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32 Cards in this Set
- Front
- Back
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Name the rapid acting insulins
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Lispro (Humalog)
Glulisine (Apridra) Aspart (Novolog) |
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Name the short-acting insulins
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Regular (Novolin, Humulin)
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Name the intermediate-acting insulins
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NPH (Novolin N)
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Name the long-acting insulins
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Glargline (lantus)
Detemir (Levemir) |
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What are the ADE;s of insulin?
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hypoglycemia, injection site reactions, lipohypertrophy, lipoatrophy
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What are two important things to remember about the use of insulin?
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Rotate the injection sites
Do not inject cold insulin |
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What is the onset and peak of rapid acting insulin?
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onset: 10-30 minutes
peak: 0.5 - 3 hours |
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What is the onset and peak of regular acting insulin?
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onset: 30 - 60 minutes
peak: 2-3 hours |
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What is the onset and peak of intermediate acting insulin?
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Onset: 2-4 hours
Peak: 6 - 10 hours |
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What is the onset and peak of the long acting insulins glargine and Detemir?
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Glargine: Onset = 4-5 hours, no peak
Detemir: Onset = 1 - 3 hours, generally flat with a minimum peak |
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What can cause an increase in glucose levels in the blood?
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eating
stress illness getting out of a hot shower |
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What can cause a decrease in blood glucose levels?
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insulin
diabetic medication exercise |
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What is pramlintide?
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A synthetic analog of the neuroendocrine hormone amylin
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What is the MOA of pramlintide?
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MOA: modulates gastric emptying, decreases postprandial glucagon release
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What are the ADE's of pramlintide?
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severe hypoglycemia
GI Nausea |
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What is the absorption and peak of pramlintide?
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absorption: Sub Q
Peak: 20 minutes |
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How is pramlintide metabolized and eliminated?
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Renally
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What drug interactions does pramlintide have and who dosage adjustments should be made?
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Insulin: decrease rapid acting insulin by 50% when initiating. Titrate gradually and monitor closely for hypoglycemia
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What are the indications of use for pramlintide?
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Type I and Type 2 DM as adjunct tx to mealtime insulin (in type 2 with or without combination with metformin or sulfonylurea)
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What are the signs of hypoglycemia?
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shaking/tremors, tachycardia, diaphoresis, anxiety, dizziness, hunger, impaired vision, weakness, fatigue, headache, irritable
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List 5 treatments for hypoglycemia
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glucose tablets
glucose gel 8 oz orange juice regular soda D5OW IV injection (in hospital) |
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What does DKA indicate?
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Poor glucose control with extreme hyperglycemia
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What happens in DKA?
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The body goes into starvation mode. Ketones become prominent in blood and in the urine
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What are the goals of treatment of DKA?
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1) replace intravascular volume
2) reverse the catabolic state 3) correct the hyperglycemia, acidosis 4) correct the fluid/electrolyte disorder |
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How do you treat the fluid deficit in DKA?
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1) replace with normal saline
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How do you treat DKA with insulin?
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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 |
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What do you do in DKA if the potassium is < 3.3 mEq/L?
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If K+ <3.3mEq/L, hold insulin & administer KCl 40mEq IV riders until corrected
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What do you do in DKA if the potassium is > 5.5 mEq/L?
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If K+ >5.5mEq/L, hold K+ supplements, administer insulin as outlined for DKA, recheck K+ q2hrs
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What do you do in DKA if the potassium is between 3.3-5.5mEq/L?
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If K+ 3.3-5.5mEq/L, add 20-30mEq/L of KCl to IVF’s
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When do you replace sodium bicarb in DKA? why?
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only in severe acidosis when the pH < 7.0. This is because the acidosis will typically self-correct with insulin administration
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Your patient has DKA and a pH of 6.9-7. What do you do?
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Na Bicarb IV 50mEq IV rider at 200mL/hr & recheck q2hrs until pH>7
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Your patient has DKA and a pH of < 6.9. What do you do?
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Na Bicarb IV 100mEq IV rider at 200mL/hr & recheck q2hrs until pH>7
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