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Name 2 rapid acting insulins
(onset, peak, length of action & timing of injection before meal)
- Humalog (Lispro)
- Novolog (Aspart)
- -log
- onset 15 min; peak 60-90min; length 3-4 hrs
0-15 min before meal
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Name 3 Short Acting/Regular insulins
(onset, peak, length of action & timing of injection before meal)
- Humulin (R)
- Novolin (R)
- ReliOn (R)
- -lin
- onset 30-60 min; peak 2-3 hrs; length 3-6hrs
30-45 min before meal
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Name 2 non-mixed intermediate acting insulins
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Name 5 mixed intermediate insulins
- Humulin 70/30
- Novolin 70/30
- Humulin 50/50
- Humulog 75/25
- Novolog 70/30
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Name 3 long acting insulins
- Lantus (no peak)
- PZI
- Ultralente
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What kind of insulin is humulog (Lispro), and what is its start/peak/length of action?
-log are rapids
15 min start/60-90min peak/3-4hrs length
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What kind of insulin is Novolog (Aspart), and what is its start/peak/length of action?
-log are rapids
15 min start/60-90min peak/3-4hrs length
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What kind of insulin is Humulin, and what is its start/peak/length of action?
-lins are short acting
30-60 min start/2-3 hrs peak/3-6hrs length
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What kind of insulin is NPH, and what is its start/peak/length of action?
NPH is non-mixed intermediate acting
3-4 hrs start/6-12 hrs peak/18-28 hrs length
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What kind of insulin is Lente, and what is its start/peak/length of action?
Lente is non-mixed intermediate acting
1-3 hrs start/8-12 hrs peak/18-28 hrs length
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What kind of insulin is Humulin 70/30 or Novolin 70/30, and what is its start/peak/length of action?
-lin 70/30 is mixed intermediate acting, (intermediate with short acting)
30 min start/4-8 hrs peak/24 hrs length
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What kind of insulin is Humulin 50/50, and what is its start/peak/length of action?
-lin 50/50 is mixed intermediate acting, (intermediate with short acting)
30 min start/3 hrs peak/22-24 hrs length
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What kind of insulin is Humulog 75/25, and what is its start/peak/length of action?
-log 75/25 is mixed intermediate acting, (intermediate with rapid acting)
15 min start/30-60 min and 2-4 hrs peak/6-12 hrs length
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What kind of insulin is Novolog 70/30, and what is its start/peak/length of action?
-log 70/30 is mixed intermediate acting, (intermediate with rapid acting)
15 min start/1-4 hrs peak/12-24 hrs length
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What kind of insulin is PZI, and what is its start/peak/length of action?
- PZI is Long acting insulin
- 4-6 hour start/14-24 hr "peak"/36 hrs
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What kind of insulin is Lantus, and what is its start/peak/length of action?
- Lantus is Long acting insulin
- 1 hour start/no "peak"/24 hrs
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What kind of insulin is Ultralente, and what is its start/peak/length of action?
- Ultralente is Long acting insulin
- 4-6 hour start/18-24 hr "peak"/36 hrs
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What are the three "Ps" of classic diabetes symptoms?
- Polydipsia (excessive thirst - late symptom)
- Polyuria (excessive urination)
- Polyphagia (excessive huger)
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What are some symptoms of DKA, and which will differentiate it from HHNKS?
- Suddent onset
- Hyperglycemia BG > 300
- + Ketones
- Kussmaul respirations
Occurs in absence of insulin
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What are some symptoms of HHNKS, and which will differentiate it from DKA?
- Gradual onset
- Hyperglycemia BG > 600
- NO Ketones
- Altered mental state
- severe dehydration (far more than DKA)
Occurs in presence of some insulin
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What is the treatment for DKA or HHNKS?
- IV fluids
- insulin IV drip
- electrolyte replacement
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What type of insulin cannot be mixed with any other?
Lantus (Glargine)
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Which type of insulin can be given via IV?
Regular (short-acting)
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Which type of insulin is cloudy?
- Intermediate insulins
- NPH
- Lente
- mixed insulins
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Which insulin might you suggest a snack about 6 hours after injection?
Intermediate insulin
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What sites can you inject insulin, and in what order are they preferred?
- Abdomen
- arm
- thigh
- buttock
- (all subcutaneous)
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How might a diabetic become hypoglycemic?
- too little food, skipped meal
- too much insulin
- more active (exercise than usual)
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What are 5 complications of insulin therapy?
- Hypoglycemia
- Lipodystrophy
- Allergic reaction
- Somogyi effect
- Dawn phenomenon
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What are the symptoms of Somogyi effect?
- Rebound effect (overnight) from overdose of insulin which causes hypoglycemia (usually between 2-4am)
- usually during hours of sleep
- counter-regulatory hormones released -> rebound hyperglycemia (in morning) -> ketosis
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What are the treatments for Somogyi effect?
- bedtime snack
- reevaluate insulin therapy levels - reduce bedtime levels (Somogyi = "so much" insulin before bed)
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What are the symptoms of the Dawn Phenomenon?
