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56 Cards in this Set

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rapid acting insulin
lispro (Humalog)

onset: less than 15 min
peak 0.5-1 hour
duration: 3-4 hour

other: insulin aspart- (Novolog)
insulin gluclisine (Apidra)
short acting
regular insulin Humulin R
onset 0.5- 1 hour
peak 2-3 hour
duration- 3-4 hr

regular insulin (Novolin R)
intermediate acting
NPH insulin Humulin N
onset: 1-2 hours
Peak: 4-12 hours
duration: 18-24 hours

insulin detemir (Levemir)
long acting
Insulin glargine (Lantus)
onset: 1 hr
peak: none
duration: 24 hours
premixed insulins
70% NPH and 30% Regular (Humulin 70/30)

75% insulin lispro protamine and 25% insulin lispro (Humalog 75/25)
mixture of intermediate acting and rapid acting
insulin MOA
decreases glucose levels
converts glucose into glycogen
moves potassium into cells (along with glucose)
insulin uses
glycemic control of DM (type 1, type 2, gestational) to prevent complications
insulin adverse
risk for hypoglycemia (too much insulin)- monitor for hypoglycemia

administer glucose- for conscious patients administer a snack of 15 g carbohydrate
if client is not fully conscious- administer glucose parenterally

lipohypertrophy- systematically rotate injection sites
insulin interactions
sulfonylureas, meglitinides, beta blockers, alcohol have additive hypoglycemic effects with concurrent use

thiazide diuretics and glucocorticoids may raise blood glucose levels

beta blockers may mask SNS response to hypoglycemia
insulin admin
when mixing short-acting insulin with longer acting insulin, draw the short acting insulin up into the syringe first then the longer acting insulin.

Insulin suspensions: gently rotate vial between palms to disperse the particles throughout the vial

do not administer short acting insulins if they appear cloudy or discolored

insulin glargine and insulin detmir are clear- not admin IV and should not be mixed in a syringe with other insulin

lispro, aspart, glulisine, and regular insuline SubQ injection, infusion, IV route

administer NPH- subq

ensure proper insulin storage
oral antidiabetics
thiazolidinediones (Glitazones)
pioglitazone (Actos)
alpha glucosidase inhibitors
sulfonylureas first gen
tolburamide (Orinase)
other: chlorpropamide
sulfonylureas second gen
glipizide (Glucotrol, Glucotrol XL)

other: glyburide (Diabeta), glimepiride (Amaryl)
sulfonylureas MOA
insulin release from the pancreas
Proto: repaglinide (Prandin)
other: nateglinide (Starlix)
meglitinide MOA
insulin release from the pancreas
proto: metformin HCL (Glucophage)
biguanide MOA
reduces production of glucose within the liver though suppression of gluconeogenesis
increases muscles glucose uptake and use
thiazolidinediones (Glitazones)
pioglitazones (Actos)
thiazolidinediones MOA
increases cellular response to insulin by decreasing insulin resistance
increased glucose uptake and decreased glucose production
alpha glucosidase inhibitors
proto: acarbose (Precose)
other meds: miglitol (Glyset)
alpha glucosidase inhibitor MOA
slows carbohydrate absorption and digestion
sitagliptin (Januvia)
gliptins MOA
augments naturally occuring incretin hormones which promote release of insulin and decrease secretion of glucagon
lowers fasting and postprandial blood glucose levels
oral antidiabetics use
control blood glucose levels in type 2 diabetes
metformin HCL is used to treat PCOS
glipizide and repaglinide adverse
metformin HCL adverse
GI effects
Vitamin B and folic acid deficiency
lactic acidosis (hyperventiliation, myalgia, sluggishness, somnolence)- can be treated with hemodialysis
pioglitazone adverse
fluid retention
elevations in LDL cholesterol
acarbose adverse
intestinal effects
oral antidiabetics contraindications
renal failure, hepatic dysfunction, heart failure
contraindicated in the treatment of diabetic ketoacidosis
metformin is contraindicated for clients who have severe infections, shock, hypoxic condition
acarbose is contraindicated in GI disorders
pioglitizone is contraindicated in HF, bladder cancer, active hepatic disease
glipizide interactions
alcohol- result in dislfiram-like reaction (intense nausea, vomiting, flushing, palpitations)
alcohol, NSAIDS, sulfonamides, ranitidine (Zantac) and cimetidine (Tagament)- additive hypoglycemic effect
beta blockers- mask SNS response to hypoglycemia
repaglinide and pioglitazone interactions
concurrent use of gemfibrozil (Lopid)- hypoglycemia
metformin interactions
alcohol- lactic acidosis
iodine-containing contrast media- kidney failure
acarbose interactions
sulfonylureas or insulin- hypoglycemia
metformin- additive GI effects and risk for hypoglycemia
oral antidiabetics admin
glipizide- 30 min prior to a meal
repaglinide - eat within 30 min of admin 3 times a day
metformin- take immediate release tabs twice a day with breakfast and dinner- take sustained tabs once a day with dinner
pioglitazone- once a day, with or without food
acarbose- take with first bite of food, three times per day
sitagliptin- once a day with or without food
amylin mimetics
pramlintide (Symlin)
amylin mimetics MOA
mimis the actions of naturally occuring peptide homone amylin, resulting in reduction of postprandial glucose levels
amylin mimetics USE
supplemental glucose control for clients with type 1 and type 2 diabetes
used in conjunction with insulin or an oral antidiabetic medication, usually metformin or a sulfonylurea
amylin mimetics adverse
reaction at injection site
amylin mimetics contraindications
kidney failure
thyroid disease, osteoporosis, alcoholism
amylin mimetics interactions
insulin increases risk for hypoglycemia
concurrent use of pramlintide with meds that slow gastric emptying time, such as opioids, or meds that delay food absorption such as acarbose
amylin mimetics admin
administer prior to meals using thigh or abdomen
keep onopened vials in the refrigerator and do not freeze
incretin mimetics
exenatide (Byetta)
other: liraglutide (Victoza)
incretin mimetics MOA
mimics effects of naturally occuring glucagon like peptide 1 and thereby promotes release of insulin, decreases secretion of glucagon, and slows gastric emptying
Fasting and postprandial blood glucose levels are lowered
incretin mimetics use
supplemental glucose control for clients who have type 2 diabetes
may be used in conjunction with an oral antidiabetic, usually metformin or a sulfonylurea
incretin mimetics adverse
GI effects
incretin mimetics contraindications
kidney failure, UC, Crohn's
older adults and clients with renal or thyroid disease
incretin mimetics interactions
oral contraceptives, antibiotics, acetaminophen absorption is delayed
concurrent use of sulfonylurea increases risk of hypoglycemia
incretin mimetics admin
give injection within 60 min before the morning and evening meal
NEVER administer after a meal
incretin mimetics effectiveness
preprandial glucose levels- 90-130 mg/dl
HbA1c less than 7%
hyperglycemic agent
proto: glucagon (GlucaGen)
hyperglycemic agent MOA
increases blood glucose levels by increasing breakdown of glycogen into glucose
hyperglycemic agent use
emergency management of hypoglycemic reactions, such as insulin overdose in clients who are unable to take oral glucose
decrease in gastric motility in clients undergoing radilogical procedures of the stomach and intestines
hyperglycemic adverse
GI distress
hyperglycemic contraindications
glucagon is ineffective for hyoglycemia resulting from inadequate glycogen stores (starvation)
caution to those with cardiovascular disease
hyperglycemic effectiveness
blood glucose level greater than 50mg/dl