline (lantus)
Detemir (Levemir)
What are the ADE;s of insulin?
hypoglycemia, injection site reactions, lipohypertrophy, lipoatrophy
What are two important things to remember about the use of insulin?
Rotate the injection sites

Do not inject cold insulin
What is the onset and peak of rapid acting insulin?
onset: 10-30 minutes
peak: 0.5 - 3 hours
What is the onset and peak of regular acting insulin?
onset: 30 - 60 minutes
peak: 2-3 hours
What is the onset and peak of intermediate acting insulin?
Onset: 2-4 hours

Peak: 6 - 10 hours
What is the onset and peak of the long acting insulins glargine and Detemir?
Glargine: Onset = 4-5 hours, no peak

Detemir: Onset = 1 - 3 hours, generally flat with a minimum peak
What can cause an increase in glucose levels in the blood?
eating
stress
illness
getting out of a hot shower
What can cause a decrease in blood glucose levels?
insulin
diabetic medication
exercise
What is pramlintide?
A synthetic analog of the neuroendocrine hormone amylin
What is the MOA of pramlintide?
MOA: modulates gastric emptying, decreases postprandial glucagon release
What are the ADE's of pramlintide?
severe hypoglycemia

GI

Nausea
What is the absorption and peak of pramlintide?
absorption: Sub Q

Peak: 20 minutes
How is pramlintide metabolized and eliminated?
Renally
What drug interactions does pramlintide have and who dosage adjustments should be made?
Insulin: decrease rapid acting insulin by 50% when initiating. Titrate gradually and monitor closely for hypoglycemia
What are the indications of use for pramlintide?
Type I and Type 2 DM as adjunct tx to mealtime insulin (in type 2 with or without combination with metformin or sulfonylurea)
What are the signs of hypoglycemia?
shaking/tremors, tachycardia, diaphoresis, anxiety, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable
List 5 treatments for hypoglycemia
glucose tablets
glucose gel
8 oz orange juice
regular soda
D5OW IV injection (in hospital)
What does DKA indicate?
Poor glucose control with extreme hyperglycemia
What happens in DKA?
The body goes into starvation mode. Ketones become prominent in blood and in the urine
What are the goals of treatment of DKA?
1) replace intravascular volume
2) reverse the catabolic state
3) correct the hyperglycemia, acidosis
4) correct the fluid/electrolyte disorder
How do you treat the fluid deficit in DKA?
1) replace with normal saline
How do you treat DKA with insulin?
1) use a low dose CI (regular insulin) following an IV bolus
2) titrate CI to goal
3) continue CI until ketosis is corrected, then switch to intermittent insulin coverage
What do you do in DKA if the potassium is < 3.3 mEq/L?
If K+ <3.3mEq/L, hold insulin & administer KCl 40mEq IV riders until corrected
What do you do in DKA if the potassium is > 5.5 mEq/L?
If K+ >5.5mEq/L, hold K+ supplements, administer insulin as outlined for DKA, recheck K+ q2hrs
What do you do in DKA if the potassium is between 3.3-5.5mEq/L?
If K+ 3.3-5.5mEq/L, add 20-30mEq/L of KCl to IVF’s
When do you replace sodium bicarb in DKA? why?
only in severe acidosis when the pH < 7.0. This is because the acidosis will typically self-correct with insulin administration
Your patient has DKA and a pH of 6.9-7. What do you do?
Na Bicarb IV 50mEq IV rider at 200mL/hr & recheck q2hrs until pH>7
Your patient has DKA and a pH of < 6.9. What do you do?
Na Bicarb IV 100mEq IV rider at 200mL/hr & recheck q2hrs until pH>7