How does insulin affect fat metabolism?
it stimulates triglyceride synthesis and inhibits fat breakdown
How does insulin affect protein metabolism?
it increases protein synthesis and inhibits protein breakdown
How do you prepare/give NPH and Regular insulin together?
air into NPH (cloudy) equal to dosage
air into Regular (clear) equal to dosage and withdraw dose
withdraw NPH dose to equal total amount of units
Clear to Cloudy...short acting first and affect will happen rapidly to make sure they are ok
Absorption sites......which are fastest?
fastest-abdomen, then arm then thigh
Which insulin has no pronounced peak and has a low chance of causing hypoglycemia?
Lantus (Long Acting)
Which insulin has a high chance for hypoglycemia in the afternoon between lunch and dinner?
How do I prevent it?
give them snacks
2 rapid acting insulins
2 Short Acting Regular Insulins
Intermediate acting Insulin
Long Acting Insulin
lispro-Humalog and aspart-Novolog
Onset 15 min
Peak 1-1.5 hrs
Duration 3-4 hrs
Humulin R and Novolin R
Onset 30-60 min
Peak 2-3 hrs
Duration 3-6 hrs
Onset 2-4 hrs
Peak 4-10 hrs
Duration 10-16 hrs
Onset 1-2 hrs
Duration 24+ hrs
Advantages of oral agents
less chance of hypoglycemia
more flexibility with diet
Disadvantages of oral meds
Potential sulfa allergies
Multiple side effects
How do orinase, diabines, Glucotrol, micronase Prandin and Starlix work?
all cause the pancreas to release insulin
Adverse effects of orinase, diabines, Glucotrol, micronase, Prandin and Starlix
How do you prevent hypoglycemia?
carry snacks and know the s/s
How does Metformin work?
suppresses glucogenesis by reducing the production of glucose within the liver
Adverse effects of Metformin
B12 and folic acid deficiency
Lactic acidosis from hyperventilation
Patient for teaching for Metformin
discontinue the medication if you
myalgia (muscle pain)
What is somnolence a sign of?
How does Pioglitazone and Rosiglitazone work?
decreases insulin resistance/increase cellular response to insulin
Adverse effects of Pioglitazone and Rosiglitazone
Elevation of LDL's
Patient teaching for Pioglitazone and Rosiglitazone
monitor cholesterol and report symptoms of hepatotoxicity
How does Precose and Glyset work?
slows carb absorption and digestion
Adverse effects of Precose and Glyset
Abdominal distention and cramping
hyperactive bowel sounds
Patient teaching for Precose and Glyset
Have hemoglobin and iron levels monitored
How does Januvia work?
Increases hormones which release insulin and decrease secretion of glucagon
Adverse effects for Januvia