- hyperglycemia present on awakening in the morning
- due to release of counter-regulatory hormones in pre-dawn hours
- growth hormones/cortisol possible factors
- consistent high BG levels 5-6 am
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What are the treatments for the Dawn phenomenon?
- (Dawn means down amount of insulin before bed)
- increase bedtime insulin level
- change exercise timing before bed
- limit bedtime carbs
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What is the effect on blood glucose with increased cortisol levels? (stress hormone)
Increase in blood glucose level (get ready for fight or flight)
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What are 5 diagnostic tests for diabetes?
- fasting plasma glucose level (< 126 mg/dL for non-pregnant adults)
- random or casual plasma glucose >= 200 plus symptoms
- 2 hr OGTT level >=200 using a glucose load of 75g
- Hemoglobin A1C - checks levels over previous 3-4 months
- 2-hour postprandial glucose (PPG) - eat, then test 2 hrs later
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What are some major signs of hyperglycemia?
- 3 Ps (thirst, urination, hunger)
- dry skin (from dehydration)
- blurred vision
- drowsiness
- decreased healing
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What are some major signs of hypoglycemia?
- shaking
- fast heartbeat
- sweating
- dizziness
- anxious, irritable, headache
- impaired vision
- weakness, fatigue
- hunger
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What is an immediate response to hypoglycemia?
- Get sugar in system. Juice, milk, soft candies, glucose tablets or gel
- test blood glucose 30 min later
- eat light snack
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What syndrome or effect is tested for by testing blood glucose between 2-4am?
Somogyi effect. Pt will be hypoglycemic 2-4am due to too much insulin before bed. Counter-regulatory hormones will cause pt to become hyperglycemic by morning.
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What syndrome or effect has hyperglycemia between 5-6 am?
Dawn effect. Normal release of hormones overnight increases blood glucose, and there wasn't enough insulin the night before to deal with it.
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What are the 5 types of oral hypoglycemic agents?
- Sulfonylureas
- Meglitinides
- Biguanides
- alpha-glucosidase inhibitors
- Thiazolidinediones
(mnemonic: Suck My Big Ass Tits)
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What is the mechanism of sulfonylureas, and when are they taken?
What body system/organ does it work on?
How often is it taken?
- They work on the pancreas to increase insulin production.
- It's usually taken daily, with the first meal. Glipizide is sometimes bid.
- Glipizide (Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (Diabeta, Micronase)
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What is the mechanism of Meglitinides, and when is it taken?
What body system/organ does it work on?
How often is it taken?
- It works on the pancreas to increase insulin production.
- It's taken only with/30 min before meals
- Repaglinide (Prandin)
- Nateglinide (Starlix)
- Prandimet (Repaglinide/Metformin combo)
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What is the mechanism of biguanides, and when is it taken?
What body system/organ does it work on?
How often is it taken?
It works on the liver to reduce glucose production. (memory cue: The liver is a BIG organ) Also works on insulin sensitivity at tissues.
Starting drug of choice for DM II
- Metformin - twice daily with morning and evening meal
- Glucophage XR, Glumetza, Fortamet: long acting - daily before breakfast
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What is the mechanism of alpha-glucosidase inhibitors, and when is it taken?
What body system/organ does it work on?
How often is it taken?
It works on the gut to slow down absorption of CHO in small intestine
- (remember, -ases are enzymes, the name implies what it does: blocks the breakdown of large sugars into problematic small sugars)
- "Starch blockers"
Taken with the first bite of each MAIN meal.
- Acarbose (Precose)
- Miglitol (Glyset)
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What is the mechanism of thiazolidinediones, and when is it taken?
What body system/organ does it work on?
How often is it taken?
It works on the muscle/body cells to increase insulin sensitivity. It affects DNA.
Taken once or twice a day, without regard to meals.
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
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What's are 2 important facts about sulfonylureas?
- side effect: gain weight
- it has the best post-meal BG levels
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What's an important fact about Meglitinides?
They must be taken before/with a meal.
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What are two important facts about Biguanides?
- Need to watch for lactic acidosis
- They must be withheld for 48 hours for contrast dyes and surgery (anasthesia)
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What's an important contraindication for alpha-glucosidase inhibitors?
People with GI problems shouldn't take them - GI issues are common side effects.
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What are two important things to watch out for with thiazolidinediones?
- It can reduce oral contraceptive effectiveness
- watch for very dark urine (liver issues)
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What drugs have interactions with diabetes medications?
- beta-adrenergic blockers -mask symptoms of hypoglycemia; prolong hypoglycemic effects of insulin
- thiazide/loop diuretics - can potentiate hyperglycemia (by inducing potassium loss)
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What is the effect of exercise on blood glucose levels?
It is an "invisible insulin" so it can cause hypoglycemia
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What three acute diabetic situations require immediate interventions?
- Severe hypoglycemia
- diabetic ketoacidosis (DKA)
- Hyperosmolar hyperglycemic non-ketotic syndrom (HHNKS)
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What are the effects of stress or illness/surgery on blood glucose levels for a diabetes patient?
increases the blood glucose level (fight or flight) at risk for hyperglycemia. May require short-term changes/increases in insulin.
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